Abdo Short Case

Question 1

Differential for massive splenomegaly without hepatomegaly

Answer 1

1. Chronic myeloid leukaemia
2. Myelofibrosis
3. Primary splenic lymphoma
4. Infection (malaria, leishmaniasis)

Note than all haematological causes of splenomegaly can cause hepatomegaly due to extramedullary haematopoiesis

Question 2

Differential for moderate splenomegaly

Answer 2

1. Causes of massive splenomegaly (CML, MF)
2. Portal hypertension
3. Lymphoma
4. Leukaemia (acute or chronic)
5. Thalassaemia
6. Glycogen storage disease

Question 3

Differential for mild splenomegaly

Answer 3

1. Causes of large splenomegaly (CML, MF, portal HTN, lymphoma, leukaemia, infection)
2. Myeloproliferative disorders (e.g. polycythaemia vera)
3. Haemolysis
4. Infection (EBV, infective endocarditis)
5. Autoimmune (RA - Felty syndrome, SLE)
6. Infiltrative disease (sarcoid, amyloidosis)

Question 4

Differential for tender hepatomegaly

Answer 4

A. Viral hepatitis
B. Alcohol hepatitis
C. Malignancy/HCC
D. Hepatic congestion (heart failure)
E. Portal venous thrombosis

Question 5

Differential for hepatomegaly

Answer 5

1. Alcoholic liver disease
2. NAFLD
3. Malignancy (HCC or secondary)
4. Alcohol hepatitis
5. Myeloproliferative disorders

Mild-moderate: 
6. Viral hepatitis 
Infiltrative disease (amyloid, sarcoid) 
7. Portal venous thrombosis
8. Polycystic liver disease