Abdomen

Question 1

What are the causes of hepatomegaly without splenomegaly?

Answer 1

Malignancy (HCC or mets, esp met CRC)
Cirrhosis
Hepatic congestion from right heart failure
Alcoholic hepatitis
Infectious
Infiltrative - amyloid, sarcoid
Vascular - budd chiari (obstruction of the hepatic venous outflow)
Polycystic kidney disease with polycystic liver
Haemochromatosis

Question 2

Causes of splenomegaly

Answer 2

Haematological - lyphoproliferative and myeloproliferative disorders including malignancies and others like polycythaemia RV and ET
Portal HT
Haemolytic anaemia
Felty’s

Question 3

What are the characteristics of a spleen on palpation?

Answer 3

Enlarges towards the right iliac fossa 
Medial notch 
Dull to percuss 
cannot palpate above 
not ballotable

Question 4

Why might you get hepatomegaly when there is splenomegaly from a hematological cause?

Answer 4

Due to extra-medullary hematopoiesis

Question 5

Haemochromatosis clinical signs

Answer 5

Bronze to slate grey skin pigmentation 
Koilonychia (spoon nails)
Hepatomegaly and other CLD features 
Arthropathy - get pseudogout 
Look for evidence of BSL testing or insulin injecting