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Causes of hepatosplenomegaly

Hepatomegaly

  • Malignancy
    • Primary or secondary
  • Hepatic congestion
    • Right heart failure
    • Hepatic vein thrombosis (Budd-Chiari syndrome)
  • Haematological
    • Lymphoma/leukaemia/myeloproliferative
  • Infection
    • Infectious mononucleosis
    • Viral hepatitis
  • Anatomical
    • Riedel’s lobe
  • Other
    • Non-alcoholic fatty liver disease
    • Alcoholic liver disease
    • Sarcoidosis
    • Amyloidosis
    • Infective endocarditis

NB: the liver is often not palpable in cirrhosis because it shrinks. Splenomegaly due to portal hypertension is a more common finding.

Splenomegaly

  • Infiltration
    • Leukaemia
    • Lymphoma
    • Myeloproliferative disorders
  • Increased function
    • ↑Extravascular haemolysis (haemoglobinopathy, thalassaemia, spherocytosis)
    • ↑Extramedullary haematopoiesis (myelofibrosis, malignant bone marrow infiltration)
    • ↑Response to infection (HIV/AIDS, glandular fever, infective endocarditis, malaria, autoimmune disorders)
  • Vascular congestion
    • Cirrhosis (causing portal hypertension)
    • Splenic vein obstruction
    • Budd-Chiari syndrome

NB: Massive splenomegaly is usually due to: chronic Myeloid leukaemia, Myelofibrosis, Malaria (or less commonly splenic lymphoma or visceral leishmaniasis).

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
    • Amyloidosis
    • Sarcoidosis
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