Hepatomegaly / Splenomegaly
Splenomegaly
| Incidental findings | Lymphadenopathy |
| +ve signs | Spleen enlarged at … cm |
| Differential diagnosis | Splenomegaly, Polycystic kidney; Causes below |
| Function | |
| Tests |
FBC – for pancytopaenia Blood film – for ↓RBC/platelets/neutrophils USS abdomen ±Bone marrow biopsy |
Hepatomegaly
| Incidental findings | CCF, cachexia |
| +ve signs | Liver is palpable … cm below costal margin. ?Tender/smooth/firm |
| Differential diagnosis | Hepatomegaly, kidney; Causes below |
| Function | Stigmata chronic liver disease / decompensation |
| Tests |
|
Massive spleen CML Myelofibrosis (Malaria) (Kala-azar) |
Moderate spleen Myeloproliferative Lymphoproliferative Cirrhosis |
Liver Cirrhosis Metastasis CCF |
Liver + spleen Myeloproliferative Lymphoproliferative Cirrhosis |
Notes
- Causes of small spleen same as moderate with addition of infections e.g. SBE, glandular fever.
- If hepatosplenomegaly and lymphadenopathy think of CLL/lymphoma and infectious mononucleosis.
- Other causes hepatosplenomegaly: Hepatitis, brucellosis, Weil’s, Toxoplamosis, CMV, Pernicious anaemia, storage disorders, amyloidosis.
- Other causes splenomegaly: brucellois, sarcoid, ITP, Felty’s, amyloid, gauchers (massive).
- ∆∆ Of hepatosplenomegaly is polycystic kidney disease.
- Myeloproliferative = CML, myelofibrosis, PCRV, essential thrombocythaemia.
- Lymphoproliferative = CLL, lymphoma, waldenstroms.
- Normal upper border liver is 5th IC midclavicular line.