PassMED: Medical Finals Examination Revision

Hepatomegaly/Splenomegaly

Incidental findings	Lymphadenopathy
Signs	Spleen enlarged at ... cm
Differential diagnosis	Splenomegaly, Polycystic kidney; Causes below
Tests	FBC - for pancytopaenia Blood film - for decreased RBC/platelets/neutrophils USS abdomen ± Bone marrow biopsy

Incidental findings	Heart failure, cachexia
Signs	Liver is palpable ... cm below costal margin. ?Tender/smooth/firm
Differential diagnosis	Hepatomegaly, kidney; Causes below
Function	Stigmata chronic liver disease / decompensation

Massive spleen
CML
Myelofibrosis
(Malaria)
(Kala-azar)

Moderate spleen
Myeloproliferative
Lymphoproliferative
Cirrhosis

Liver
Cirrhosis
Metastasis
CCF

Liver + spleen
Myeloproliferative
Lymphoproliferative
Cirrhosis

Causes of small spleen same as moderate with addition of infections e.g. SBE, glandular fever.
If hepatosplenomegaly and lymphadenopathy think of CLL/lymphoma and infectious mononucleosis.
Other causes hepatosplenomegaly: Hepatitis, brucellosis, Weil's, Toxoplamosis, CMV, Pernicious anaemia, storage disorders, amyloidosis.
Other causes splenomegaly: brucellois, sarcoid, ITP, Felty's, amyloid, gauchers (massive).
Differential of hepatosplenomegaly is polycystic kidney disease.
Myeloproliferative = CML, myelofibrosis, PCRV, essential thrombocythaemia.
Lymphoproliferative = CLL, lymphoma, waldenstroms.
Normal upper border liver is 5th IC midclavicular line.