SPLENOMEGALY TROMBOFLEBITICHESKAYA

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SPLENOMEGALY TROMBOFLEBITICHESKAYA (Greek splen spleen + megas, megalon big; Greek thrombos a piece, a clot + phleps, phlebos a vein + - itis) — increase in a spleen owing to blockade of a trunk of a portal vein or one of its leading branchs. Page of t. is private option extrahepatic portal hypertensia (see). The term gradually loses the value because there was an opportunity to reveal more specific forms of extrahepatic portal hypertensia.

Page of t. can develop in connection with phlebosclerosis (see), obliteration or thrombosis, inborn stenosis or atresia, prelum hems, tumors or infiltrates portal vein (see) or its branches. The phlebosclerosis, an obliteration or thrombosis in vessels of portal system are connected by hl. obr. with the postponed infections, napr, malaria, a typhoid, scarlet fever, tuberculosis, and also with injuries. Blockade of a trunk of a portal vein or one of its leading branchs causes build-up of pressure in a splenic vein, outflow of blood on it is at a loss, develop stagnation in a spleen and the collateral blood stream through veins of a stomach and a gullet which is followed by their varicosity. At gis-tolite. a research of a spleen in these cases reveal, in addition to stagnation, thrombosis and phlebitis, the expressed fibroadenia of its pulp. The main are connected with it a wedge, symptoms of extrahepatic blockade: Page of t., a varicosity of a stomach and (or) gullet, bleeding from them, supertension in a portal vein, a hypersplenism; sometimes after bleedings develops ascites (see). The course of a disease usually long, especially if bleedings from varicose veins (a hematemesis, a melena) are rare or are absent. Development of anemia, thrombocytopenia and leukopenia burdens the forecast. Is the most dangerous manifestation and a frequent cause of death of patients gastrointestinal bleeding (see).

Diagnosis establish to a tromboflebitichesky splenomegaly taking into account the listed symptoms. Crucial importance at the same time is attached to angiographic methods of a research of portal blood circulation: splenoportografiya (see) and tseliakografiya (see), a computer tomography, with the help to-rykh reveal a condition of a vascular bed, and also level of blockade in system of a portal vein and hepatic artery and measure venous pressure.

Etiological and pathogenetic differential diagnosis at extrahepatic portal hypertensia it is complicated; it is carried out on the basis of data of a splenoportografiya or tseliakografiya, and a thicket during operation. Differential diagnosis is carried out between suprahepatic and intra hepatic forms of portal hypertensia. Suprahepatic portal hypertensia is caused most often by Kiari's disease (see. Kiari disease ), characterized by spontaneous thrombosis of hepatic veins, and Badd's syndrome — Kiari (see. Portal hypertensia). At Kiari's disease the stenosis, an obliteration or a prelum of the lower vena cava at the level or above hepatic veins is observed by a tumor, inflammatory infiltrate or hems. Suprahepatic portal hypertensia is characterized by significant increase in a liver, jaundice, a phlebectasia of an abdominal wall, ascites and supertension in the lower vena cava; on a splenoportogramma passability of a splenopor-talny bed is noted; Page of t. is not a constant symptom.

Intra hepatic portal hypertensia is connected with cirrhosis, fibrosis, is more rare with a tumor of a liver (see. Hepatolienal syndrome ). At this form in the anamnesis the disease of a liver usually comes to light; Page of t. is a frequent, but not constant symptom; the liver is, as a rule, increased and its functions are broken; on splenoportogramma passability of a splenoportalny bed comes to light.

Treatment Page of t. operational. Carry out a splenectomy with imposing splenorenalny anastomosis (see). In the presence of contraindications (an exacerbation of thrombophlebitis, a pylephlebitis, an aggravation hron. pancreatitis, an acute heart attack of a spleen) — waiting tactics, treatment of complications and associated diseases. Acute management at bleedings from varicose veins of a gullet or a stomach includes the following events: high bed rest, prohibition of meal and liquids and adequate parenteral food; purgation from the streamed blood by means of an enema; introduction to a gullet and a stomach of the obturatsionny probe of Bleykmor (see. Portal hypertensia ), electrothermic coagulation of the bleeding sites; haemo static therapy (drugs of calcium, Vikasolum, ascorbic to - that, vasoconstrictors) and hemotransfusionic (a fresh whole blood, its drugs and components). At unsuccessfulness of the listed actions carry out esophago - or a gastrotomy with underrunning of the bleeding veins and actions for fight against a posthemorrhagic hypoxia (e.g., hyperbaric oxygenation is recommended). S.'s forecast of t. in the conditions of reconstructive vascular surgery becomes more favorable.



Bibliography: Patsiora M. D. Surgery of portal hypertensia, M., 1974; Portal hypertensia, under the editorship of M. D. Patsiora, etc., M., 1979. See also bibliography to St. Portal hypertensia.


R. A. Mokeeva.

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