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Causes of hepatosplenomegaly

Hepatomegaly

  • Malignancy
    • Primary (e.g. hepatocellular carcinoma)
    • Primary or secondary
  • Venous congestion
    • Right heart failure
    • Hepatic vein thrombosis (Budd-Chiari syndrome)
  • Inflammation
    • Viral hepatitis (EBV, CMV, hepatitis A-E)
    • Alcoholic hepatitis
    • Drug-induced hepatitis
  • Infiltration
    • Non-alcoholic fatty liver disease
    • Sarcoidosis
    • Amyloidosis

Splenomegaly

  • Infiltration
    • Leukaemia
    • Lymphoma
    • Leukaemia
    • Lymphoma
    • Myeloproliferative disorders
  • Increased function
    • ↑Extravascular haemolysis (haemoglobinopathy, spherocytosis, immune-mediated haemolytic anaemia)
    • ↑Extramedullary haematopoiesis (myelofibrosis, malignant bone marrow infiltration)
    • ↑Response to infection (HIV, EBV/CMV, infective endocarditis, malaria)
  • Venous congestion
    • Portal hypertension (most commonly due to liver cirrhosis)
    • Splenic vein thrombosis

Hepatosplenomegaly

  • Chronic liver disease with portal hypertension 
    • Any cause of chronic liver disease 
  • Haematological
    • Leukaemia
    • Lymphoma
    • Myeloproliferative disorders
  • Infections
    • Acute viral hepatitis
    • CMV/EBV
    • Malaria
    • Visceral leishmaniasis
  • Infiltration
    • Sarcoidosis
    • Amyloidosis

Test your knowledge

What would you expect to happen to the size of the liver and spleen in liver cirrhosis?

Which other clinical findings may you expect to find in a patient with hepatosplenomegaly due to a haematological cause?

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  1. Hepatosplenomegaly abdominal exam
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