HEPATOSPLENOMEGALY

Dr. C.V. RAVISEKAR

Assistant Professor of Pediatrics
Institute of Child Health & Hospital for Children, Chennai
 Normal Palpability of Liver
• Liver normally palpable 2 cm below right costal
margin till 4 years of age
• 1 cm palpable below right costal margin till 12 years
of age
• Not palpable beyond 12 years of age
 Liver Span
• Liver span is more important index, determined by
percussion
• Upper border of liver percussed at
5th ICS in mid clavicular line
7th ICS in mid axillary line
9th ICS in scapular line
 Normal Liver Span
Age Liver span
• Percussion of upper border
Birth 5.6 – 5.9
in MCL and lower border
by percussion or palpation. 2 months 5 cm
• > 7 cms in less than 2 yrs 1 year 6 cm
needs evaluation. 2 year 6 cm
3 year 6.5 cm
4 year 7 cm
5 year 8 cm
12 year 9 cm
 Consistency of Liver
Normally palpable liver is normal in consistency, not
tender, smooth-edges are normal.

Firm liver TB, Cirrhosis

Hard liver Malignancy
Mangalore tile Indian childhood cirrhosis
Nodular liver Cirrhosis, neoplasm
Tender liver CCF, infection (abscess, hepatitis)
Rubbery Trauma, malignancy, infection.
 Visceroptosis
Ptosis of liver
• Rickets – ligament laxity
• Subdiaphramatic abscess, empyema, emphysema,
pneumothorax.
 Only Hepatomegaly With Minimal
Splenomegaly.
• Infections – Viral hepatitis, HIV, dengue, typhoid,
leptospirosis, tuberculosis, amoebiasis.
• Congestive – CCF
• Infiltrative – nutritional (fatty infiltration), glycogen
storage, malignancy.
• Cirrhosis – Early congenital hepatic fibrosis.
• Miscellaneous – VOD, Budd - Chiari syndrome,
hydatid cyst.
 Splenomegaly
• Spleen may be normally palpable in 30% of
newborns, 15% of infants.
 Splenomegaly - Causes
• Infections – viral, bacterial or protozoal.
• Haematological
• RBC – Haemolytic anaemia,
• WBC – leukemias
• Platelet – ITP
• Portal hypertension - cirrhosis, EHPO
• Infiltrative - Hodgkin and nonhodgkin
• Connective tissue disorder
• Storage disorder
• Miscellaneous
 Massive Splenomegaly
• Chronic myeloid leukemia
• Storage disorder (adult gauchers)
• Haemolytic anaemia
• Tropical splenomegaly
• Kala-azar
• Myeloproliferative disorders
 Cases of Hepatosplenomegaly
Infection
• Fever (+)
– Acute / chronic
– Viral, bacterial or parasitic
 Haemotological
• Pallor
• Bleeding
• Lymphadenopathy
• Fever
• Mild jaundice
• Recent blood transfusion
• Failure to thrive
• Age of onset
 Congestive HSM
• Cirrhosis with PHT - h/ojaundice, chronic history,
haemetemesis, malena, anorexia, loss of weight
• Caput medussae
• Ascites
• Gynaecomastia
• Testicular atrophy
• Palmar erythema
• Spider nevi
• Vitamin deficiency (A, D, E, K)
 Infiltrative Disease
• Hodgkins & NHL
– Fever
– Lymphadenopathy
– Systemic symptoms
– duration
 Making a Diagnosis
• Always discuss the points for and points
against the various causes and make a near
normal diagnosis

• Inborn error of metabolism - always exclude all

the possible conditions and then make the
diagnosis
Thank you