Quiz 17 Hepatomegaly

Front 1

In this 25 year-old man the illness started insidiously with generalized malaise, arthralgia and anorexia. There was low grade fever and right upper abdominal pain. Jaundice appeared on the third day and progressed over next four days. Clinical examination showed moderate icterus and tender hepatomagaly of 4 cm below right margin.

Back 1

Acute Infective Hepatitis

Front 2

This 55 year-old diabetic patient presented with complaints of vague abdominal pain in the right upper quadrant. There was no history of fever or jaundice to begin with; nor was any history of drug intake. Clinical examination of the abdomen showed a moderately enlarged liver, 12cm below RCM and soft in consistency.

Back 2

Non-alcoholic Steato-hepatitis

Front 3

This 45 year-old chronic alcoholic patient presented with anorexia, edema and hematemesis. The liver was palpable 10cm below the right costal margin and firm if not hard in consistency. The liver margin was sharp and the surface nodular. There was also mild icterus, presence of free fluid in the abdomen and chronic liver failure.

Back 3

Cirrhosis of Liver

Front 4

This 35 year-old lady who presented with progressive exertional breathlessness and orthopnea, also complained of discomfort in the right hypochondrium. Clinical examination showed a 3cm enlargement of liver with rounded border, soft consistency but exquisite tenderness on palpation.

Back 4

Congestive Hepatomegaly

Front 5

This 55 year-old chronic alcoholic patient presented with history of sever right hypochondrial pain and fever of 15 days duration. He also gave a history of chronic dysentry in the past. The liver was enlarged 15cm below the RCM and severely tender. The percussion of chest base on right side was stony dull.

Back 5

Amoebic Liver Abscess

Front 6

This 45 year-old lady presented with high grade fever of one week duration and severe pain in the right hypochondrium. Clinical examination showed high grade swinging fever, severely tender enlargement of liver, presence of intercostal edema and tenderness and moderate jaundice of hepatocellular variety.

Back 6

Pyogenic Liver Abscess

Front 7

This 35 year-old lady had a palpable mass in the right hypochondrium, which remained without much pain for several years. Then suddenly, she developed acute onset of pain and tenderness in the area along with hypotension and the positive history of intake of oral contraceptive medications several years.

Back 7

Hepatic Adenoma

Front 8

There was sudden deterioration in the general condition of this 65 year-old male patient with cirrhosis of the liver, who was formerly stable. On examination there was tender heptomegaly and a palpable mass with a soft and faint murmuring sound on auscultation. He was also having significant jaundice and cachexia.

Back 8

Hepatocellular Carcinoma

Front 9

This 75 year-old male patient had chronic constipation since several months. He now presented with distension of abdomen and discomfort in the right upper abdomen. Liver was grossly enlarged and had an rregular margin and irregularly nodular surface with varying consistency. However no bruit was audible.

Back 9

Secondary Deposits in The Liver

Front 10

This 55 year-old woman presented with complaints of an enlargement of the abdomen and a visible mass in the right hypochondrium. There was no splenomegaly or lymphadenopathy. The diagnosis was suggested by the presence of spotty calcified densities and calcified cavities in the liver in USS abdomen.

Back 10

Hydatid Cyst Liver

Front 11

In this 45 year-old male patient who was asymptomatic routine clinical examination detected to enlargement of the liver to 15 cm below the right costal margin soft to firm in consistency with rounded border. The kidneys on either sides were also found to be enlarged and non-tender.

Back 11

Polycystic Disease

Front 12

The clinical presentation in this 45 year-old woman included progressive jaundice, painful tender hepatic enlargement, splenomegaly and ascites. On examination he was found to be markedly plethoric. However there was no history of intake of any cytotoxic drugs or oral contraceptives prior to onset of symptom.

Back 12

Budd Chiarri Syndrome

Front 13

This patent was extensively investigated for Fever of undetermined origin. All the investigation including, serology, bone marrow examination and imaging studies turned out to be negative. Finally the mild hepatomegaly, he had gave the clue to the diagnosis in the form of granulomas seen in liver biopsy specimen.

Back 13

Miliary Tuberculosis

Front 14

This 25 year-old man presented with resting, postural and kinetic tremor and dystonic movements with resulting dysarthria and dysphagia. He had emotional lability and behavioral and personality problems along with progressive jaundice and hepatomegaly and positive slit lamp examination.

Back 14

Wilson's Disease

Front 15

This 45 year-old man presented with fever, arthralgia, and hepatomegaly. . He had extensive skin pigmentation, which was a combination of two colors, slate-grey and brown resulting in a bronze hue. In addition there were evidences to suggest symptoms and signs of diabetes mellitus and its complications.

Back 15

Hemochromatosis

Front 16

This middle aged man had evidence of a huge hepatomegaly of 15 cm below right costal margin with rounded margins and a smooth surface. There was also evidence of moderate splenomegaly. He also had anemia and thrombocytopenia and recurrent bone fractures since early childhood involving femur and radius.

Back 16

Gaucher's Disease

Front 17

In this 45 year-old chronic alcoholic patient a continuous murmur is heard only in the epigatrium and around the umbilicus. On examination there is edema, hepatomegaly, splenomegaly and ascites. There is palmar erythema and spider naevi over the upper chest.

Back 17

Chronic Liver Disease