Hepatosplenomegaly

Physical Examination

General Examination:

• Palmar erythema or Dupuytren's contracture could indicate chronic liver disease.

• Presence of clubbing, leukonychia or koilonychia could suggest chronic disease or malignancy.

• Lymphadenopathy, such as cervical or axillary, may suggest lymphoma or chronic infection.

• Spider naevi and gynecomastia could indicate liver disease or portal hypertension.

Inspection:

• Abdominal distention might be visible, with an enlarged liver or spleen causing a visible fullness or mass.

• Ascites may be apparent as generalised abdominal distension and caput medusae could indicate portal hypertension.

• Signs of weight loss, pallor, or jaundice may suggest underlying malignancy or chronic disease.

• Bruising or petechiae could suggest coagulopathy related to liver disease.

Palpation:

• Enlarged liver and spleen may be palpable. The liver may have a firm, smooth surface and sharp edge, while the spleen typically feels firm and has a sharp tip.

• Tenderness over the liver or spleen could suggest inflammation, congestion or infiltration.

• Detection of any abdominal masses, nodules, or other irregularities.

Percussion:

• Confirm hepatomegaly or splenomegaly through percussion note change.

• Assess for the presence of ascites via shifting dullness or fluid thrill.

Auscultation:

• Listen for bowel sounds, which may be altered in gastrointestinal involvement.

• Hepatic bruits could indicate liver malignancy or vascular disorder.

• Listen for splenic rub

Additional Examination if Required:

• Assess for peripheral stigmata of liver disease, such as ankle oedema

• Check for signs of heart failure, such as peripheral oedema, raised JVP, or abnormal heart sounds, which could be causing passive congestion of the liver and spleen.

• If there is suspicion of a haematological cause, examine the lymph nodes and do a full blood examination, including checking for petechiae, pallor, and other signs of blood disorders.

Causes of Hepatosplenomegaly

• Liver cirrhosis (e.g., alcoholic liver disease, viral hepatitis, non-alcoholic fatty liver disease)

• Infectious mononucleosis (caused by the Epstein-Barr virus)

• Portal hypertension (commonly due to liver cirrhosis)

• Hematological disorders (e.g., leukaemia, lymphoma, myelofibrosis, sickle cell disease, thalassemia)

• Infectious diseases (e.g., malaria, brucellosis, visceral leishmaniasis, typhoid fever)

• Infiltrative diseases (e.g., Gaucher's disease, Niemann-Pick disease, amyloidosis)

• Metabolic disorders (e.g., Wilson's disease, glycogen storage diseases)

• Autoimmune disorders (e.g., autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis)

• Congestive heart failure (severe heart failure leading to liver congestion)

• Tumors (primary liver tumours, metastatic tumours to the liver)