ABDOMINAL ORGANOMEGALY

Liver Anatomy

 Healthy liver measures 14-17cm in midclavicular line  From right 5th intercostal space to costal

margin  4 lobes → Dual blood supply from hepatic artery (25%) & hepatic portal vein (75%)

 A portal venous system is when one A portal venous system capillary bed pools into another without first returning to the heart

 Hepatic portal vein receives venous blood from the spleen, stomach, gallbladder, pancreas and small & large intestine

Hepatomegaly

 May be suspected on physical examination by percussion or palpation of a liver edge

 Non- specific finding requiring further investigation  Causes include: Normal Liver Surface Markings

Infective Neoplastic/ Haematological Hepatitis Metastases

Glandular fever Hepatocellular carcinoma Liver abscess Hepatoma Malaria Haematological malignancy Amoebic infection Haemolytic anaemias

Leptospirosis Drugs & alcohol Metabolic Alcohol abuse →cirrhosis Haemochromotosis

Statins Wilson’s disease

Paracetamol Porphyria Macrolides Amiodarone Biliary disease Infiltrative

Obstruction Sarcoidosis Primary biliary cirrhosis Amyloidosis Primary sclerosing cholangitis

CAP 2 Kevin Gervin 18/5/17

Splenic anatomy & function  Anatomical values can be remembered by 1 x 3 x 5 x 7 x 9 x 11 rule:  Measures 1” x 3” x 5”

 Weighs 7 oz. (200g)  Situated between 9th & 11th ribs on the left  Diaphragmatic surface is smooth

 Visceral surface is divided by a ridge, into gastric (anterior) & renal (posterior surface, and has a vascular hilum  Arterial supply from splenic artery, a branch of the coeliac trunk

 2 forms of ‘pulp’:  Red pulp filters defective erythrocytes, antigens and microorganisms o Stores erythrocytes & platelets

 White pulp involved in active immune response via humoral & cell mediated pathways

o Rich in B & T Lymphocytes o Produces opsonins Splenomegaly Moderate splenomegaly: 11-20cm & >400g Massive splenomegaly: >20cm & >1kg Infectious Haematological Encapsulated bacteria, Haemoglobinopathies abscess, TB, Sickle cell crisis Sepsis Haematopoietic Viral infections e.g. malignancy e.g. EBV & HIV Lymphoma Parasitic infections e.g. Leukaemia Leishmaniasis, Malaria Myelofibrosis Myeloproliferative

Metastases

Congestive Infiltrative Portal hypertension Sarcoidosis Budd- Chiari syndrome Amyloidosis

Inflammatory Gaucher disease Lupus Neimann- Pick disease Felty syndrome

CAP 2 Kevin Gervin 18/5/17