View Full Version : BILHARZIAL SPLENOMEGALY(Etiology-Pathology-Clinical picture-Complications-Investigations-Treatment)

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06-08-2008, 07:22 AM
Incidence: common in young adult. Male > Female. Common in lower Egypt.
(I) Pathogenesis: The splenic enlargement may be due to:
1- Hyperplasia of the reticulo-endothelial element in response to Bilharzial toxins. "Bilharzial ova rarely found in spleen".
2- Congestion due to portal hypertension.
3- Thickened capsule and trabeculae may play a role.
(II) Gross Picture:
Spleen; Marked enlargement may reach > 4kgm. Firm in consistency sharp border with prominent notch. Whitish area on the surface due to old infarction.
Blood vessels; especially the veins are dilated & tortuous with big anastomotic channels with diaphragm.
(III) Cut section:
Early: Congestion with prominent lymphoid follicles.
Late: Atrophy and fibrosis of the follicles.
(IV) Associated lesions:
Bilharzial periportal fibrosis of the liver & chronic Bilharzial colitis.
Clinical Picture:
Stage (I): Hepatomegaly. " Usually passed unoticed".
Stage (II): Hepatosplenomegaly " Moderate enlargement of both".
Stage (III): Splenamegaly (Marked) with shrunken liver.
Stage (IV): Ascitis + huge spleen + shrunken liver.
Stage (V): Liver cell failure " Cholaemia".
Simply, we can put the patient in one of two groups:
1- Compensated splenomegaly (Stages I, II, III).
2- Decompensated splenomegaly (Stages IV, V).
General weakness and easy fatiguability.
Heaviness in left hypochondrium
Stetching or stabbing pain indicate splenic infarction or perisplenitis.
Dyspepsia due to cogestion of the stomach and viscera.
Signs: Abdominal examination may reveal:
1- Enlarged tender liver. 2- Enlarged spleen.
3- Dilated veins over the abdomen (caput Medusa around umbilicus).
The Character of Splenic Mass:
1- Originated in the Lt. hypochondrium and directed downward and medially may reach Rt. iliac fossa.
2- It moves up and down with respiration.
3- You cann't insinuate your fingers between the costal margin and the mass to feel its upper border.
4- It has sharp border with noch. The noch may be closed due to fibrosis or malignancy.
5- Its dullness is contineous with the normal splenic dullness.
6- No band of resonance infront of the mass.
7- It gives no posterior pallotment.
Treatment of Compensated Splenomegaly:
Medical support of the liver and correction of anemia and follow up:
Splenectomy is indicated in:
1- To abolish hypersplenism which improve anaemia & leucopenia.
2- It was thought that its removal decrease the portal hypertension but now many surgeon denay this role as the patient may pass to uncompensated stage due to progress in liver pathology.
With the result of progress in the periportal fibrosis of the liver. The liver function gradually impaired. The portal pressure will increase.
Which will leads to:
* Ascitis. * Bleeding varices. * Liver failure
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