Explore this informative Slide share presentation to delve into the intricacies of Hepatomegaly, a condition characterized by an enlarged liver. This comprehensive slide deck covers the causes, symptoms, diagnostic approaches, and management strategies related to Hepatomegaly. Gain valuable insights into liver health, medical imaging, and associated pathologies. Whether you're a healthcare professional or some one curious about liver conditions, this presentation provides a detailed overview to enhance your understanding. Navigate through a visual journey that outlines the diverse symptoms associated with hepatomegaly, enabling a nuanced understanding of clinical presentations. The presentation extends beyond diagnosis to encompass management strategies, emphasizing the importance of a multidisciplinary approach in treating Hepatomegaly.

1. PRESENTED BY;
P. KRISHNA KEERTHI
PHARM D
NARAYANA PHARMACY COLLEGE

2.  Hepatomegaly is the condition of having an “ Enlarged liver”. It is a non specific
medical sign having many causes, which can broadly be broken down into
infection, direct toxicity, hepatic tumours, or metabolic disorder. Often ,
hepatomegaly will present as an abdominal mass. Depending on the cause, it may
sometimes present along with jaundice.

4.  NORMAL LIVER SIZE( age related ranges):
 1 week of age : 4.5 – 5cm.
 At 5 years of age : 6 – 8 cm.
 12 years , boys: 7-9 cm
 girls : 6-8 cm
 Above 12 years, boys : 7- 10.5 cm
 girls: 6- 9.5 cm.
 LOCATION: right upper quadrant of the abdomen.
 Liver typically extends from the fifth intercostal space to the midclavicular line.

5.  HEPATOMEGALY LIVER SIZE:
 >15 cm - mild hepatomegaly
 Location: right hypochondriac region ,
epigastric region, left hypochondriac
region.
 It extents upper border 6 th rib , inferior
border- crosses midline at the level of
transpyloric plane ( at the level of L1
vertebrae ).

6.  In these case, liver enlargement may be attributed to defects in single genes –
 HEMO CHROMATOSIS- HFE gene (6p21. 3).
 HEMOJUVELIN (1q21).
 HEPCIDIN( 19q13).

7. 75%
50%
35%
95%
Sales
10- 15 YRS 15- 25 YRS 25- 40 YRS PREGNANCY

8.  Abdominal pain
 Poor appetite
 Shortness of breath
 Fatigue
 Nausea, weight loss
 Dark urine, pale stool
 Increase in abdominal size
 Jaundice

9. causes
infective
congestive
Degenerate
and infiltrative
Storage
disorders
neoplasia
toxins

10.  INFECTIVE- along the biliary tree( Cholangitis ),along portal vein ( amoebiasis,
bacterial infections ),along hepatic artery- bacterial(Typhoid, TB, syphilis), viral (
infective hepatitis, infectious mononucleosis), protozoal( malaria), fungal
(actinomycosis, histoplasmosis ), parasitic ( Echinococcosis- it means cystic form ).

11.  CONGESTIVE - congestive cardiac failure, cardiomyopathy, congestive pericarditis.
 DEGENERATIVE AND INFILTRATIVE – alcoholic fatty liver, lymphomas, Leukemias,
multiple myeloma.
 STORAGE DISORDERS- Neimann pick disease, Gaucher’s disease, Amylodosis.

12.  NEOPLASIA- hepatocellular carcinoma, cholangio carcinoma.
 TOXINS- alcohol , arsenic, phosphorous, chlorpromazine.

14. Obesity
• Alcohol addiction
• High cholestrol
Liver cancer
• Hepatitis
• diabetes

15.  DIPPING METHOD:
 When the organ is enlarged , assess the following:
 Edge or border ( sharp / rounded).
 Surface ( smooth/ nodular).
 Consistensy ( soft / hard).
 Presence of tenderness.
 Movement of respiration.

17.  A complete blood count to check for an abnormal number of blood cells.
 Liver enzymes to evaluate liver function.
 Abdominal X- ray.
 CT- scan high resolution images of abdomen.
 MRI
 Ultrasound – the use of sound waves to evaluate the liver and abdominal organs.
 Taking a sample, or biopsy, of the liver tissue for further analysis.

18.  Depends on underlying causes..
 HEPATITIS :
 Anti viral drugs, depend upon types of hepatitis treated.
 Alcoholic liver disease:
 Behavioural therapy( motivational enhancement therapy), family
therapy, group therapy.

19.  NON ALCOHOLIC FATTY LIVER DISEASE:
 Reducing the intake of cholesterol and fats.
 Maintaining a moderate weight.
 Controlling blood sugar levels
 Managing underlying health conditions, such as type-2 diabetes ( insulin therapy-
Human Actrapid INJ ).

20.  NEOPLASIA (Cancer):
 Chemotherapy
 Radiation therapy
 Immunotherapy
 Surgery to remove the tumour
 Liver transplantation

21.  HEART FAILURE:
 ACE Inhibitors
 Beta blockers
 Diuretics
 Angiotensin 2 receptor blockers
 Lifestyle changes
 In some cases , surgery to correct irregularities or blocked arteries.

22.  SUBJECTIVE EVALUATION:
 A male patient ( Rupesh Kumar ) , age 23 years admitted in the general medicine
ward with the chief complaints of weakness and unable to walk since 1 week ,
severe abdominal pain, breathlessness and fever since 10 days, vomiting 2
episodes per day.
 Known alcoholic and smoking since 10 years.

23.  OBJECTIVE EVALUATION:
 On physical examination patient was found to be conscious and coherent ,
temperature was found to be increased (102).
 Blood pressure- 130/70
 Pulse rate- 76 bpm
 Respiratory rate- 18 breaths per min
 On systemic examination:
 CVS – S1 S2 +
 CNS- normal
 RS – BLAE+

24.  OBJECTIVE EVALUATION:
 On laboratory investigation ;
 Hb – 8g/dl
 ESR- 28mm/hr
 RBS- 108mg/dl
 Bleeding time- 2’-40’’
 Serum bilirubin – 0.8mg/dl
 Serum creatinine- 1.1 mg/dl

25.  ASSESMENT:
 Based on subjective and objective evaluation the patient was diagnosed as Mild
hepatomegaly.

26.  PLANNING:
 ON DAY-1:
 INJ DOXYCYCLINE – it is an antibiotic with 1g dose given twice a day, it has common
adr’s of stomach upset, Diarrhoea, nausea, vomiting, difficulty in swallowing.
 INJ PANTOP – it is an anti ulcerative agent with 40mg dose given once a daily, it has
common adr’s of nausea, headache and dizziness.
 INJ TRAMADOL- it is analgesic with 500mg dose given once a day, it has common
adr’s of dizziness, constipation, sweating, dry mouth.

27.  INJ ONDONSERTON- it is an anti emetic drug with 4mg dose given twice a day, it
has common adr’s of headache, chills, constipation.
 SYP SUCRALFATE- it is an anti ulcerative 10ml dose given thrice a day, it has
common adr’s of constipation.
 TAB PARACETAMOL – it is an antipyretic 500mg dose given thrice a day , it has
common adr’s of dark urine, nausea, loss of appetite.
 ON DAY-2: - same treatment was continued
 INJ PIPTAZ (4.5g twice a day) and INJ AMIKACIN (500mg once a day) were added.
 Both are antibiotics , common adr’s of diarrhea, pruritis, hearing, rashes.

28.  ON DAY-3:
 Same treatment was continued.
 Add INJ DICLOFENAC -2cc dose , once a day. It is an non-steroidal anti
inflammatory drug, it has common adr’s of edema , constipation, heart burn.
 ON DAY-4, 5,6:
 Same treatment was continued.

29.  ON DAY- 7:
 Patient was feeling better and discharged with following medication;
 TAB PANTOP- 40mg / OD
 TAB B COMPLEX – 67.4 mg / OD
 TAB CALCIUM – 500mg / OD
 TAB DICLOFENAC – 20mg SOS
 TAB PARACETAMOL – 500mg SOS

30.  Physician did not prescribed any vitamin supplements even though patient Hb
level was found to be low.
 Physician stopped the INJ tramadol on day 2 even though patient complaints of
severe pain.

31.  On day 3 patient was given with vitamin supplements.

32.  DRUG-DRUG:
 Ondansetron reduce the effects of Tramadol.
 Ondansetron + tramadol = increase risk of serotonin syndrome and heart beat.
 Take doxycycline at least 2 hrs before sucralfate.
 Doxycycline + sucralfate = sucralfate that contain alluminium may interfere with
absorption of doxycycline into the blood stream and reduce its effect.
 DRUG-FOOD:
 Tramadol + alcohol = increase the CNS effects such as dizziness, drowsiness,
difficulty in concentrating.

33.  Avoid alcohol and smoking consumption.
 Follow the low salt diet.
 Take plenty of water.
 Take fresh and uncontaminated food.
 Maintain body weight
 Treat the previous diseases
 Go for regular checkup
 Don’t skip the dose.
 Take medications regularly.
 Avoid sexual contact.