The volume of the normal liver is closely related to body weight. The content on the uptodate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. How to be productive at home from a remote work veteran. Associate professor of pediatrics and chief, joint program in gastroenterology and nutrition, department of pediatrics, ucsd school of medicine, san diego, ca. Hepatosplenomegaly in pediatrics by sami aswad on prezi. List the important diagnostic considerations in patients who have hepatomegaly. 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.
The average liver span is 45 cm in newborns and 68 cm in children at 12 years of age. After completing this article, readers should be able to. Approach to hepatomegaly, splenomegaly and hepatosplenomegaly free download as powerpoint presentation. Know the causes, symptoms, treatment, recovery, complications, and prognosis of enlarged liver or hepatomegaly. Splenomegaly is a feature of a broad range of diseases, and presents to clinicians in many. Severe heart failure causes blood to back up from the heart into the inferior vena cava the large vein that carries blood from the lower parts of the body to the heart. Hepatomegaly is not an uncommon occurrence in infancy and childhood. Evaluation of splenomegaly approach bmj best practice. Other functions include filtering senescent and defective red blood cells, presenting antigens to the immune system, and destroying.
If both the liver and spleen are enlarged, it is called hepatosplenomegaly. Pediatric gastrointestinal unit, massachusetts general hospital, boston, massachusetts 02114 hepatomegaly an approach to differential diagnosis w. See also overview of blood vessel disorders of the liver. There are several reasons which can cause enlarged liver or hepatomegaly. Lavine, md, phd objectives after completing this article, readers should be able to. Laboratory approach to the diagnosis of amyloidosis. Early diagnosis and treatment of children who have liver disease is important because specific treatments are available for some diseases that can prevent disease progression or hepatic failure. What is enlarged liver or hepatomegalycausessymptoms. Hepatomegaly is the clinical term for an enlarged liver 1. Hepatomegaly with an illdefined soft edge may occur in cml. Evaluation of jaundice in adults american academy of.
Congestive hepatomegaly is a backup of blood in the liver, resulting from heart failure. When the pediatrician encounters a patient with an enlarged liver, he must carefully evaluate that patient in order to determine the necessary approach to establishing a diagnosis. Hepatomegaly splenomegaly hepatosplenomegaly flashcards. What is the differential diagnosis of hepatomegaly. Hepatomegaly in the absence of signs of cld is unlikely to be. With amyloidosis involving the spleen and resulting in splenomegaly, large hyaline masses are seen as lesions occupying the white pulp space. Hepatomegaly denotes a disproportionate increase in liver volume in relation to the. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Hepatomegaly general presentation hepatomegaly can represent intrinsic liver disease or may be the presenting physical finding of a generalized disorder. Mar 27, 2019 hepatomegaly is abnormal enlargement of the liver. A normal liver should feel soft and is easily moveable upon inspiration. Hepatomegaly is another word to describe this problem.
In this chapter we will briefly discuss some aspects of hepatomegaly as they pertain to the clinical. Necessary to specify the age at which there were first signs of the disease hepatosplenomegaly in children is more common than in adults, since early communication elements of a single mononuclear phagocytic system is much stronger, the presence of similar symptoms in other family members should also be checked. The name of this condition hepatosplenomegaly comes. Hepatomegaly pediatrics clerkship the university of chicago. Differential diagnosis of hepatosplenomegaly homeopathy. Hepatosplenomegaly hpm is a disorder where both the liver and spleen swell beyond their normal size, due to one of a number of causes. Hepatomegaly denotes a disproportionate increase in liver volume in relation to the normal body weight. Toxicological approach for elucidation of clobazaminduced. It is a reservoir for platelets and a site for the proliferation of blymphocytes. It is important to realize that the liver is easily palpated in most children at 12 cm below the right costal margin. The border of the liver can be found by palpation, percussion, and auscultation.
Hepatomegaly in neonates and children american academy of. This can cause hepatomegaly affecting either the whole of the liver or occasionally only he left lobe. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. Toxicological approach for elucidation of clobazaminduced hepatomegaly in male rats article in regulatory toxicology and pharmacology 603. However, in late stages of hairy cell leukemia, pain and fever may be accompanied by parasplenic fluid or splenic rupture. 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. Dr ujjal poddar, professor, department of pediatric gastroenterology, sgpgims, lucknow 226 014, uttar pradesh, india. Depending on the cause, it may sometimes present along with jaundice. A diagnostic approach to the neonate who has hepatomegaly is outlined in figure 1. According to the mayo clinic, an enlarged liver is not the problem, but rather it is a sign of an underlying problem that needs to be addressed 1. Nafld covers a disease spectrum, ranging from simple steatosis in the absence of inflammation to nonalcoholic steatohepatitis nash, liver cirrhosis, and hepatocellular carcinoma hcc. Hepatosplenomegaly commonly abbreviated hsm is the simultaneous enlargement of both the liver hepatomegaly and the spleen splenomegaly. Two forms exist, including the sago spleen, in which amyloid deposits are limited to follicles, and the lardaceous spleen, in which amyloid is deposited in the walls of the splenic sinusoids.
Liver diseases like cirrhosis, fatty liver disease, hepatitis and benign liver tumors can cause your liver to be enlarged, as can cancer and cardiovascular problems 1. Identify the possible causes of simultaneous hepatomegaly and splenomegaly. Hepatomegaly is the condition of having an enlarged liver. Dec 20, 20 hepatosplenomegaly how do we approach 1. Approach to hepatomegaly, splenomegaly and hepatosplenomegaly. Hepatomegaly is enlargement of the liver beyond its normal size and occurs mainly as a consequence of pathologic conditions table 1. Approach to constipation in children ujjal poddar from department of pediatric gastroenterology, sanjay gandhi postgraduate institute of medical sciences, lucknow, uttar pradesh, india. Congestive hepatomegaly msd manual consumer version. Hepatomegaly can represent intrinsic liver disease or may be the presenting physical finding of a generalized disorder. Since liver volume is not measured in clinical practice, in practical terms hepatomegaly simply signifies an increase in liver size. Often, hepatomegaly will present as an abdominal mass. Hepatomegaly in neonates and children american academy.
Laboratory approach to the diagnosis of amyloidosis note. In some patients, extensive radiological and laboratory investigations. Answer your doctor will do a physical exam to see if your liver is larger than it should be. The prevalence of nafld is high and might reach up to 30% in certain populations such as us americans or asians. Hepatomegaly is caused by inflammation, infiltration, obstruction, storage abnormalities and vascular congestion. Kupffer cell hyperplasia with tb or other generalized infections 3.
The capacity of this parasite to cause disseminated, hyperinfection syndrome in patients treated with. Splenomegaly general presentation the spleen is a hematopoietic organ supporting the megakaryotic, lymphoid, erythroid, myeloid, and reticuloendothelial systems. Hepatomegaly is when you have an abnormally large liver. Diagnostic algorithm is based on a thorough observation of data from medical history and patient complaints and physical examination. The swelling of the liver which looks like an abnormal mass when pictured in an xray or scan of the abdomen can be caused by infection, jaundice, tumours or some disorder in the metabolism. Hepatomegaly in the absence of signs of cld is unlikely to be due to cirrhosis. Approach to a child with hepatosplenomegaly summary of pathophysiological mechanisms 1. The prevalence of nafld is high and might reach up to 30% in certain populations such as us.
An investigatory and analytic thinking approach to the clinical situation is demonstrated. Although a comprehensive approach to diagnosis of helminthelicited eosinophilia is not within the scope of this perspective article, the clinician should be aware of the potential gravity of infection with s. How to approach a patient with nonalcoholic fatty liver. Necessary to specify the age at which there were first signs of the disease hepatosplenomegaly in children is more common than in adults, since early communication elements of a single mononuclear phagocytic system is much stronger, the presence of similar. Identify the possible causes of simultaneous hepatomegaly and spleno megaly. Necessary to specify the age at which there were first signs of the disease hepatosplenomegaly in children is more common than in adults, since early communication elements of a single mononuclear phagocytic system is much stronger, the presence. Approach to the patient with hepatomegaly springerlink. Nonalcoholic fatty liver disease nafld has evolved as the most common liver disease worldwide. Enlarged liver refers to swelling of the liver beyond its normal size. April 9, 2020 homeopathicum 10m world leaders online on april 10 events in homeopathy april 8, 2020 online medical practice test series for postgraduate scholars effective preparation april 7, 2020 why record keeping is important homeopathic repertory. Kupffer cell hyperplasia with tb or other generalized infections. Seema alam pediatric hepatologist, ilbs, new delhi panelists. Evaluation of jaundice in adults american academy of family.
The liver may be transiently enlarged in acute alcoholic hepatitis. This approach is difficult in liver disease because the physical manifestations of hepatic dysfunction are protean, and many multisystem diseases affect the liver. 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. In cases of suspected familial amyloidosis, see amyloidosis familial test algorithm possible patient presentations nephroticrange proteinuria with or without renal insuf.
Hepatomegaly general presentation hepatomegaly can represent. 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. Approach to hepatomegaly, splenomegaly and hepatosplenomegaly liver situated at right hypochondriac region moves down with inspiration unable to get above enlarged to right illiac fossa dull on percussion hepatomegaly the presence of a palpable liver does not. An algorithmic approach to the evaluation of jaundice in adults. Aug 15, 2019 hepatomegaly is when you have an abnormally large liver. Practical approach to the patient with hypereosinophilia.1150 665 476 1117 156 278 1077 61 820 572 1306 337 565 1192 497 388 429 259 618 1034 1413 620 1176 1342 208 378 463 183 959 548 546 1347 306 1124 85 374 1233 871 91 934