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