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. A biopsy is required to confirm the diagnosis of amyloidosis. One third of newborns and 10% of children may normally have a palpable spleen. Hepatosplenomegaly litfl ccc differential diagnosis. His rapid strep was positive and he was treated with penicillin. Organ specific biopsies that is, liver, kidney, cardiac have the greatest diagnostic yield, but have significant procedure related morbidity.
Among the many causes for these findings is severe rickets, which has been shown to be associated with secondary myelofibrosis and myeloid metaplasia. Pdf prolonged fever, hepatosplenomegaly, and pancytopenia. Hepatomegaly can represent intrinsic liver disease or may be the presenting physical finding of a generalized disorder. Jul 08, 2019 splenomegaly in childhood is generally first suspected upon physical examination. Em in 5 blog is a series of 5 minute emergency medicine lectures on high yield topics. Jun 18, 2007 a biopsy is required to confirm the diagnosis of amyloidosis. Mri is fluorosis, myelofibrosis, mastocytosis, lymphoma, osteo petrosis, osteoblastic metastasis, and. Differential diagnosis patients with streptococcal pharyngitis or one of several viral pharyngitides present with sore throat, fatigue, and adenopathy. Hepatosplenomegaly medical definition merriamwebster. Delay of developmental motor milestones from the age of 89 months and central hypotonia constitute the first neurological symptoms, which become more evident between 1 and 2. The massive splenomegaly narrows down the differential diagnosis.
Viral infection viral infection like hepatitis, rubella, cytomegalovirus disease, infectious mononucleosis etc can cause hepatosplenomegaly bacterial infection cat scratch disease is a bacterial infection that causes hepatosplenomegaly. Prolonged fever, hepatosplenomegaly, and pancytopenia in a 46. C 2, 3 the diagnosis of catscratch disease is usually confirmed by a history of cat exposure and antibodies to. Use the serum albumin to ascitic albumin difference serum albumin minus ascites albumin to help differentiate the cause of ascites. Other functions include filtering senescent and defective red blood cells, presenting antigens to the immune system, and destroying. The name of this condition hepatosplenomegaly comes from the two words that comprise it.
Since these organs are so situated that on enlarging they soon become palpable, definite enlargements become helpful in differential diagnosis. Catscratch disease should be included in the differential diagnosis in any patient with lymphadenopathy. Hepatomegaly is enlargement of the liver beyond its normal size and occurs mainly as a consequence of pathologic conditions. Differential diagnosis included hepatoblastoma, hepatocellular carcinoma, and embryonal sarcoma. Anemia and hepatosplenomegaly are common reasons for referring a child to a pediatric hematologist or oncologist. Hepatosplenomegaly how do we approach linkedin slideshare.
Hepatomegaly pediatrics clerkship the university of chicago. Of note, the liver may be displaced downward by the diaphragm or thoracic contents leading to false impression of hepatomegaly. 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. Hepatosplenomegaly is a medical condition in which both the liver and the spleen become enlarged. Hepatosplenomegaly in pediatrics by sami aswad on prezi. This article needs editing for compliance with wikipedias manual of style. Patient presentation a 9yearold male came to clinic with fever and stomachache. Hepatosplenomegaly medigoo health medical tests information. Maddreys discriminant function test was described by maddrey and colleagues in 1978 to predict prognosis in alcoholic hepatitis.
This can occur from a number of pathologies, including. Fetal hepatosplenomegaly refers to the combined enlargement of both the fetal liver and the fetal spleen. Balistreri, evaluation of liver disease in the pediatric patient, pediatr. Hepatosplenomegaly an overview sciencedirect topics.
Misdiagnosis of hepatosplenomegaly including hidden diseases, diagnosis mistakes, alternative diagnoses, differential diagnoses, and misdiagnosis. For instance, if a person comes in with jaundice and complaining of. These include infectious causes, such as bacterial typhoid fever. Systemic venous hypertension can also increase the risk for.
Hepatosplenomegaly refers to an enlargement of the liver and spleen. What is the differential diagnosis of hepatomegaly. Get a printable copy pdf file of the complete article 297k, or click on a page image below to browse page by page. 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. Reduce trauma in house eliminate sharp objects, beak and toe trim, avoid wet litter or leaking drinkers. It is a reservoir for platelets and a site for the proliferation of blymphocytes. Its causes include a variety of conditions that affect these two organs, including liver disease, hiv, anemia, infections, and. Kupffer cell hyperplasia with tb or other generalized infections 3. Hepatosplenomegaly symptoms, diagnosis, treatments and causes. Uptodate, electronic clinical resource tool for physicians and patients that provides information on adult primary care and internal medicine, allergy and immunology, cardiovascular medicine, emergency medicine, endocrinology and diabetes, family medicine, gastroenterology and hepatology, hematology, infectious diseases, nephrology and. The border of the liver can be found by palpation, percussion, and auscultation. Fetal hepatosplenomegaly radiology reference article.
See chapter, peritoneal abdominal paracentesis for more details. Hepatomegaly is an enlarged liver or swollen liver. 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. 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. Create marketing content that resonates with prezi video. Leukaemias lymphomas myelofibrosis myeloproliferative disease essential thrombocytopenia, polycythaemia, primary myelofibrosis, cml haemolytic anaemias hb disorders. Prolonged fever, hepatosplenomegaly, and pancytopenia in a. Clinical diagnosis without jaundice, without signs of liver cell failure in a developmentally delayed child 1.
Medicinenet does not provide medical advice, diagnosis or treatment. Approach to a child with hepatosplenomegaly summary of pathophysiological mechanisms 1. Get a printable copy pdf file of the complete article 932k, or click on a page image below to browse page by page. Hepatosplenomegaly information including symptoms, diagnosis, misdiagnosis, treatment, causes, patient stories, videos, forums, prevention, and prognosis. The spleen cannot be balloted, is dull to percussion, has a notch and you should be able to get above it. Table 1 presents the differential diagnosis of acute low back pain. Pdf hepatosplenomegaly and reticulocytopenia as prominent.
Continuing education understanding the nurses role in. Diagnostic algorithm to arrive at the most common diagnoses for a neonate who has hepatomegaly. It is important to understand that this condition can lead to a serious or lifethreatening symptoms, if proper medical treatment. Differential diagnosis of hepatosplenomegaly homeopathy. Primary liver cancer only constitutes 12% of all pediatric malignancies. What links here related changes upload file special pages permanent link. Based on identification of the defective enzyme, the disturbed transport mechanism or the particularly affected compound, more than 50 lysosomal storage diseases have been identified so far.
Hepatosplenomegaly symptoms, causes, diagnosis, treatment. Hepatomegaly is enlargement of the liver beyond its normal size and occurs mainly as a consequence of pathologic conditions table 1. 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. C 3, 19 most cases of catscratch disease are selflimited and do not require antibiotic therapy. Storage products usually abnormal appearance, neurological signs and marked firm enlargement of liver and. In newborns, thalssemia, and storage disorders are the major reason for hepatosplenomegaly. Based on identification of the defective enzyme, the disturbed transport mechanism or the particularly affected compound, more than.
A case of rhombencephalitis rebecca bystrom, md internal medicine, pgy2 acp maine chapter meeting 2018. 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. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Pasteurella multocida fowl cholera and erysipelothrix erysipelas preventiontreatment. Hepatosplenomegaly can occur as the result of acute viral hepatitis, infectious mononucleosis, and histoplasmosis or it can be the sign of a serious and. He had no sore throat, diarrhea, changes in bowel or urinary. Three weeks later he complained of abdominal pain again, accompanied by a lowgrade fever, some nausea, early satiety and mild fatigue. American medical association, american society of clinical oncology, american society of hematology, american society of pediatric hematologyoncology, childrens oncology group. Christopher cheung approach to pediatric abdominal pain. As an autosomal recessive condition requiring both parents to be carriers, gaucher disease is rare. May 6, 2020 500 case based application level medical practice questions and explanations case taking and repertory. 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.
Pdf a 7 year old girl with anemia and massive hepatosplenomegaly. Hidden camera investigation on what really happens to your car cbc marketplace duration. Hepatomegaly splenomegaly hepatosplenomegaly quizlet. Hepatosplenomegaly and reticulocytopenia as prominent features of atypical hemolytic uremic syndrome article pdf available in pediatric emergency care 267. Hepatosplenomegaly hpm is a disorder where both the liver and spleen swell beyond their normal size, due to one of a number of causes. Anemia and hepatosplenomegaly as presenting features in. Splenomegaly general presentation the spleen is a hematopoietic organ supporting the megakaryotic, lymphoid, erythroid, myeloid, and reticuloendothelial systems. References nelsons text book of pediatrics, 19th edition. Hepatosplenomegaly hsm isnt always serious, but it can represent an indicator of a very serious medical condition. Dec 12, 2018 medicinenet does not provide medical advice, diagnosis or treatment.
An enlarged liver and spleen, medically known as hepatosplenomegaly, occur when the liver and spleen swell beyond their normal size. Jul 12, 2011 hepatosplenomegaly in children is associated with many disorders like. The average liver span is 45 cm in newborns and 68 cm in children at 12 years of age. It is important to realize that the liver is easily palpated in most children at 12 cm below the right costal margin. Hepatosplenomegaly aetiology of hepatosplenomegaly chronic liver disease and portal hypertension see chronic liver disease section for further differentials haematological disease. The name of this condition hepatosplenomegaly comes. When both, your liver and your spleen become enlarged, it is a condition known as hepatosplenomegaly but there is a little bit more to this condition than just the symptoms of it. Hepatosplenomegaly commonly abbreviated hsm is the simultaneous enlargement of both the liver hepatomegaly and the spleen splenomegaly. The differential diagnosis of an enlarged spleen is usually a palpable left kidney. When the diagnosis of amyloidosis is suspected, safer procedures include subcutaneous fat aspiration, rectal biopsies and bone marrow trephine.
Acute lymphoblastic leukemia all cavernous transformation of the portal vein. 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. Nov 14, 2012 approach in children with hepatosplenomegaly to summarize 33. Dec 20, 20 clinical diagnosis without jaundice, without signs of liver cell failure in a developmentally delayed child 1. Lysosomal storage diseases as differential diagnosis of. Hepatosplenomegaly is the simultaneous enlargement of both the liver hepatomegaly and the spleen splenomegaly. The liver is a large accessory organ in the digestive system, responsible for a number of functions including bile secretion to break down food, storage of iron and vitamins. Transfer summary november 2017 62 year old woman with minimal past medical. 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. Chris is an intensivist and ecmo specialist at the alfred icu in melbourne. Full text full text is available as a scanned copy of the original print version. Differential diagnosis of causes of hepatosplenomegaly in alphabetical order.
Hepatosplenomegaly what is,causes,symptoms,treatment, etc. Delay of developmental motor milestones from the age of 89 months and central hypotonia constitute the first neurological symptoms, which become more evident between 1 and 2 years of age. Bacterial culture of joints, bone, or yolk sac is definitive. Hepatosplenomegaly is usually diagnosed with an ultrasound or a computed tomography ct scan of the abdomen. Hepatosplenomegaly refers to having both the liver and the spleen enlarged or swollen. Hepatosplenomegaly often with a history of neonatal icterus has been present since early life. Splenomegaly is an enlarged spleen or swollen spleen. 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. After ruling out the most common causes of hepatomegaly, how do you determine the underlying. Classification systems now that we have covered the overall skeleton of history taking and physical examination of a patient with lymphadenopathy, lets now discuss a system to narrow your differential according to presenting signs and symptoms. Discussion liver masses in children include primary liver cancer, metastatic cancer from other sites, cysts and inflammatory masses. Acute cytomegalovirus cmv infection and toxoplasmosis can share many additional characteristics with infectious mononucleosis, including splenomegaly, hepatomegaly.
A normal liver should feel soft and is easily moveable upon inspiration. The differential diagnosis for low marrow signal intensity on. Hepatosplenomegaly commonly abbreviated hsm is the simultaneous enlargement of both. Prolonged fever, hepatosplenomegaly, and pancytopenia in a 46yearold woman article pdf available in plos medicine 64. Christopher cheung approach to pediatric abdominal. Pleasurable journey of homoeopathic healing agents homeopathic pharmacy.