Hepatomegaly ياتسنسننسوسووسومنار جلال.pdf

hepatomegaly

1. Hepatomegaly
By \ManarGalalAlqershi
Supervisor \dr. Mokhtar
Alnahary

2. Topic title :
* Anatomy of liver.
Definition.*
Pathophsiology(Mechansim)*
Causes.*
Diagnosis.*
Inevestigation.*
*Treatment.

3. Anatomy:
* The liver is one of the largest organs in the human body second only to the
skin.
* The liver has general shape of a prism or weadgewith it is base to the RT and
the apex to the left.
* It is pinkish brown in color with soft consistency and is highly vascular and
easily friable.
* The liver weight about (1.2-1.5)kg and had multifunction as nutrient
metabolism, storage ,protein synthesis and immune functions.
* The site of liver in the RHQ and epigastric area.
* The liver classically divided Lt and Rtlobes by thflaciformligament.

5. * The liver have 3 borders and 2 surfaces:
-Upper borderLt MClat 6th rib
In RtMClat 5th inter costal
space .
-Lateral border at 7th _11th rib in Rt
midaxiallaryline.
-Lower border diagonal line connecting
tip of Rt9 thcostal cartilagepass
midwaybetweenxiphisternum
andumblicusto 6 thrib at left MCL.
* Two surfaces:
-Antersuperior: diaphragmaticsurface.
-Posteroinferior: visceral surface.
-Thnormal liver span (8-12) cm at RtMCl
and (4-6 ) at midline.

6. At the surgeon doctorthe
liver divided to 8 segment
according to hepatic and
portal vein each segment
has own brancheof the
hepatic artery and biliary
tree.

7. The liver is unique as
organit has dual perfusion
by hepatic artery and th
majorsupply is portal vein
(50-90%).

8. Histology

9. Def: it is medical term for enlarged liver,
the liver span large than 12 cm.
It can be a sign of an underlying disease.
Types of hepatomegaly:
Acut: less than 6 months.
Chronic: more than 6 months.
Hepatomegaly

10. Pathophysiology (Mechanism):
Hepatomegaly generally occurs via
five mechanisms:
1-inflammation
2-excessive storage
3-infilitration
4-congestion( imparirdvenous
drainage)
5-obstruction( cholestasis)

11. Causes
*Bacterial
Pyogenic liver abscess
Typhoid
Brucellosis and syphilis of liver
*parasitic:
Malaria
Kalazar
Schistosomiasi
Hydatid cysts
* viral :
Hepatitis
Infectious
mononucleosis
according the cause: Infectious:

12. *Hepatic:
Early cirrhosis
Alcoholic fatty liver
Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosis cholongitis.
Non Infectious: :
*Congestive:
Congestive cardiac failure
Constrictive pericarditis
Budd-chiarisyndrome
*infilitrative:
Sarcoidosis
Heamochromatosis
Amyloidosis
Wilson's disease
Glycogen storage disease
Alpha-1 antitrypsin deficiency

13. *Neoplasm :
HCC
Cholangiocarcinoma
Secondary tumors (metastatic)
Leukemia
Lymphoma
Hepatoma
Non Infectious: :
*Blood disorder :
Hemolytic anemia (sickle cell and
thalassemia)
Megaloblastic anemia
Polycythemia
*Others :
Low lying diaphragm as in
emphysema
Sub diaphragmatic abcess
Normal in thin people
Riedel’s lobe

14. *Smooth and tender:
1-Rt heart failure due to:
PHTN pulmonary embolism
suggested by !JVP , leg edema .
Due to tricusped
regurgitationsuggested by pulstail
liver +jaundice,!JVPsystolic murmur
louder on inspiration.
2-Alcoholic hepatitis suggested by
history of drinking alcohol
+jaundice,AST+ ALT
3-Infectious hepatitis suggested by
sharp edge no or splenomegaly
+jaundice
4-Infectious mononucleosis (glandular
fever)
Suggested by cervical LN ,sharp edge
+splenomegaly +jaundice.
# according to pain and surface:
*Smooth but not tender:
1-Early cirrhosis suggested by
firm round edge + splenomegaly
+stigmata of chronic liver disease
2-Lymphoma suggested
bygeneralized LN +splenomegaly
3_ Leukemia suggested by LN
+splenomegaly
4_ Heamochromatosissuggested
by bronze skin
5_ Primary biliary cirrhosis 
suggested by xanthelasmtaand
xanthoms+scratch marks +arthralgia
+splenomegaly
6-Amyloidosis suggested
bychronic infective disease.
* irregularnot tender:
1-Metastatic carcinom
suggested by hard +nodular
+chchexia
2-Hepatoma suggested by
Serum AFP +arterial bruit
+firm nodular edge.
3-Hydatid cysts suggested
byhard nodular.

15. *Neonate
*Children
*Pregnancy
# according special population:

17. # Diseases associated with pregnancy
1-interhepaticcholestasis of pregnancy
2-hyperemesis gravidarum
3-Acutfatty liver of pregnancy
4-pre-eclampsia or eclampsia
5-HELLP syndrome
6-Dubin-Johnson syndrome

18. *The diagnosisof hepatomegaly typically
involves multiple steps:
1-Taking good history.
2_ DO the examination of the size and
consistency if the liver
3_ Do the lab investigation, imaging and
biopsy.
#Diagnosis:

19. *people may experience some accompanying
symptoms of an underlying liver:
1-abdominal pain in RUQ
2_ fatigue, fever
3-nausea and vomting
4-Itching ,jaundice
5_ ascites
6_ porrappetite
7-feeling ofdiscomfort.

20. Examination:

21. The method of palpitation:
1-ordinary ( standard ) palpitation.
2_ Biannual palpitation.
3_ Hooking palpitation.
4-Dipping palpitation .

22. *by Palpitation we take the following
information of :
1-site
2-size ( megalyor shurken)
3-Edge sharp in ( cirrhosis, B. fibrosis)
Round ( inflammation, infilitrative, tumors)
4-consistencysfot(information,
infilitrative)Hard ( Malignancy )
firm ( bilharaisis)
cystic ( amebic or hydatid cyst)
5-surfacesSmooth ( congestion)
irregular ( cirrhosis)
Nodular ( Malignancy)
6-Tenderness or not.
7-pulsation: TR,TS, pericardial ds, hemangiom.

23. *By precussion: determine the liver span
upper border heavy ( tidal percussion)
.at 2nd ICS at RT MCL.
lower border: fromeRIF at MCL.
*Note :
Resonance below 5
th
ICS in:
1-Hyperinflated lung.
2-interposition of transvers colon between liver and
diaphragm( chilaiditi’ssign)

24. investigation

25. 1-C.B.C anddifferentialcount
liverfunctiontest2-
AST (SGOT) *
ALT ( SGPT)
totalprotein*
* Albumin level
* Bilirubin level
* prothrombinetime.
3-urin anlysis
4-Electrolyte
5-Glucose
6-imagine:
*Abdominal US
*Abdominal CT-scan
7-Echo and ECG.
8-liver biopsy.

26. Extended list of
investigation may be
required.
How ever you will need
specific investigation
to catch or confirm the
cause.

27. Treatment:

28. * Making lifestyle changes:
1-quitting smoking and qat
2_ avoiding alcohol and more abuse drug
stress3-managing stress
4-reaching moderate weight
5-eating a nutrition and balanced diet
6-performing regular exercise.
* the tttfor hepatomegaly depends on the underlying cause.

29. Thank you