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Hepatosplenomegaly (Pathophysiological mechanisms (Infection (Acute (Viral…
Hepatosplenomegaly
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diagnosis
Anamnesis
- Age at onset, Sex, Fever, jaundice
- Signs of malignancy - proptosis, subcutaneous nodules, weight loss, abnormal sweating
- Food or drug exposure
- Travel history - endemic diseases
- Past medical history:
exposure to infections (hepatitis, mononucleosis, TB, amebiasis)
hematological disease (SCA, Thalassemia) - bleeding, bruising
cardiac disease, storage diseases, abdominal distention
- Family history
- skin lesions, subcutaneous nodules, lymphadenopathy, spider angiomata or stigmata of storage disease
Physical Exam
- Measure liver span
- Determine liver’s contour & consistency: surface smooth, irregular or nodular, edge rounded or sharp
- Is palpation painful? DO NO HARM
- Listen for bruit
Laboratory
- Urinalysis, Complete blood count, Electrolytes, Glucose
- Total protein, Serum albumin, Serum aminotransferases, bilirubin
- Alkaline phosphatase, Prothrombin time
- others
Imaging
- Abdominal ultrasonography with Doppler flow
- Abdominal computed tomography or magnetic resonance imaging
- Radionuclide biliary scan, Cholangiography, Cardiac ultrasonography
Pathology
- Liver biopsy, Bone marrow biopsy
Liver span
- palpable liver ≠ hepatomegaly
- Liver span is determined by measuring the distance between the upper edge, determined by percussion, and the lower edge, determined by palpation, in the midclavicular line.
- Liver span increases linearly with body weight and age in both genders
- Mean liver span:
In the newborn: 4.5 –5 cm
At 12 years: boys: 7–8cm
At 12 years: girls: 6 –6.5 cm
Spleen
- Tip of spleen is normally palpable in 1/3 of full-term infants
- May be felt up to 5 years of age.
- After that a palpable spleen is presumed to be enlarged
Splenomegaly
- Risk of spleen rupture and injury
- Usually caused by systemic diseases and not by primary splenic disease
- The most common causes: – Infection, Autoimmune, Hemaolysis
- Splenomegaly ≠ hipersplenism
with
- FEVER --> malaria, bacteriemia, kala-azar, enteric fever, malignancy
- ANOREXIA, VOMITING, HAEMATEMESIS, MELENA --> liver disease especially cirrhosis with portal hypertension
- JAUNDICE/ RECURRENT JAUNDICE --> liver disease, hemolytic anaemia
- DELAYED DEVELOPMENT --> carbohydrate/ lipid storage disorders
- HAEMOLYTIC ANAEMIA --> hereditary spherocytosis, sickle cell anemia, thalassaemia, autoimmune haemolytic anemia
- PETECHIAE, PURPURA, ECCHYMOSIS, LYMPHADENOPATHY --> leukaemia
- DYSPNOEA, DIFFICULTY IN FEEDING --> Cardiac causes
- KOILONYCHIA --> Iron deficiency
- MENTAL RETARDATION --> mucopolisaccharoidoses
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Liver edge
- Lower edge of the liver:
not more than 2 cm below the costal margin in infancy
not more than 1 cm in childhood
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