Haematology

Question 1

Causes of hepatomegaly

Answer 1

Massive

1. Metastases
2. ETOH with fatty infiltration
3. Myeloproliferative disorder
4. Right heart failure
5. Hepatocellular carcinoma

Moderate

1. Haemochromatosis
2. Haematological - CML, lymphoma
3. Fatty liver - obesity, DM, toxins

Mild

1. Hepatitis (viral, drugs)
2. Cirrhosis
3. Biliary obstruction
4. Granulomatous disorders
5. Hydatid disease
6. Amyloidosis and other infiltrative diseases
7. HIV infection
8. Ischaemia

Question 2

Causes of splenomegaly

Answer 2

Massive

1. CML
2. Myelofibrosis
3. Primary lymphoma of the spleen, hairy cell leukaemia, malaria, kara-azar

Moderate

1. Portal HTN
2. Lymphoma
3. Leukaemia (chronic or acute)
4. Thalassemia
5. Storage disease (eg Gaucher’s)

Small

1. Other myeloproliferative - polycythaemia rubra vera, thrombocytaemia
2. Haemolytic anaemia
3. Megaloblastic anaemia
4. Infection - viral (EBV, hepatitis), bacterial (IE)
5. Connective tissue disease or vasculitis = RA, SLE, PAN
6. Infiltration - amyloidosis, sarcoidosis

Question 3

Causes of hepatosplenomegaly

Answer 3

1. Chronic liver disease with portal hypertension
2. Haematological disease - myeloproliferative, lymphoma, leukaemia, pernicious anaemia, sickle cell anaemia
3. Infection - acute viral hepatitis, EBV, CMV
4. Infiltration - amyloidosis, sarcoidosis
5. Acromegaly
6. Thyrotoxicosis

Question 4

Causes of diffuse goitre

Answer 4

1. Idiopathic
2. Puberty, pregnancy, postpartum
3. Graves disease
4. Thyroiditis - Hashimoto’s thyroiditis, subacute thyroiditis (tender), chronic fibrosing thyroiditis
5. Simple goitre - iodine deficiency
6. Goitrogens - iodine excess, drugs
7. Inborn errors of thyroid hormone synthesis - Pendred’s syndrome (AR disorder)