What are the causes of hepatosplenomegaly?
CHIICAT
- Chronic liver disease with portal hypertension
- Haematological diseases: lymphoma, myeloproliferative disease, leukemia
- Infections: viral hepatitis, CMV, EBV
- Infiltrative: sarcoidosis, amyloidosis
- Connective tissue: SLE
- Acromegaly
- Thyrotoxicosis
Causes of massive hepatomegaly?
Al My Right Hand Man
- Alcoholic liver disease with fatty infiltration
- Myeloproliferative disease
- Right heart failure
- Hepatocellular carcinoma
- Metastasis
Causes of moderate hepatomegaly?
(Al My Right Hand Man) Has Hairy Feet
- Haemachromatosis
- Haematological diseases: CML, lymphoma
- Fatty liver - obesity, diabetes myelitis, toxins
Causes of mild hepatolmegaly?
(Has hairy feet)
- Infiltrative: sarcoidosis, amyloidosis
- Infection: Hepatitis, HIV, granulomatosis
What are causes of firm and irregular liver?
- Cirrhosis
- Hepatocellular carcinoma
- Cysts, hydatid disease, granulomas, amyloid
What are causes of tender liver?
- Hepatitis
- HCC
- Rapid liver enlargement: RHF, Budd Chiari syndrome
What are causes of pulsatile liver?
- Tricuspid regurgitation
- HCC
- Vascular abnormality
Causes of renal masses (bilateral)?
Poly Ha Ha Ah Ah Ah
- Polycystic kidney disease
- Hydronephrosis or pyonephrosis
- Hypernephroma (bilateral renal cell carcinoma)
- Acute renal vein thrombosis (bilateral)
- Acromegaly
- Amyloid, lymphoma and other infiltrative diseases
Causes of unilateral renal masses?
Poly Ha Ha Ah No
- Polycystic kidney diease
- Hydronephosis/pyonephrosis
- Renal cell carcinoma
- Acute renal vein thrombosis
- Normal right kidney or a solitary kidney
If you find polycystic kidney disease on exam, what do else do you want to examine for in extra time?
- BP
- Urinalysis - haematuria, proteinuria
- Anaemia/polycythemia
- Hepatic cysts, splenic cysts
- Can discuss cerebral aneurysm screening
Causes of massive splenomegaly
Chris My Pimp Hairy Man Kala-Azar
- CML
- Myelofibrosis
- Primary lymphoma
- Hairy cell leukemia
- Malaria
- Kala-Azar
Causes of moderate splenomegaly?
Causes of massive splenomegaly + Poor Little Lucy Standing There
- Portal hypertension
- Lymphoma
- Leukemia
- Storage diseases (Gaucher)
- Thalassemia
Causes of Right Iliac Fossa Mass
- Appendiceal abscess
- Carcinoma of caecum
- Crohn’s disease
- Pelvic kidney
- Ovarian tumour or cyst
- Carcinoid tumour
- Amoebiasis
- Psoas abscess
Causes of Left Iliac Fossa masses
- Faeces
- Carcinoma of sigmoid or descending colon
- Diverticular disease
- Ovarian tumour or cyst
- Psoas abscess
Causes of upper abdominal mass?
- Retroperitoneal lymphadenopathy (lymphoma/teratoma)
- Abdominal aortic aneurysm
- Carcinoma of stomach
- Pancreatic pseudocyst
- Pyloric stenosis
- Carcinoma or transverse colon
How to distinguish between a spleen and a kidney?
- Spleen has no palpable border
- Spleen has a notch
- Spleen moves inferomedially on inspiration
- There is no resonance over a splenic mass
- Spleen is not ballotable
- Friction rub may be heard over spleen
Signs of decompensated liver disease?
Staging?
Any complication of cirrhosis: (4+3)
- Ascites
- SBP
- Variceal haemorrhage
- Hepatic encephalopathy
- Hepatorenal syndrome
- Hepatopulmonary syndrome
- HCC
Child Pugh Staging
- Bilirubin
- INR
- Albumin
- Ascites
- Encephalopathy
Signs of portal hypertension
- Caput medusa
- Ascites
- Splenomegaly
- Oesophageal/gastric varices; haemorrhoids
Indications for HCC screening?
- Surveillance - 6 monthly liver USS and AFP
- Indications
- Anyone with cirrhosis
- In chronic HBV: FHx/PMHx HCC, Asian men >40 or women >50; africans >20
- HBV >40yo w high HBV DNA and high ALT
- Indications
