The differential diagnosis of anemia, thrombocytopenia and. Cirrhosis of the liver enlarged spleen, enlarged liver. These include infectious causes, such as bacterial typhoid fever, mycobacterium tuberculosis, or aids with m. Morphological changes in hepatolienal syndrome characterized mainly by hyperplasia of the reticulohistocytes liver and spleen, fibroplastic reaction, in some cases, infiltrativeproliferative and degenerative diseases of blood vessels processes. He is also the innovation lead for the australian centre for health innovation at alfred health, a clinical adjunct associate professor at monash university, and the chair of the australian and new zealand intensive care society anzics education committee. May 6, 2020 500 case based application level medical practice questions and explanations case taking and repertory. Hidden camera investigation on what really happens to your car cbc marketplace duration.
He was the 6pound, 7 ounce product of an uncomplicated 37 week gestation to a 38yearold g2p2 female. Department of pediatrics, national university hospital, singapore. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Alexander gozman, md assistant professor, department of pediatrics, division of hematologyoncology, albany medical center alexander gozman, md is a member of the following medical societies. Leukaemias lymphomas myelofibrosis myeloproliferative disease essential thrombocytopenia, polycythaemia, primary myelofibrosis, cml haemolytic anaemias hb disorders. Diagnosis of hepatosplenomegaly including differential diagnoses, hidden causes, misdiagnosis, confirming diagnoses, and diagnostic tests. Prolonged fever, hepatosplenomegaly, and pancytopenia in a. Hepatosplenomegaly refers to an enlargement of the liver and spleen. Hepatosplenomegaly can occur as the result of acute viral hepatitis, infectious mononucleosis, and histoplasmosis or it can be the sign of a serious and. Common and important causes of hepatomegaly for doctors and medical students this page is currently being written and will be available soon. Hepatomegaly splenomegaly hepatosplenomegaly to be evaluated based on the history and associated.
References nelsons text book of pediatrics, 19th edition. Presentation hepatomegaly causes of hepatomegaly hepatitis o infections viral hepatitis acute and chronic ebv and cmv malaria abscesses amoebic or pyogenic autoimmune hepatitis alcoholic liver disease non alcoholic fatty liver disease previously known as nash tumours o metastases o hepatocellular carcinoma hcc. American medical association, american society of clinical oncology, american society of hematology, american society of pediatric. Chris is an intensivist and ecmo specialist at the alfred icu in melbourne. Splenomegaly general presentation the spleen is a hematopoietic organ supporting the megakaryotic, lymphoid, erythroid, myeloid, and reticuloendothelial systems. Study of etiological and clinical pro le of hepatosplenomegaly in children between 1 month and 15 years of age. Full text full text is available as a scanned copy of the original print version. Hepatosplenomegaly information including symptoms, diagnosis, misdiagnosis, treatment, causes, patient stories, videos, forums, prevention, and prognosis. Use the serum albumin to ascitic albumin difference serum albumin minus ascites albumin to help differentiate the cause of ascites. Hepatomegaly is enlargement of the liver beyond its normal size and occurs mainly as a consequence of pathologic conditions table 1. Oct, 2008 patient presentation a 9yearold male came to clinic with fever and stomachache. Hepatomegaly is an enlarged liver or swollen liver. Hepatosplenomegaly can occur as the result of acute viral hepatitis, infectious mononucleosis, and histoplasmosis or it can be the sign of a serious and lifethreatening lysosomal storage disease. Omitting the steroids the hemoglobin concentration and the platelet count dropped to 6.
This can occur from a number of pathologies, including. Hepatomegaly pediatrics clerkship the university of. Hepatosplenomegaly refers to having both the liver and the spleen enlarged or swollen. Investigations liver functions hematology date age 25211 15 months 10. Fabrys disease, the most prevalent lysosomal storage disease, does usually not affect the liver, but causes painful episodes of hands or feet pain acroparesthesias, left ventricular hypertrophy, renal failure, early stroke and decreased life expectancy ncbi. This caucasian newborn boy was transferred for evaluation of hepatosplenomegaly. The differential diagnosis of an enlarged spleen is usually a palpable left kidney. Splenomegaly is a symptom that can be caused by a variety of conditions that affect different organ systems. Hepatosplenomegaly litfl ccc differential diagnosis. It is a reservoir for platelets and a site for the proliferation of blymphocytes. Differential diagnosis for a repiratory disesae outbreak.
Among the many causes for these findings is severe rickets, which has been shown to be associated with secondary myelofibrosis and myeloid metaplasia. Of note, the liver may be displaced downward by the diaphragm or thoracic contents leading to false impression of hepatomegaly. A 2yearold boy is admitted for evaluation of massive hepatosplenomegaly. One third of newborns and 10% of children may normally have a palpable spleen. The term splenomegaly generally denotes a palpably enlarged spleen.
Pdf liran levy and colleagues discuss the differential diagnosis, investigation, and management of a 46yearold woman with fever. Table 1 presents the differential diagnosis of acute low back pain. May 05, 2016 hepatomegaly is enlargement of the liver. Kupffer cell hyperplasia with tb or other generalized infections. Evaluation of splenomegaly differential diagnosis of. Ebv is in the herpes virus family, and is also known as human herpes virus type 4. Lysosomal storage diseases as differential diagnosis of hepatosplenomegaly.
Hepatosplenomegaly hpm is a disorder where both the liver and spleen swell beyond their normal size, due to one of a number of causes. Its causes include a variety of conditions that affect these two organs, including liver disease, hiv, anemia, infections, and. Detection of haematological malignancy is also difficult due to less availability of facility2. There are a number of diagnostic testsfor hepatosplenomegaly to be performed to confirm the exact cause of the disease. Organ specific biopsies that is, liver, kidney, cardiac have the greatest diagnostic yield, but have significant procedure related morbidity. The border of the liver can be found by palpation, percussion, and auscultation. In the united kingdom, one in 2000 children develop thedisorder,with around450 new cases being diagnosed annually. Approach to a child with hepatosplenomegaly summary of pathophysiological mechanisms 1. Balistreri, evaluation of liver disease in the pediatric patient, pediatr. Pdf prolonged fever, hepatosplenomegaly, and pancytopenia in.
May 6, 2020 500 case based application level medical practice questions and explanations case taking and repertory may 6, 2020 crude cinchona to potentized vaccines. The name of this condition hepatosplenomegaly comes. Jun 18, 2007 a biopsy is required to confirm the diagnosis of amyloidosis. Hepatosplenomegaly, thrombocytopenia, and bone pain in children raise the differential diagnosis of other metabolic storage. Jul 12, 2011 the hepatosplenomegaly diagnosis tests include. Anemia and hepatosplenomegaly as presenting features in. The best way to assess size is by percussion a normalsized liver can appear. When the diagnosis of amyloidosis is suspected, safer procedures include subcutaneous fat aspiration, rectal biopsies and bone marrow trephine.
Lysosomal storage diseases as differential diagnosis of. Hepatosplenomegaly is a medical condition in which both the liver and the spleen become enlarged. He is also the innovation lead for the australian centre for health innovation at alfred health, a clinical adjunct associate professor at monash university, and the chair of the australian and new zealand intensive care society anzics education committee he is a cofounder of the australia and new zealand. Original article aetiology of pyrexia with hepatosplenomegaly. Approach in children with hepatosplenomegaly to summarize 33. Hepatosplenomegaly symptoms, causes, diagnosis, treatment. Kupffer cell hyperplasia with tb or other generalized infections 3.
When evaluating a child with splenomegaly it is important to identify conditions in which immediate medical intervention is needed and provide appropriate treatment options. Hepatosplenomegaly medigoo health medical tests information. If the difference is may 19, 2018 hepatosplenomegaly refers to an enlargement of the liver and spleen. Hepatomegaly splenomegaly hepatosplenomegaly quizlet. Higginson, the geographical pathology of liver disease in man gastroenterology 57. Differential diagnosis of hepatosplenomegaly homeopathy. If a healthcare provider suspects that a person has a disease that affects the liver and spleen, heshe will usually order tests for that condition as well. Hepatomegaly refers to an increase in size or enlargement of the liver. There was a prominent hepatosplenomegaly 6 and 5 cm below costal margin. He is also the innovation lead for the australian centre for health innovation at alfred health, a clinical adjunct associate professor at monash university, and the chair of the australian and new zealand intensive care society anzics education committee he is a cofounder of the. Medicinenet does not provide medical advice, diagnosis or treatment. Pleasurable journey of homoeopathic healing agents homeopathic pharmacy. To be updated when it is complete please like us on facebook, follow us on twitter or subscribe on youtube using the foll. The name of this condition hepatosplenomegaly comes from the two words that comprise it.
Presentation hepatomegaly causes of hepatomegaly hepatitis o infections viral hepatitis acute and chronic ebv and cmv malaria abscesses amoebic or pyogenic autoimmune hepatitis alcoholic liver disease non alcoholic fatty liver disease previously known as nash tumours o metastases. Get a printable copy pdf file of the complete article 932k, or click on a page image below to browse page by page. He had no sore throat, diarrhea, changes in bowel or urinary. Request pdf lysosomal storage diseases as differential diagnosis of hepatosplenomegaly in adults, elevated transaminases and hepatomegaly, often mild, with moderate to massive idiopathic. See chapter, peritoneal abdominal paracentesis for more details. A doctor will likely order many diagnostic tests to determine the most. Sasskortsak, evaluation of the radioactive rose bengal test for the differential diagnosis of obstructive jaundice in infants new eng. Hepatomegaly pediatrics clerkship the university of chicago. To be updated when it is complete please like us on facebook, follow us on twitter or subscribe on youtube using the follow us buttons.
Hepatosplenomegaly commonly abbreviated hsm is the simultaneous enlargement of both the liver hepatomegaly and the spleen splenomegaly. Request pdf lysosomal storage diseases as differential diagnosis of hepatosplenomegaly in adults, elevated transaminases and hepatomegaly, often mild, with moderate to. Other functions include filtering senescent and defective red blood cells, presenting antigens to the immune. Sep 19, 2017 hepatosplenomegaly hpm is a disorder where both the liver and spleen swell beyond their normal size, due to one of a number of causes. The massive splenomegaly narrows down the differential diagnosis, as only a few conditions generally cause this degree of splenic enlargement. It is important to understand that this condition can lead to a serious or lifethreatening symptoms.
Patient presentation a 9yearold male came to clinic with fever and stomachache. As a result diagnosis of visceral leishmaniasis kalaazar is difficult3,4. Fetal hepatosplenomegaly refers to the combined enlargement of both the fetal liver and the fetal spleen. Chronic granulomatous disease enlarged spleen, enlarged liver. There are many diseases in which hepatosplenomegaly is an associated condition. Hepatosplenomegaly an overview sciencedirect topics. Pathophysiology and clinical presentation correct diagnosis infectious mononucleosis is a highly contagious viral disease caused by the epsteinbarr virus ebv. He was previously healthy, with no history of jaundice, loss of appetite, or weight loss. Hepatosplenomegaly symptoms, diagnosis, treatments and.
Splenomegaly is an enlarged spleen or swollen spleen. Chronic hepatitis c enlarged spleen, enlarged liver. The spleen cannot be balloted, is dull to percussion, has a notch and you should be able to get above it. Hepatomegaly is enlargement of the liver beyond its normal size and occurs mainly as a consequence of pathologic conditions. He is the only child of nonconsanguineous parents and was born at term after an. Maddreys discriminant function test was described by maddrey and colleagues in 1978 to predict prognosis in alcoholic hepatitis. However, massive enlargementssplenomegaly and especially hepatomegalyare caused by relatively few diseases, and the knowledge of this fact will greatly aid in arriving at a correct differential diagnosis by precluding from consideration a large group of diseases that could scarcely be the basis of such enlargement. What is the differential diagnosis of hepatomegaly.
This diagnosis should be suspected when these biliary and renal abnormalities are associated with hepatosplenomegaly in a patient with normal liver function. Hepatosplenomegaly is usually diagnosed with an ultrasound or a computed tomography ct scan of the abdomen. There are different medical conditions that can lead to the simultaneous appearance of hepatomegaly and splenomegaly, as you will have the opportunity to discover below. His rapid strep was positive and he was treated with penicillin. Mar 27, 2019 chris is an intensivist and ecmo specialist at the alfred icu in melbourne. Pdf study of aetiological profile, clinical presentation and outcome. Fetal hepatosplenomegaly radiology reference article. Hepatomegaly can result from a vast range of pathology including, but not limited to, the following.
For instance, if a person comes in with jaundice and complaining of. The average liver span is 45 cm in newborns and 68 cm in children at 12 years of age. However, it may also refer to an enlarged spleen detected by an imaging test. Splenomegaly can be found in 3% of the normal population. In examining tissue samples, a key consideration is niemann. Nov 14, 2012 approach in children with hepatosplenomegaly to summarize 33. Jul 08, 2019 splenomegaly in childhood is generally first suspected upon physical examination. Pathophysiology and clinical presentation correct diagnosis.
A patient with hepatosplenomegaly, peripheral cytopenias, teardrop poikilocytosis, leukoerythroblastosis, and bm fibrosis probably has pmf, but other disorders may also lead to this clinical picture see table 70. Three weeks later he complained of abdominal pain again, accompanied by a lowgrade fever, some nausea, early satiety and mild fatigue. The liver edge is normally palpable in children and thin adults and some patients may have a palpable right lobe of the liver. Anemia and hepatosplenomegaly are common reasons for referring a child to a pediatric hematologist or oncologist. Differential diagnosis of hepatosplenomegaly by muhammad taimoor definition.
A biopsy is required to confirm the diagnosis of amyloidosis. Hepatosplenomegaly, thrombocytopenia, and bone pain in children raise the differential diagnosis of other metabolic storage diseases and malignancy. Differential diagnosis for hepatomegaly oxford medical. On histopathological examination, both had congenital hepatic fibrosis.
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