Organomegaly

Medicine > Gastrointestinal

Differential Diagnosis Schema 🧠

Hepatomegaly

Liver diseases: cirrhosis (early stage), hepatitis, hepatocellular carcinoma, metastases, abscess, fatty liver disease
Congestive causes: right heart failure, constrictive pericarditis, Budd-Chiari syndrome
Infiltrative disorders: amyloidosis, sarcoidosis, hemochromatosis, Wilson’s disease
Haematological disorders: lymphoma, leukemia, myeloproliferative disorders
Infectious diseases: malaria, schistosomiasis, echinococcosis
Endocrine/metabolic causes: glycogen storage diseases, acromegaly

Splenomegaly

Haematological conditions: hemolytic anemia, hereditary spherocytosis, thalassemia, myeloproliferative disorders, lymphoma, leukemia
Infectious causes: infectious mononucleosis, malaria, endocarditis, schistosomiasis, leishmaniasis
Congestive causes: portal hypertension, splenic vein thrombosis
Infiltrative diseases: amyloidosis, sarcoidosis, Gaucher’s disease
Autoimmune conditions: systemic lupus erythematosus, rheumatoid arthritis

Renomegaly

Renal tumors: renal cell carcinoma, angiomyolipoma, lymphoma
Hydronephrosis: secondary to obstruction (e.g., stones, tumors)
Polycystic kidney disease: autosomal dominant or recessive
Pyelonephritis: acute or chronic
Renal vein thrombosis: often secondary to nephrotic syndrome

Generalized Organomegaly

Haematological malignancies: lymphoma, leukemia
Infectious causes: disseminated tuberculosis, systemic fungal infections
Metabolic disorders: amyloidosis, sarcoidosis, storage diseases (e.g., Gaucher’s disease)

Key Points in History 🥼

Presenting Symptoms

Abdominal pain: suggestive of hepatic or splenic enlargement; consider causes such as malignancy, infection, or infarction
Jaundice: may indicate liver disease (hepatitis, cirrhosis) or hemolysis (leading to splenomegaly)
Weight loss: raises suspicion for malignancy, chronic infection, or metabolic disease
Fever: could suggest infection (e.g., infectious mononucleosis, malaria) or lymphoma
Early satiety: common in massive splenomegaly, often due to hematologic disorders or portal hypertension
Dyspnea or orthopnea: may suggest heart failure, potentially leading to hepatic congestion and hepatomegaly
Pruritus: associated with cholestasis and chronic liver disease

Background

Past Medical History: relevant conditions include chronic liver disease, heart failure, previous infections (e.g., infectious mononucleosis, malaria), known hematologic disorders
Drug History: certain medications may cause organomegaly (e.g., methotrexate and liver disease, ACE inhibitors and angioedema)
Family History: look for hereditary conditions such as polycystic kidney disease, hereditary spherocytosis, or Gaucher’s disease
Social History: alcohol use may indicate alcoholic liver disease; travel history might suggest tropical infections (e.g., malaria, schistosomiasis)
Occupational History: potential exposure to hepatotoxins or infectious agents

Possible Investigations 🌡️

Blood Tests

Full Blood Count (FBC): assess for anemia, leukocytosis, thrombocytopenia
Liver Function Tests (LFTs): elevated enzymes suggest liver pathology; consider bilirubin levels for jaundice
Coagulation profile: prolonged PT or INR may indicate liver dysfunction
Renal Function Tests: assess urea, creatinine; consider if renomegaly is present
Viral serology: hepatitis B and C, EBV, CMV, HIV
Autoimmune screen: ANA, ASMA, AMA for autoimmune hepatitis or systemic lupus erythematosus
Blood cultures: if systemic infection is suspected
Genetic testing: where a hereditary condition like hemochromatosis or Wilson’s disease is suspected

Imaging

Ultrasound: first-line imaging for hepatomegaly, splenomegaly, and renomegaly; can assess structure and blood flow
CT/MRI: provides detailed cross-sectional images; useful in identifying masses, vascular abnormalities, or infiltrative diseases
Echocardiography: assess for heart failure or pericardial disease as a cause of hepatomegaly
Endoscopy: may be indicated if gastrointestinal bleeding is suspected in portal hypertension cases

Specialist Tests

Bone marrow biopsy: in cases of unexplained splenomegaly, particularly when hematologic malignancy is suspected
Liver biopsy: may be required for definitive diagnosis in chronic liver disease or suspected infiltrative disorders
Lymph node biopsy: if lymphoma is suspected as the cause of organomegaly
Genetic testing: particularly in cases where metabolic or hereditary conditions are suspected

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