Transcript HSM
FAHAD AL ZAMIL Professor & Consultant Paediatric Infectious Diseases King Khalid University Hospital King Saud University, Riyadh Mean liver span: In the Newborn: 4.5 – 5 cm 12 years: boys: 7 – 8 cm 12 years: girls: 6 – 6.5 cm Extends from 5th intercostal space in the midclavicular line 5 – 8 cm Lower edge not more than 2 cm below the costal margin in infancy (1 cm in childhood) A normal-size liver may be displaced downward (e.g. pulmonary hyperinflation) Tip of spleen is normally palpable in 1/3 of full-term infants May be felt up to 5 years of age. After that a palpable spleen is presumed to be enlarged Fever, jaundice, pallor, bleeding, tea-colored urine, bone & joint pains, weight loss, abnormal sweating, anorexia, abdominal distention, pain, trauma, food or drug exposure Exposure to infections (hepatitis, mononucleosis, TB, amebiasis) Hematological disease (SCA, Thalassemia), cardiac disease, collagen vascular disorder, storage diseases Measure liver span Determine liver’s contour & consistency Is the surface smooth, irregular or nodular? Is the edge rounded or sharp? Is palpation painful? DO NO HARM! Listen for bruit Any ascites ? Increased portal venous pressure, tissue infiltration, or reticuloendothelial cell hyperplasia In newborns: do fundoscopy for chorioretinitis Congenital infections Note: skin lesions, subcutaneous nodules, lymphadenopathy, spider angiomata or stigmata of storage disease Infective: Viral: Hepatotrophic (A,B,C,D,E) Other viruses (herpes, cytomegalo, Ebstein-Barr, varicella, HIV, rubella, adenovirus, enterovirus, arbovirus) Infective: Protozoal: malaria, kalazar, amoebic, toxoplasma Bacterial: sepsis; tuberculosis, brucellosis, syphilis Helminths: hydatid, visceral larva migrans Fungal: histoplasmosis Hematological: Haemolytic: haemolytic disease of newborn, thalassaemia Metabolic: Nieman-Pick, Gaucher, gangliosidosis, mucopolysaccharidosis, glycogen storage Malignancies: Leukemia, histiocytic syndromes, myeloproliferative syndromes, lymphomas Immunological: Chronic granulomatous disease, hereditary neutrophilia, Ommen syndrome. Developmental: Congenital hepatic fibrosis Congestive: Hepatic vein obstruction, constrictive pericarditis According to the case, may include: CBC, retics Blood film Malaria smear LFT, PT, Ammonia Hepatitis tests Monospot test PPD TORCH α-fetoprotein Bone Marrow Aspiration Urinalysis Ultrasound CT scan Angiography Needle aspiration