List six causes of hepato-splenomegaly.                (30% marks)

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College answer

• Chronic liver disease with portal hypertension
• Viral infections e.g. viral hepatitis, EBV
• Myeloproliferative disease e.g. myelofibrosis
• Lymphoma
• Leukaemia
• Pernicious anaemia
• Amyloidosis
• Malaria
• Sarcoidosis
• Acromegaly
• Thyrotoxicosis
• SLE
• Metabolic storage disease
• Obesity
• Kala-Azar (visceral leischmaniasis)

Discussion

Massive splenomegaly is also discussed in Question 24.3 from the first paper of 2009, but that time there was nothing hepato about it. 

The lists of causes for hepatosplenomegaly and massive splenomegaly are actually quite similar. Here they are side by side:

Causes of Massive splenomegaly and Hepato-Splenomegaly
Causes common to  both
Massive splenomegaly Hepato-splenomegaly
  • Kala-Azar (visceral leischmaniasis)
  • Malaria
  • Myelofibrosis
  • Sarcoidosis
  • Amyloidosis
  • Chronic myeloid leukaemia (CML)
  • Lymphoma
  • Chronic liver disease
  • Kala-Azar (visceral leischmaniasis)
  • Malaria
  • Myelofibrosis
  • Sarcoidosis
  • Amyloidosis
  • Chronic myeloid leukaemia (CML)
  • Lymphoma
  • Chronic liver disease 
Causes unique to one or the other:
  • Pernicious anaemia
  • Acromegaly
  • Thyrotoxicosis
  • SLE
  • Metabolic storage disease
  • Obesity
  • Viral infections, eg. EBV

References

References

Luo, Esther J., and Lee Levitt. "Massive splenomegaly." Hospital Physician 31 (2008).

Hoffbrand's Essential Haematolgy has a table with the causes of splenomegaly in chapter 10.

Johnson, H. A., and R. A. Deterling. "Massive splenomegaly." Surgery, gynecology & obstetrics 168.2 (1989): 131-137.

Poulin, E. C., J. Mamazza, and C. M. Schlachta. "Splenic artery embolization before laparoscopic splenectomy." Surgical endoscopy 12.6 (1998): 870-875.

Bedu-Addo, George, and Imelda Bates. "Causes of massive tropical splenomegaly in Ghana." The Lancet 360.9331 (2002): 449-454.

Raje, Noopur, and Judith A. Ferry. "Case 27-2001: A 50-Year-Old Man with Marked Splenomegaly and Anemia." New England Journal of Medicine 345.9 (2001): 682-687.

Wyler, David J., and Anthony R. Mattia. "Case 11-1994: A 35-Year-Old Ethiopian Man with Splenomegaly and Recurrent Fever." New England Journal of Medicine 330.11 (1994): 775-781.

Vick, Eric J., et al. "Proliferation through activation: hemophagocytic lymphohistiocytosis in hematologic malignancy." Blood advances 1.12 (2017): 779-791.