8. Hypersplenism syndrome

Hypersplenism is an increase in spleen function.

REASONS: diseases that occur with portal hypertension, hepatitis and cirrhosis of the liver,

accumulation diseases, granulomatosis with enlarged spleen (sarcoidosis, lymphogranulomatosis), diffuse connective tissue diseases, parasitic lesions of the spleen. SIGNS:

1. anemia;

2. leukopenia;

3. thrombocytopenia.

9. Portal hypertension

This is an increase in pressure in the portal vein pool, associated with the presence of an obstruction to the outflow of blood.

REASONS of portal hypertension:

I - prehepatic (subhepatic) portal hypertension:

1. Thrombosis or occlusion of the portal vein by a tumor or lymph nodes.

2. Increased portal venous blood flow: arteriovenous fistula, splenomegaly, not associated with liver disease, portal vein cavernomatosis;

II Intrahepatic portal hypertension:

1. Cirrhosis of the liver, cirrhosis, less commonly veno-occlusive disease, sarcoidosis,

schistosis

III Posthepatic (suprahepatic) portal hypertension:

1. Hepatic vein thrombosis (Budd-Chiari syndrome), membranous obstruction of the inferior vena cava, constrictive pericarditis, liver fibrosis in congestive heart failure, tumor compression of the inferior vena cava and hepatic veins;

SYMPTOMS: Supporting symptoms: - ascites

- Varicose veins in the system of portocaval anastomoses (cardial sections of the esophagus and stomach, superficial veins of the abdomen, hemorrhoidal veins)

- Esophageal, hemorrhoidal bleeding

- Increased pressure in the portal vein and its expansion (instrumental signs)

1. Complaints. Decreased appetite, nausea, flatulence, signs of dyspepsia, decreased diuresis. Flatulence often precedes the appearance of ascites. Sometimes, bloody vomiting, stool with blood.

2. Objectively: clinical signs of ascites (enlarged swollen abdomen, navel protrusion, expansion of the saphenous veins of the abdominal wall - the ―jellyfish head‖, frog stomach, positive symptom of fluctuations, dull percussion sound) often emaciation to cachexia, peripheral edema (edematous ascites may occur) syndrome due to hypo- and dysproteinemia, secondary hyperaldosteronemia).

3. Sometimes (with the development of collaterals through the umbilical veins), venous noise occurs on the anterior abdominal wall. Noise is especially pronounced in the umbilical region with cirrhosis of the liver in combination with non-closure of the umbilical vein (Crewellier-Baumgarten syndrome).

4. Blood: dysproteinemia (less often a decrease in the total amount of protein), a decrease in albumin, sometimes positive sedimentary reactions.

5. Urine - often oliguria.

6. EFGDS - determined by varicose veins of the lower esophagus and the entrance of the stomach, rectum.

7. Ultrasound - detected fluid in the abdominal cavity, increased venous pressure in the portal vein and its expansion.

Table 4.1 Ascites fluid:

	Transudate	Exudate
Specific gravity	lower 1015	above 1018
Protein	lower 30,0 г/л	above 30,0 г/л
Rivalta Test	-	+
		70

Pic 4.5 Ascites, expansion of superficial veins of the abdomen (head of Medusa).