hepatomegaly

introduction

patients with hepatomegaly or splenomegaly should be advised to avoid all contact sports as there is a risk of fatal organ rupture
rupture risk is higher in older patients as the capsule thins with age

aetiology

inflammatory response to infection or auto-immune conditions:
hypertrophy due to increased work of RBC destruction:
- thallasaemia major
- malaria
- hemoglobin SC disease
- NB. sickle cell disease results in a small, infarcted spleen rather than splenomegaly
venous congestion:
- RVF/CCF
- Budd–Chiari syndrome (hepatic vein thrombosis or compression)
  - acute syndrome presents with rapidly progressive severe upper abdominal pain, jaundice, hepatomegaly (enlarged liver), ascites, elevated liver enzymes
  - most have a painless more chronic form
  - aetiology:
    - polycythemia vera
    - pregnancy or puerperium
    - combined oral contraceptive pill (OCP)
    - paroxysmal nocturnal hemoglobinuria
    - hepatocellular carcinoma
    - infection such as tuberculosis (TB)
    - IVC stenosis
    - thrombophilia
drugs/toxins:
- ethanol (alcohol and alcohol withdrawal)
congenital:
- haemolytic anaemia
- Riedel's lobe is an extended, tongue-like, right lobe of the liver
- polycystic disease
- Cori's disease
- Zellweger syndrome
- carnitine palmitoyltransferase I deficiency
myeloproliferative:
- eg. chronic myeloid metaplasia
infiltrative / metabolic:
- steatohepatitis (fatty liver)
- sarcoidosis
- amyloidosis
- haemochromatosis
- Gaucher's disease
- Niemann Pick disease
- Hurler's syndrome
- Von Gierke disease (Glycogen Storage Disease type 1)
- Glycogen Storage Disease types III, VI and IX
- some neoplasia / cancer / tumours
neoplastic:
- hepatocellular carcinoma
- chronic lymphocytic leukemia
- lymphoma
- mm
- metastases
miscellaneous:
- traumatic haematoma
- cysts
- abscesses - pyogenic or ameobic