CAUSES OF
HEPATOMEGALY
HEPATOMEGALY
Massive:
♦
Metastases
♦
Alcoholic
liver disease with fatty infiltration
♦
Myeloproliferative
disease
♦
Right
heart failure
♦
Hepatocellular
cancer
Moderate:
♦
Haemochromatosis
♦
Haematological
disease - e.g. chronic leukaemia, lymphoma, myeloproliferative disorders
♦
Fatty
liver - e.g. secondary to diabetes mellitus
♦
Infiltration
- e.g. amyloid
Mild:
♦
Hepatitis
♦
Biliary
obstruction
♦
Hydatid
disease
♦
Human
immunodeficiency virus (HIV) infection
Firm and
Irregular Liver
♦
Hepatocellular
carcinoma
♦
Metastatic
disease
♦
Cirrhosis
♦
Hydatid
disease, granuloma (e.g. sarcoid), amyloid, cysts, lipoidoses
Tender Liver
♦
Hepatitis
♦
Rapid
liver enlargement
>
Right heart failure
>
Budd-Chiari Syndrome (hepatic vein thrombosis)
♦
Hepatocellular
cancer
♦
Hepatic
abscess
♦
Biliary
obstruction/cholangitis
CAUSES OF SPLENOMEGALY
Massive Moderate
♦
Chronic myeloid leukaemia ♦ Portal hypertension
♦
Myelofibrosis ♦ Lymphoma
♦
Malaria ♦ Leukaemia (acute or chronic)
♦
Kala
azar ♦ Thalassaemia
♦
Primary
lymphoma of spleen ♦ Storage diseases e.g. Gaucher’s disease
Small
♦ Other myeloproliferative
disorders
>
Polycythaemia rubra vera (PCV)
>
Essential thrombocythaemia (ET)
♦
Haemolytic
anaemia
♦
Infection:
>
Viral (e.g. infectious mononucleosis, hepatitis)
>
Bacterial (e.g. infective endocarditis)
>
Protozoal (e.g. malaria)
♦ Connective tissue diseases:
>
Rheumatoid arthritis
>
Systemic lupus erythematosus
>
Polyarteritis nodosa
♦ Infiltrations:
>
Amyloid
>
Sarcoid
♦
Megaloblastic
anaemia (rarely)
♦
Secondary
carcinomatosis is a rare cause of splenomegaly
CAUSES OF HEPATOSPLENOMEGALY
♦
Chronic
liver disease with portal hypertension (therefore signs of liver disease/portal
hypertension are critical features in assisting with DDx of
hepatosplenomegaly)
♦
Haematological
disease:
>
Lymphopopliferative disorders: Hodgkins
lymphoma, NHL, ALL
>
Myeloproliferative disorders: AML, CML/CGL
>
Other : pernicious anaemia, sickle cell,
thalassaemia
♦
Infiltration:
amyloid, sarcoid Gauchers
♦
Infection:
viral hepatitis, EBV, CMV
♦
Connective
tissue disease: SLE
♦
Metabolic:
>
Acromegaly
>
Thyrotoxicosis
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