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 .