Hepatomegaly can result from a vast range of pathology including, but not limited to, the following. Oct, 2008 anatomic pathology reported a diagnosis of embryonal cell sarcoma with tumor free surgical margins and negative abdominal lymph node biopsies. List the important diagnostic considerations in patients who have. Anemia and hepatosplenomegaly as presenting features in. Hepatosplenomegaly refers to an enlargement of the liver and spleen. The differential diagnosis for an infant presenting with fever, hepatosplenomegaly, and pancytopenia includes a number of infectious diseases such as epsteinbarr virus, cytomegalovirus, and other disseminated fungal infections such as coccidioidomycosis and blastomycosis. Assessment of splenomegaly differentials bmj best practice. This caucasian newborn boy was transferred for evaluation of hepatosplenomegaly. Chris is an intensivist and ecmo specialist at the alfred icu in melbourne. Hepatosplenomegaly is a medical condition in which both the liver and the spleen become enlarged.
Ce 110 a guide to clinical differential diagnosis of. The border of the liver can be found by palpation, percussion, and auscultation. Approach to a child with hepatosplenomegaly summary of pathophysiological mechanisms 1. Fever, hepatosplenomegaly, and pancytopenia in a 5month. Get a printable copy pdf file of the complete article 297k, or click on a page image below to browse page by page. Diagnosis of hepatomegaly and splenomegaly transmission experiments with human volunteers have been invaluable in recognizing these two forms of hepatitis and establishing the epidemiology of the two diseases but are not practicable for the study of individual patients. Department of pediatrics, national university hospital, singapore. A 2yearold boy is admitted for evaluation of massive hepatosplenomegaly. Doctors give trusted, helpful answers on causes, diagnosis, symptoms, treatment, and more. One third of newborns and 10% of children may normally have a palpable spleen. To be updated when it is complete please like us on facebook, follow us on twitter or subscribe on youtube using the foll. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis.
These include infectious causes, such as bacterial typhoid fever, mycobacterium tuberculosis, or aids with m. A conjugated bilirubin of more than 1 mgdl in combination with a total bilirubin of 20% of the total, if total bilirubin is 5. Mar 27, 2019 chris is an intensivist and ecmo specialist at the alfred icu in melbourne. Bangladesh and there are several differential diag. Hepatosplenomegaly medigoo health medical tests information. The best way to assess size is by percussion a normalsized liver can appear. This article cites 1 articles, 0 of which you can access for free at. Hepatosplenomegaly hpm is a disorder where both the liver and spleen swell beyond their normal size, due to one of a number of causes. 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. For patients with a relevant travel or exposure history, one should. He was previously healthy, with no history of jaundice, loss of appetite, or weight loss. Churchills pocketbook of differential diagnosis pdf 4th. Splenomegaly in childhood is generally first suspected upon physical examination.
Nov 14, 2012 approach in children with hepatosplenomegaly to summarize 33. A quick guide for pediatric uti homeopathic repertory. Anemia and hepatosplenomegaly are common reasons for referring a child to a pediatric hematologist or oncologist. 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. Kupffer cell hyperplasia with tb or other generalized infections 3. May 05, 2016 hepatomegaly is enlargement of the liver.
Study of etiological and clinical pro le of hepatosplenomegaly in children between 1 month and 15 years of age. As with all medical conditions, there may be many causal factors. What is the differential diagnosis 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. It is smooth, uniform, nontender and descends to meet the palpating fingers on inspiration. May 12, 2020 phd homoeopathy admission 2020 homoeopathy university jaipur phd in homoeopathy may 12, 2020 a case of adenoids managed by homoeopathy case presentations may 12, 2020 alphabetical repertory of characteristic symptoms. Common and important causes of hepatomegaly for doctors and medical students this page is currently being written and will be available soon. Hidden camera investigation on what really happens to your car cbc marketplace duration.
The differential diagnosis of hepatomegaly and splenomegaly. Malek on what is the nursing diagnosis for hepatosplenomegaly. Differential diagnosis of hepatosplenomegaly homeopathy. 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. We have uploaded churchills pocketbook of differential diagnosis 3rd edition. Hepatosplenomegaly an overview sciencedirect topics. We describe an infant with a history, physical examination results, and laboratory findings that would raise significant concern for any pediatrician. The churchills pocketbook gives a deep insight as well as a quick view to the differential diagnosis that can be made up with a symptom or sign. The massive splenomegaly narrows down the differential diagnosis, as only a. When the liver is enlarged, it can be felt at the upper right of the abdomen, just below the ribs. Since these organs are so situated that on enlarging they soon become palpable, definite enlargements become helpful in differential diagnosis.
Churchills pocketbook of differential diagnosis is the best differential diagnosis book for medical students who are working or are looking forward to more of the clinical approach to the field. Because there are multiple problems detailed in the case presentation, my approach to the evaluation and diagnosis of this patient focuses on the most immediately troublesome aspects of the. The medical history questions that the doctor many ask the hepatosplenomegaly patient. T he churchills pocketbook of differential diagnosis is the best differential diagnosis book for medical students who are working or are looking forward to more of clinical approach to the field. The differential diagnosis of multiple myeloma usually. Hepatosplenomegaly commonly abbreviated hsm is the simultaneous enlargement of both the liver hepatomegaly and the spleen splenomegaly. He is the only child of nonconsanguineous parents and was born at term after an. Prolonged fever, hepatosplenomegaly, and pancytopenia in a 46. 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.
A diagnostic approach to nc and recommendations for initial management. Its causes include a variety of conditions that affect these two organs, including liver disease, hiv, anemia, infections, and. She died four days after admission, while still under investigation. Pdf a 7 year old girl with anemia and massive hepatosplenomegaly.
Diagnosis of hepatosplenomegaly including differential diagnoses, hidden causes, misdiagnosis, confirming diagnoses, and diagnostic tests. Among the many causes for these findings is severe rickets, which has been shown to be associated with secondary myelofibrosis and myeloid metaplasia. Leukaemias lymphomas myelofibrosis myeloproliferative disease essential thrombocytopenia, polycythaemia, primary myelofibrosis, cml haemolytic anaemias hb disorders. Diagnostic algorithm to arrive at the most common diagnoses for a neonate. 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.
Use the serum albumin to ascitic albumin difference serum albumin minus ascites albumin to help differentiate the cause of ascites. In cases of prolonged neonatal jaundice, the fractionated bilirubin needs to be determined as a first step figure figure1. Sasskortsak, evaluation of the radioactive rose bengal test for the differential diagnosis of obstructive jaundice in infants new eng. Differential diagnosis of nafld a short summary naspghan. More news related information on causes of hepatosplenomegaly. Pdf prolonged fever, hepatosplenomegaly, and pancytopenia. Start studying hepatomegaly splenomegaly hepatosplenomegaly. Get free shipping, medical support, and fast results from accredited labs. The liver edge is normally palpable in children and thin adults and some patients may have a palpable right lobe of the liver.
Differential diagnosis for hepatomegaly oxford medical. Of note, the liver may be displaced downward by the diaphragm or thoracic contents leading to false impression of hepatomegaly. Balistreri, evaluation of liver disease in the pediatric patient, pediatr. Diarrhoea differential diagnosis dizziness emergencies examination fatigue. 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. Full text full text is available as a scanned copy of the original print version. An infant with fever, hepatosplenomegaly, and pancytopenia.
The meaning is nonspecific and refers to brain encephalo, pathology pathy. 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. The differential diagnosis of hepatomegaly and splenomegaly carl h. Prolonged fever, hepatosplenomegaly, and pancytopenia in a 46yearold woman article pdf available in plos medicine 64. Differential diagnosis of hepatosplenomegaly by muhammad taimoor definition. Neonatal cholestasis differential diagnoses, current. What is the nursing diagnosis for hepatosplenomegaly. Clinical differential diagnosis is the cognitive process of applying logic and knowledge, in a series of stepbystep decisions, to create a list of possible diagnoses. That is any brain abnormality which might be diffuse, could be labeled with term. Hepatosplenomegaly is usually diagnosed with an ultrasound or a computed tomography ct scan of the abdomen. The carman and ann adams department of pediatrics, division of hospital medicine, childrens hospital of michigan, wayne state university school of medicine, detroit, mi.
Hepatosplenomegaly symptoms, causes, diagnosis, treatment. Pdf prolonged fever, hepatosplenomegaly, and pancytopenia in. Does not imply any causation or actual underlying diagnosis. It is important to understand that this condition can lead to a serious or lifethreatening symptoms, if proper medical treatment.
Coupled with the history of fever, hepatosplenomegaly, and pancytopenia, the patients housing situation should have placed disseminated histoplasmosis high in the differential diagnosis. Prolonged fever, hepatosplenomegaly, and pancytopenia in a. Identify the possible causes of simultaneous hepatomegaly and spleno. Hepatomegaly pediatrics clerkship the university of chicago. Pdf liran levy and colleagues discuss the differential diagnosis, investigation, and. Massive hepatosplenomegaly caused by penicillium marneffei. 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. Prolonged fever, hepatosplenomegaly, and pancytopenia in a 46year old woman. Dec 05, 2014 even though severely anaemic patient with pa may have spleno megaly, hepatosplenomegaly coexisting with pernicious anaemia is not considered to be a characteristic feature of pa, 1,2. The edge of the liver is firm and thin, and cannot be felt with fingers in a disease free state. Higginson, the geographical pathology of liver disease in man gastroenterology 57. Download churchills pocketbook of differential diagnosis 3rd edition pdf free.
Once the cirrhosis becomes decompensated, and ascites appears, either diagnosis of hepatomegaly and splenomegaly with or without an associated icterus, diagnosis is simple. Pa should be kept in mind in the differential diagnosis of hepatosplenomegaly like in our patient. Start a free trial of quizlet plus by thanksgiving lock in 50% off all year try it free. The average liver span is 45 cm in newborns and 68 cm in children at 12 years of age. Jul 12, 2011 the edge of the liver is firm and thin, and cannot be felt with fingers in a disease free state. In this part of the article, you will be able to access the. Diffuse lymphadenopathy should always be evaluated by careful history and physical examination and perhaps laboratory investigation. Click here to download free teaching notes on hepatosplenomegaly. Em in 5 blog is a series of 5 minute emergency medicine lectures on high yield topics.
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. 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. He was the 6pound, 7 ounce product of an uncomplicated 37 week gestation to a 38yearold g2p2 female. See chapter, peritoneal abdominal paracentesis for more details. Jul 08, 2019 splenomegaly in childhood is generally first suspected upon physical examination. Hepatomegaly pediatrics clerkship the university of. 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. Fever, hepatosplenomegaly, and pancytopenia in a 5monthold. Hepatosplenomegaly often with a history of neonatal icterus has been present since early life. Both cases involved young adults presenting with fever, pharyngitis, lymphadenopathy, hepatosplenomegaly, and atypical lymphocytosis confirmed by serologic tests, liver biopsy ncbi. However, massive enlargementssplenomegaly and especially hepatomegalyare caused by relatively few diseases, and the knowledge of this fact will greatly aid in arriving at a correct differential diagnosis by precluding from consideration a large group of diseases that could scarcely be the basis of such enlargement. The name of this condition hepatosplenomegaly comes.
Hepatosplenomegaly is a condition in which both your liver and your spleen are enlarged. The massive splenomegaly narrows down the differential diagnosis, as only a few conditions generally cause this degree of splenic enlargement. Hepatomegaly splenomegaly hepatosplenomegaly quizlet. Systemic venous hypertension can also increase the risk for. Churchills pocketbook of differential diagnosis download. Anatomic pathology reported a diagnosis of embryonal cell sarcoma with tumor free surgical margins and negative abdominal lymph node. The laboratory evaluation included liver function tests, hepatitis panel, alphafetoprotein levels, human chorionic gonadotropin levels, carcinoembryonic antigen, and routine cancer markers. May 12, 2020 phd homoeopathy admission 2020 homoeopathy university jaipur phd in homoeopathy. Further relevant information on causes of hepatosplenomegaly may be found in. Postmortem examination revealed antibodies to human immunodeficiency virus, disseminated. Children who are immunosuppressed, particularly those with cellular immune dysfunction, are at increased risk for disseminated histoplasmosis. At a monthly followup the patient was free of symptoms, and. Lysosomal storage diseases as differential diagnosis of hepatosplenomegaly.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. The initial clinical differential diagnosis included tuberculosis and melioidosis. For instance, if a person comes in with jaundice and complaining of. Maddreys discriminant function test was described by maddrey and colleagues in 1978 to predict prognosis in alcoholic hepatitis. Differential diagnosis should be approached on the basis of. 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. Differential diagnosis diagnosing lesions of the oral mucosa is necessary for the proper management of patients. Hepatomegaly is enlargement of the liver beyond its normal size and occurs mainly as a consequence of pathologic conditions. The following medical news items are relevant to causes of hepatosplenomegaly. Get a printable copy pdf file of the complete article 932k, or click on a page image below to browse page by page. A 29 year old thai woman presented with nonspecific features and examination revealed left upper zone consolidation and hepatosplenomegaly. References nelsons text book of pediatrics, 19th edition. Hepatomegaly refers to an increase in size or enlargement of the liver.