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Hepatosplenomegaly

Aetiology of hepatosplenomegaly

• Chronic liver disease and portal hypertension
  • (see chronic liver disease section for further differentials)
• Haematological disease:
  • Leukaemias
  • Lymphomas
  • Myelofibrosis
  • Myeloproliferative disease
    • Essential thrombocytopenia, polycythaemia, primary myelofibrosis, CML
  • Haemolytic anaemias
    • Hb disorders: Thalassaemia, sickle cell disease (eventually leads to splenic atrophy)
    • Red cell structure: Spherocytosis/elliptocytosis
    • Enzyme: G6PD deficiency, pyruvate kinase deficiency

• Infection:
  • Acute viral hepatitis
  • EBV, CMV
  • Foreign/tropical
    • Malaria
    • Leishmaniasis
• Connective tissue disease
  • SLE
  • Amyloidosis
  • Sarcoidosis
• Metabolic disease:
  • Niemann Pick disease
  • Gaucher’s disease

 History in hepatosplenomegaly

• Presenting complaint
  • Abdominal swelling
• History of presenting complaint
  • Abdominal pain
  • Bloating
  • Abnormal bruising/bleeding
  • Pruritus
  • Constitutional symptoms: weight loss, night sweats, fever
• Past medical history
  • Previous EBV
• Medications
  • Hepatotoxic medications
• Family history
  • Malignancy
  • Connective tissue disease
  • Metabolic disorders
• Social history
  • Travel history
  • Alcohol consumption
  • Smoking

 Examination of hepatosplenomegaly

• Hepatosplenomegaly
• Signs of chronic liver disease
• Lymphadenopathy
• Anaemia

 Initial investigation of hepatosplenomegaly

• See pages on hepatomegaly and splenomegaly

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