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Hepatosplenomegaly

Hepatosplenomegaly. DR. FAHAD AL ZAMIL Professor & Consultant Paediatric Infectious Diseases King Khalid University Hospital King Saud University, Riyadh. Liver. Mean liver span: In the Newborn: 4.5 – 5 cm 12 years: boys: 7 – 8 cm 12 years: girls: 6 – 6.5 cm

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Hepatosplenomegaly

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  1. Hepatosplenomegaly DR. FAHAD AL ZAMIL Professor & Consultant Paediatric Infectious Diseases King Khalid University Hospital King Saud University, Riyadh

  2. Liver • Mean liver span: • In the Newborn: 4.5 – 5 cm • 12 years: boys: 7 – 8 cm • 12 years: girls: 6 – 6.5 cm • Extends from 5th intercostal space in the midclavicular line 5 – 8 cm

  3. Lower edge not more than 2 cm below the costal margin in infancy (1 cm in childhood) • A normal-size liver may be displaced downward (e.g. pulmonary hyperinflation)

  4. Spleen • Tip of spleen is normally palpable in 1/3 of full-term infants • May be felt up to 5 years of age. • After that a palpable spleen is presumed to be enlarged

  5. History • Fever, jaundice, pallor, bleeding, tea-colored urine, bone & joint pains, weight loss, abnormal sweating, anorexia, abdominal distention, pain, trauma, food or drug exposure • Exposure to infections (hepatitis, mononucleosis, TB, amebiasis) • Hematological disease (SCA, Thalassemia), cardiac disease, collagen vascular disorder, storage diseases

  6. Physical Exam • Measure liver span • Determine liver’s contour & consistency • Is the surface smooth, irregular or nodular? • Is the edge rounded or sharp? • Is palpation painful? DO NO HARM! • Listen for bruit

  7. Cont. P/E • Any ascites ? • Increased portal venous pressure, tissue infiltration, or reticuloendothelial cell hyperplasia • In newborns: do fundoscopy for chorioretinitis • Congenital infections • Note: skin lesions, subcutaneous nodules, lymphadenopathy, spider angiomata or stigmata of storage disease

  8. Hepatosplenomegaly: Causes • Infective: • Viral: • Hepatotrophic (A,B,C,D,E) • Other viruses (herpes, cytomegalo, Ebstein-Barr, varicella, HIV, rubella, adenovirus, enterovirus, arbovirus)

  9. Cont. Infective Causes of HSM • Infective: • Protozoal: malaria, kalazar, amoebic, toxoplasma • Bacterial: sepsis; tuberculosis, brucellosis, syphilis • Helminths: hydatid, visceral larva migrans • Fungal: histoplasmosis

  10. Hepatosplenomegaly: Causes • Hematological: • Haemolytic: haemolytic disease of newborn, thalassaemia • Metabolic: • Nieman-Pick, Gaucher, gangliosidosis, mucopolysaccharidosis, glycogen storage

  11. Hepatosplenomegaly: Causes • Malignancies: • Leukemia, histiocytic syndromes, myeloproliferative syndromes, lymphomas • Immunological: • Chronic granulomatous disease, hereditary neutrophilia, Ommen syndrome.

  12. Hepatosplenomegaly: Causes • Developmental: • Congenital hepatic fibrosis • Congestive: • Hepatic vein obstruction, constrictive pericarditis

  13. Investigations According to the case, may include: • CBC, retics • Blood film • Malaria smear • LFT, PT, Ammonia • Hepatitis tests • Monospot test • PPD

  14. Cont. Investigations • TORCH • α-fetoprotein • Bone Marrow Aspiration • Urinalysis • Ultrasound • CT scan • Angiography • Needle aspiration

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