HEPATOSPLENOMEGALY

Dr. C.V. RAVISEKARAssistant Professor of Pediatrics

Institute of Child Health & Hospital for Children, Chennai

Normal Palpability of Liver

• Liver normally palpable 2 cm below right costal margin till 4 years of age

• 1 cm palpable below right costal margin till 12 years of age

• Not palpable beyond 12 years of age

Liver Span

• Liver span is more important index, determined by percussion

• Upper border of liver percussed at 5th ICS in mid clavicular line 7th ICS in mid axillary line 9th ICS in scapular line

Normal Liver Span

• Percussion of upper border in MCL and lower border by percussion or palpation.

• > 7 cms in less than 2 yrs needs evaluation.

Age Liver spanBirth 5.6 – 5.9

2 months 5 cm1 year 6 cm2 year 6 cm3 year 6.5 cm4 year 7 cm5 year 8 cm12 year 9 cm

Consistency of Liver

Firm liver TB, CirrhosisHard liver MalignancyMangalore tile Indian childhood cirrhosisNodular liver Cirrhosis, neoplasmTender liver CCF, infection (abscess, hepatitis)Rubbery Trauma, malignancy, infection.

Normally palpable liver is normal in consistency, not tender, smooth-edges are normal.

Visceroptosis

Ptosis of liver• Rickets – ligament laxity• Subdiaphramatic abscess, empyema, emphysema,

pneumothorax.

Only Hepatomegaly With Minimal Splenomegaly.

• Infections – Viral hepatitis, HIV, dengue, typhoid, leptospirosis, tuberculosis, amoebiasis.

• Congestive – CCF• Infiltrative – nutritional (fatty infiltration), glycogen

storage, malignancy.• Cirrhosis – Early congenital hepatic fibrosis.• Miscellaneous – VOD, Budd - Chiari syndrome,

hydatid cyst.

Splenomegaly

• Spleen may be normally palpable in 30% of newborns, 15% of infants.

Splenomegaly - Causes

• Infections – viral, bacterial or protozoal.• Haematological

• RBC – Haemolytic anaemia,• WBC – leukemias• Platelet – ITP

• Portal hypertension - cirrhosis, EHPO• Infiltrative - Hodgkin and nonhodgkin• Connective tissue disorder• Storage disorder• Miscellaneous

Massive Splenomegaly

• Chronic myeloid leukemia• Storage disorder (adult gauchers)• Haemolytic anaemia• Tropical splenomegaly• Kala-azar• Myeloproliferative disorders

Cases of HepatosplenomegalyInfection

• Fever (+)– Acute / chronic– Viral, bacterial or parasitic

Haemotological

• Pallor• Bleeding• Lymphadenopathy• Fever• Mild jaundice• Recent blood transfusion• Failure to thrive• Age of onset

Congestive HSM

• Cirrhosis with PHT - h/ojaundice, chronic history, haemetemesis, malena, anorexia, loss of weight

• Caput medussae• Ascites• Gynaecomastia• Testicular atrophy• Palmar erythema• Spider nevi• Vitamin deficiency (A, D, E, K)

Infiltrative Disease

• Hodgkins & NHL– Fever– Lymphadenopathy– Systemic symptoms– duration

• Always discuss the points for and points against the various causes and make a near normal diagnosis

• Inborn error of metabolism - always exclude all the possible conditions and then make the diagnosis

Making a Diagnosis

Thank you