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