Lymphadenopathy
What is the differential diagnosis for the causes of generalised lymphadenopathy?
- Haematological:
- CLL very common
- Lymphoma - hogkins vs non-hogkins
- Myeloproliferative, although will normally have massive splenomegaly
- Other malignancy
- Infective
- Granulomatous - MTB, MAC
- non-granulomatous - HIV, EBV, CMV, Q-fever
- Connective Tissue
- SLE
- RA
- Infiltrative
- sarcoidosis
- Drugs
- phenytoin
- Other:
- Angiofollicular lymph node hyperplasia (Castleman's disease)
- Kawasaki disease
Splenomegaly
General comments
- This could be a case of examine the abdomen and proceed - in which case you would be expected to quickly identify the presence of hepatomegaly and/ or splenomegaly and decide whether this is part of a haematological problem or a chronic liver disease case. It is normally going to be a haematological examination as stems for chronic liver disease arise are usually "please examine the gastrointestinal system"
- Always comment on nutritional state - is this patient well nourished or is this patient cachectic
- Comment on the presence of anaemia
- Mention the presence or absence of encephalopathy as it is an important consideration in acute fulminant hepatic failure
- This is limited and it is important to elicit as it has its own set of differentials
- Tender hepatomegaly is clinically caused by anything that has recently caused stretch of the hepatic capsule
- This include alcoholic hepatitis, NASH, malignancy, viral hepatitis, vascular liver disease (budd-chiari syndrone), hepatic congestion
- Liver disease causing hepatomegaly without secondary portal hypertension
- glycogen storage disease
- infiltrative disease (amyloidosis, sarcoidosis)
- polycystic liver disease
- infectious causes, including toxoplasmosis, hydatid cyst, pyogenic liver abscess and amoebic liver abscess
- vascular liver disease - budd-chiari syndrome
- hepatic congestion secondary to right heart failure, constrictive pericarditis and restrictive cardiomyopathy
