HEPATOSPLENOMEGALY

FAHAD AL ZAMILProfessor & ConsultantPaediatric Infectious

DiseasesKing Khalid University

HospitalKing 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

Extends from 5th intercostal space in the midclavicular line

5 – 8 cm

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)

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

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

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

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

Hepatosplenomegaly: Causes

Infective: Viral:

Hepatotrophic (A,B,C,D,E) Other viruses (herpes, cytomegalo,

Ebstein-Barr, varicella, HIV, rubella, adenovirus, enterovirus, arbovirus)

Cont. Infective Causes of HSM

Infective: Protozoal: malaria, kalazar, amoebic,

toxoplasma

Bacterial: sepsis; tuberculosis, brucellosis, syphilis

Helminths: hydatid, visceral larva migrans

Fungal: histoplasmosis

Hepatosplenomegaly: Causes

Hematological: Haemolytic: haemolytic disease of newborn,

thalassaemia

Metabolic: Nieman-Pick, Gaucher, gangliosidosis,

mucopolysaccharidosis, glycogen storage

Hepatosplenomegaly: Causes

Malignancies: Leukemia, histiocytic syndromes,

myeloproliferative syndromes, lymphomas

Immunological: Chronic granulomatous disease, hereditary

neutrophilia, Ommen syndrome.

Hepatosplenomegaly: Causes

Developmental: Congenital hepatic fibrosis

Congestive: Hepatic vein obstruction, constrictive

pericarditis

Investigations

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

Cont. Investigations

TORCH α-fetoprotein Bone Marrow Aspiration Urinalysis Ultrasound CT scan Angiography Needle aspiration

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