Lymphadenopathy and splenomegaly refer to enlarged lymph nodes and spleen respectively. Lymph nodes filter lymph and activate immune responses. The spleen filters blood and mounts immune responses. Enlargement can occur due to infection, inflammation, malignancy, or infiltration. Evaluation involves examining node/spleen characteristics and investigating for underlying causes. Treatment focuses on the specific condition causing enlargement. Hepatomegaly has many potential causes like infection, congestion, or infiltration. Evaluation involves history, exam, blood tests and imaging to identify the underlying liver problem.

1. Lymphadenopathy
Enlarged lymph nodes

2. Lymph node- basics
 Part of peripheral immune system
 Consist of fibroblasts (trabeculae),
B-cells (germinal center) &
T-cells (paracortical area)
 Function as site for immune cell contact
with antigen, leading to
activation of immune response &
elimination of antigen

3. LN enlargement- causes
 Increase in immune cells during Ag
response
 Infiltration by inflammatory cells in
infection of LN
 Malignant proliferation of LN cells
 Metastasis
 Infiltration by metabolite laden
macrophages in storage disorders

4. Evaluation
 Required when LN >1 cm.,
except inguinal >2 cm.
 Factors to consider-
 Age- malignancy more common as age
increases
 Physical charac. of LN- discrete/matted,
firm/hard, mobile/fixed, tender or not
 Node location
 Clinical setting

5. LNE- site
 Supraclavicular- metastasis from lung/GIT
 L supraclavicular (Virchow’s)- mets from GIT
 B/L epitrochlear- sarcoidosis, tularemia
 U/L axillary- breast cancer, lymphoma, UL
infection, brucellosis, cat-scratch disease
 U/L hilar- lung cancer
 B/L hilar- sarcoidosis, TB, fungal infection,
lymphoma, silicosis, berylliosis
 Inguinal- LL infection, STD (LGV)

6. Evaluation
 Relevant history- fever, other symptoms
 Examination of LN- size, location,
consistency, mobility, tenderness
 Relevant investigation
 LN FNAC &/or biopsy
Acute & tender LNE- possibly infectious, wait &
watch while treating infection

7. Splenomegaly
Enlargement of spleen
>12 cm.

8. Spleen- basics
 A lymphoreticular organ
 Located in LUQ of abdomen
 Normally not palpable
 Structure
 White pulp- B-cell containing follicles &
T-cell in perifollicular/periarteriolar areas
 Red pulp- sinuses & cords lined by
reticuloendothelial cells

9. Spleen- function
 Clearance of micro-organisms from
blood
 Generation of immune response to
foreign antigens
 Sequestration & removal of blood cells
 Regulation of portal blood flow
 Extramedullary hematopoiesis

10. Causes of splenomegaly
 Increased function-
 Infection- malaria, kala-azar, IE, TB
 Disordered immunoregulation- Felty’s syndrome
 Increased RBC destruction- spherocytosis, thalassemia,
 Extramedullary hematopoiesis
 Impaired blood flow-
 Cirrhosis
 Thrombosis/obstruction
 Infiltration-
 Amyloidosis, Gaucher/Niemann-Pick disease

Benign/Metastatic SOL

11. Massive s’megaly- >20 cms.
 CML
 Myelofibrosis
 Kala-azar
 Chronic malaria/TSS
 Thalassemia major
 Portal hypertension
 Sarcoidosis
 Hairy cell leukemia
 Portal vein
obstruction
 Gaucher disease
 Niemann-Pick
disease

12. Splenomegaly- clinical
Dull dragging LUQ pain
Enlarged spleen
Confirmed by ultrasound

13. Hypersplenism
 Splenomegaly
 Cytopenia
 Hypercellular bone-marrow
 Peripheral evidence of increased
production of cell line affected
 Immediate response after splenectomy

14. Treatment
Of underlying disease.
Splenectomy, if required
(trauma, hypersplenism)

15. Hepatomegaly
Liver has many functions

16. Hepatomegaly- causes
 Infection- IM, hepatitis, malaria
 Granulomatous- TB, sarcoidosis
 Neoplasm- secondaries, HCC, lymphoma,
hemangioma
 Congestion- CHF, hepatic vein thrombosis
 Infiltration- NASH, hemochromatosis,
amyloidosis, Gaucher/Niemann-Pick disease
 Other- ALA, hydatid cyst, ADPKD

17. Hepatomegaly- clinical
 h/o jaundice, RUQ pain
 Examination- liver span by percussion
 Liver- tender, soft/hard, smooth or not
 LFT-
 Structural- SGPT, alkaline phosphatase, GGT
 Functional- albumin, INR
 Ultrasound
 CT scan

18. Treatment
Underlying cause