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“This patient has presented with abdominal bloating and malaise.  Please examine their abdomen to elicit any pertinent clinical signs and present your findings to the examiners.”

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  • “Please tell us what clinical signs you have identified?”
  • “How would you like to investigate this patient next?”
  • “What underlying causes can account for these clinical signs?”

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Diagnosis and clinical signs”][vc_column_text]This patient has hepatosplenomegaly with cervical and inguinal lymphadenopathy.  They have no clinical evidence of chronic liver disease and appear otherwise well nourished and systemically healthy.

If encountering such a patient in MRCP PACES it would be advisable to ask to inspect the observation chart in case the patient has been pyrexial, and perhaps inspect the oropharynx for tonsil enlargement.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Discussion”][vc_column_text]

Clinical features:

Hepatosplenomegaly is not a disease itself but a manifestation of one or more underlying diseases. It is the enlargement of the liver and spleen beyond their normal sizes. There are a few associated symptoms that manifest along with this condition. These include insomnia, anxiety, abdominal pain and tenderness, fatigue, depressed mood and malaise. Tremors, fever, gastrointestinal tract symptoms, frequent hiccups are also associated. Weight loss is seen in patients with hepatosplenomegaly due to poor appetite.

Initial investigations:

The initial step is the examination of the patient, most importantly abdominal palpation. The borders of the enlarged liver and spleen should be properly palpated. Abdominal ultrasound comes next. Blood profile and liver function tests also help rule out the underline pathology.  Detection of bilirubin on a urinary dipstick may indicate whether the liver is appropriately conjugating bilirubin.

Underlying pathology:

Liver is the main metabolic center of the body and spleen degrades the blood cells along with other functions and so there are different pathologies that result in an enlarged liver and spleen. The most important and common cause of hepatosplenomegaly is infection e.g. Infectious Mononucleosis. Acute viral hepatitis which is an inflammatory condition primarily involving the liver is also common cause. Other pathologies include:

  • Hepatitis (A and B are most common)
  • Leukemia
  • Glycogen storage disease
  • Hemolytic Uremic syndrome
  • Sclerosing cholangitis
  • Hepatocellular carcinoma
  • Sarcoidosis
  • Niemann-Pick Disease
  • Reye Syndrome
  • Infectious mononucleosis
  • Primary Biliary Cirrhosis

Common Treatment:

Since hepatosplenomegaly is not itself a disease, it can be treated only after the causative disease is diagnosed. The treatment can then be given accordingly, which might include medications, dietary modifications or surgery. The pain caused by the enlargement can be relieved by analgesics and relevant medications. Antibiotics and antivirals may given if the cause of the enlargement is infectious.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Specimen case presentation”][vc_column_text]

“This patient has hepatosplenomegaly and generalised lymphadenopathy in keeping with a possible underlying haematological disorder such as a lymphoma.  Other differentials include viral infections such as EBV or HIV, and other infections such as brucellosis, leptospirosis and schistosomiasis.”