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