The Medical Abdomen - Hepatomegaly, Splenomegaly

Question 1

Hepatomegaly, Splenomegaly

What are the signs of the causes of Hepatomegaly on general inspection?

Answer 1

Haemachromatosis: venesection scars

Question 2

Hepatomegaly, Splenomegaly

What are the abdominal signs of Hepatomegaly on examination?

Answer 2

Question 3

Hepatomegaly, Splenomegaly

What are the other important signs to observe in a Hepatomegaly examination?

Answer 3

Question 4

Hepatomegaly, Splenomegaly

What is needed to complete a Hepatomegaly examination?

Answer 4

Question 5

Hepatomegaly, Splenomegaly

What are the significant negatives in a Hepatomegaly examination?

Answer 5

Question 6

Hepatomegaly, Splenomegaly

What are the most common causes of Hepatomegaly?

Answer 6

• Carcinoma (secondaries)

Question 7

Hepatomegaly, Splenomegaly

What are the other (less common) causes of Hepatomegaly?

Answer 7

Question 8

Hepatomegaly, Splenomegaly

What needed to be asked to attain the cause of Hepatomegaly in a history?

Answer 8

Question 9

Hepatomegaly, Splenomegaly

What are the bedside investigations for Hepatomegaly?

Answer 9

Question 10

Hepatomegaly, Splenomegaly

What are the blood investigations for Hepatomegaly?

Answer 10

Question 11

Hepatomegaly, Splenomegaly

What are the imaging investigations for Hepatomegaly?

Answer 11

Question 12

Hepatomegaly, Splenomegaly

What does a Liver Biopsy look for in Hepatomegaly?

Answer 12

Question 13

Hepatomegaly, Splenomegaly

What is the treatment for Hepatomegaly?

Answer 13

• Anti-viral
  
  • Indicated in chronic disease
  • HBV: PEGinterferon
  • HCV: PEGinterferon + ribavarin
  • Seroconversion: HBV – 40%, HCV – 10%

Question 14

Hepatomegaly, Splenomegaly

What are the signs of the cause of Splenomegaly on general inspection?

Answer 14

Question 15

Hepatomegaly, Splenomegaly

What are the abdominal signs of Splenomegaly on general examination?

Answer 15

Question 16

Hepatomegaly, Splenomegaly

What are the signs of Splenomegaly on palpation?

What are the other important signs to look out for?

Answer 16

Question 17

Hepatomegaly, Splenomegaly

What is needed to complete a Splenomegaly examination?

Answer 17

Question 18

Hepatomegaly, Splenomegaly

What are the significant negatives in a Splenomegaly examination?

Answer 18

Question 19

Hepatomegaly, Splenomegaly

What are the differentials for Splenomegaly?

Answer 19

• Massive splenomegaly (>8 cm):
  
  • Myeloproliferative disorders (CML and myelofibrosis)
  • Tropical infections (malaria, visceral leishmaniasis: kala-azar)
• Moderate (4–8 cm):
  
  • Myelo/lymphoproliferative disorders (CLL, Lymphoma)
  • Infiltration (Gaucher’s and amyloidosis)
• Tip (<4 cm):
  
  • Myelo/lymphoproliferative disorders
  • Portal hypertension
  • Infections (EBV, infective endocarditis and infective hepatitis)
  • Haemolytic anaemia

Question 20

Hepatomegaly, Splenomegaly

What are the common common causes of a small Spleen?

Answer 20

Question 21

Hepatomegaly, Splenomegaly

What are the less common causes of a small Spleen?

Answer 21

Question 22

Hepatomegaly, Splenomegaly

What is there difference between the treatment of Hepatosplenomegaly and Splenomegaly?

Answer 22

Question 23

Hepatomegaly, Splenomegaly

What needed to be asked to attain the cause of Splenomegaly in a history?

Answer 23

Question 24

Hepatomegaly, Splenomegaly

What are the blood investigations for (Haematological) Splenomegaly?

Answer 24

Other Bloods:

• DAT
• U+E and urate: ↑ malignancy → uropathy

Question 25

Hepatomegaly, Splenomegaly

What are seen on blood films in (Haematological) Splenomegaly?

Answer 25

Question 26

Hepatomegaly, Splenomegaly

What are the imaging investigations for (Haematological) Splenomegaly?

Answer 26

Question 27

Hepatomegaly, Splenomegaly

What are the histology investigations in (Haematological) Splenomegaly?

Answer 27

Question 28

Hepatomegaly, Splenomegaly

What is the genetic analysis in (Haematological) Splenomegaly?

Answer 28

Question 29

Hepatomegaly, Splenomegaly

What are the bedside investigations in (Infective) Splenomegaly?

Answer 29

Question 30

Hepatomegaly, Splenomegaly

What are the blood investigations for (Infective) Splenomegaly?

Answer 30

Question 31

Hepatomegaly, Splenomegaly

What are seen on blood films in (Infective) Splenomegaly?

Answer 31

Question 32

Hepatomegaly, Splenomegaly

What are the imaging investigations for (Infective) Splenomegaly?

Answer 32

Question 33

Hepatomegaly, Splenomegaly

What are the Liver related blood and imaging investigations in Splenomegaly?

Answer 33