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Query: UMLS:C0019209 (hepatomegaly)
 5,798 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Budd Chiari Syndrome, characterized by massive ascites, hepatomegaly, abdominal pain, and tenderness, nausea, and vomiting, is caused by obstruction of the hepatic venous outflow. Of the known causes of polycythemia rubra vera, hypernephroma, and other tumors invading the inferior vena cava have been most often reported, while pregnancy and oral contraceptives (OCs) have also been held as causes. In this paper the case is presented of a young woman, previously on OCs for 4 months, who developed the syndrome 2 weeks after delivery; she was also found to have multiple hepatic adenomas on laparotomy. The longterm use of OCs has been estimated to be associated with an annual incidence of liver cell adenoma of 3-4/100,000. Evidence suggests that the estrogen components, rather than the progesterone, of OCs seem more likely to cause liver cell adenoma since estrogens are carcinogenic in other organs and promote liver cell regeneration in rats. By interference with the metabolism of oncogenic bile salt derivatives, estrogen may exert its oncogenic effect. The patient is this case was told never to use OCs again since there is also evidence that the tumor may regress on stopping OCs, and she was advised against further pregnancies.
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PMID:Budd-Chiari syndrome and hepatic adenomas associated with oral contraceptives. A case report. 627 27

Since 1973 there have been more than 20 reported cases of malignant and about 200 cases of benign hepatic adenomas associated with oral contraception (OC). This article reports on the case of a 45 year old woman on OC from 1967 to 1971. In 1979 she was admitted to the hospital in the 36th week of her 9th pregnancy for nausea, vomiting, and pain. Cesarean section delivered her of a healthy baby girl, and celiotomy exposed an enlarged liver with several tumors. Resection was not possible and the woman died after 3 days. Necropsy showed numerous tumors and metastases and primary hepatic carcinoma. Even though 8 years had elapsed between OC termination and the onset of cancer, the connection between exposure to OC and liver cancer must be suspected. The time lag might be attributed to delayed development of the neoplasm rather than to its slow growth.
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PMID:A case of hepatoma in pregnancy associated with earlier oral contraception. 627 30

The possible association of hepatocellular carcinoma with oral contraceptive (OC) use is supported by the case of a 33-year old black female, gravida 5, para 4. She presented in April 1978 with right upper quadrant pain, nausea, vomiting, and fatty food intolerance. The case had been taking norethindrone, 1 mg with mestranol 0.05, for 2 years. There was no history of liver disease, alcohol abuse, or exposure to chemical toxins. The preoperative diagnosis was subacute cholecystitis; however, an unresectable primary liver tumor of both lobes was detected on surgery. OC use was discontinued, and the case refused chemotherapy. On December 1, 1978, she presented with a 9-week pregnancy which was aborted. Physical examination revealed an enlarged liver and mass in the upper right quadrant. The patient was readmitted December 11 with intractable pain and discharged. She died December 28, 1978. At autopsy the liver tumor appeared as a moderate to poorly differentiated hepatoma with irregular hyperchromatic nuclei. There was no evidence of coexistent benign lesions. The rapid progression of the disease following pregnancy suggests that hepatic growth was stimulated by the high estrogen levels of pregnancy. Earlier diagnosis and improved management are required in such cases. Ultrasonography can be used to confirm the presence of a mass, and liver scan or hepatic angiogram may be useful. Liver biopsy is required for definitive diagnosis. Treatment involves discontinuation of OC use and complete excision of the tumor where possible. If tumors have progressed beyond the stage of resectability, as in this case, the prognosis is poor.
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PMID:Hepatocellular carcinoma associated with oral contraceptive use and pregnancy. 629 72

Eighty-four cases of schistosomiasis mekongi among Cambodian refugees in holding centres in Thailand received praziquantel at 30 mg/kg body-weight orally twice in one day. Those treated were admitted to hospital in order to observe side effects for 24 hours. Assessment of the efficacy of praziquantel was based on cure rates. Side effects observed consisted primarily of abdominal pain, anorexia, nausea, emesis and headache. These were generally mild and transient. Physical signs revealed mild hepatomegaly and splenomegaly. The cure rate obtained one month after treatment was 97.5% and by 2 to 12 months after treatment reached 100%.
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PMID:Treatment of Schistosoma mekongi with praziquantel in Cambodian refugees in holding centres in Prachinburi Province, Thailand. 648 54

A study of the prevalence and intensity of opisthorchiasis viverrini in relation to morbidity as determined by standard medical examination was carried out in Nong Ranya, a small village containing 309 people in northeastern Thailand. Opisthorchis viverrini infection as determined by Stoll's quantitative egg count method had an overall prevalence of 94% and reached 100% prevalence in most age groups above the age of 10 years. With respect to intensity, 6% were uninfected, 26% had light (less than or equal to 1 eggs per mg [epmg] of feces), 37% moderate (greater than 1-10 epmg), 25% heavy (greater than 10-50 epmg), and 5% very heavy (greater than 50 epmg) infections. Peak intensity in both males and females occurred at age 40 and above. A history of eating "koipla" (a sauce consisting of ground up raw fish), of feeling weak, and of having right upper quadrant abdominal pains occurred most frequently in the infected groups and was correlated with intensity of infection. Regardless of intensity of infection, only a small proportion of the population were unable to carry out their routine activities. Anorexia, nausea or vomiting bore little relationship to the presence or intensity of infection. Hepatomegaly at the mid-clavicular line occurred in 14% of the population, mainly in the more heavily infected groups. Neither jaundice nor splenomegaly was observed in the population.
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PMID:Morbidity in relation to intensity of infection in Opisthorchiasis viverrini: study of a community in Khon Kaen, Thailand. 698 3

A case is described wherein a 29 year old woman was admitted to the hospital because of the possibility of a hepatic tumor; symptoms included abdominal pain, diffuse hepatic enlargement and absence of uptake in an area of the right hepatic lobe. After a normal pregnancy and delivery 11 years earlier the patient used oral contraceptives (OCs) composed of norethindrone with mestranol until 8 years before entry; 5 years before admission she resumed use of an OC containing norethindrone and ethinyl estradiol. She smoked 1.5 packages of cigarettes and drank 1 glass of wine daily, and there was no history of nausea, vomiting, melena, jaundice, dark urine, light stools, hepatitis, or blood transfusions. Benign lesions which are known to be caused by OCs fall into 2 groups: designated focal nodular hyperplasia and liver-cell adenoma. The evidence linking the latter with OCs is more convincing since in case-controlled studies the risk of development of adenomas has been shown to increase with the estrogen strength of the OCs and duration of use; in women who have been taking OCs over 7 years the relative risk is 500 times that for matched control nonusers. The vascular complications of OC therapy include Budd-Chiari syndrome, peliosis hepatis, and periportal sinusoidal dilatation. The patient in this case was diagnosed to have periportal and midzonal hepatic sinusoidal dilatation association with OC medication. She underwent an operation on her liver which proved to be successful combined with cessation of OC use. The mechanism by which OCs cause these lesions is not known. In 5 of 13 cases similar to the one described here clinical and biochemical abnormalities resolved and 1 patient had a follow-up liver biopsy that revealed normal findings 10 months after cessation of OC therapy; there is no evidence to suggest that sinusoidal dilatation is irreversible.
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PMID:Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 40-1982. Tender hepatomegaly in a 29-year-old woman. 711 Feb 74

Case reports are presented that link the use of oral contraceptives (OCs) to liver disease, particularly to the Budd-Chiari syndrome. This syndrome is caused by occlusion of hepatic veins and although a causative relation between OC use and this syndrome is not proven, these facts support an association: 1) the known increased incidence of venous thrombosis in women using OCs; 2) data from a review of 164 cases of the syndrome showed that in 1959 men and women suffered the syndrome about equally, but since 1975 after the introduction of OCs another study reported women contracting the disease twice as often as men; 3) the syndrome is associated with pregnancy; and 4) since the 1975 study, association with the pill was found in 16 reported cases. Clinically, the average age of these 16 women with OC-associated Budd-Chiari syndrome was 32 years. Length of time before onset of symptoms after beginning OC therapy varied from 2 weeks to 8 years (mean 23.8 months). In most cases, abdominal pain, nausea, vomiting, and abdominal distension were present. Hepatomegaly and ascites were described in most cases and splenomegaly in less than half. Liver function abnormalities were nonspecific. Prognosis is not good, and management techniques for the syndrome have been largely unsuccessful. Metabolic alterations of steroids as they pass through the liver may account for the syndromes associated with OC use. 3 major diseases or effects are linked with OCs: hepatic dysfunction, cholestatic jaundice, and benign hepatic tumors and peliosis hepatis; these, however, are benigh complications compared with the severity of contracting Budd-Chiari syndrome, and the clinician should respect a woman's decision not to use the pill in the face of such disease-inducing possibilities.
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PMID:Oral contraceptives and liver disease. 726 Aug 2

We report the use of a nasobiliary catheter in the management of a 55-yr-old female with autosomal dominant polycystic kidney disease who developed obstructive jaundice from a hepatic cyst. The patient presented with a 2-wk history of fatigue, jaundice, nausea, vomiting, and abdominal pain. Physical examination was remarkable for tender hepatomegaly. Computerized tomography revealed multiple hepatic cysts and dilated intrahepatic biliary radicles. Endoscopic stent placement failed to relieve the obstruction. Computerized tomography guided percutaneous aspiration of the obstructing hepatic cyst was successful with the aid of a nasobiliary cholangiogram allowing visualization of the biliary tree and identification of the obstructing hepatic cyst. However, the cyst rapidly accumulated fluid, and the obstruction recurred within 1 wk of simple aspiration. Relief of symptoms was maintained only after alcohol sclerosis of the obstructing hepatic cyst. Review of the literature shows that alcohol sclerotherapy is a safe and effective nonsurgical means of treating symptomatic hepatic cysts.
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PMID:Alcohol sclerosis for polycystic liver disease and obstructive jaundice: use of a nasobiliary catheter. 807 38

Massive steatosis has recently been described among a few human immunodeficiency virus-seropositive patients who were receiving antiretroviral therapy. Although clinical and light-microscopic pathological findings were carefully described, no ultrastructural studies of the liver were performed in these cases. We report the light-microscopic and ultrastructural findings at autopsy of a 35-year-old woman with AIDS who developed severe lactic acidosis and hepatic failure. The patient had been receiving standard doses of zidovudine for 5 months when she was hospitalized because of the rapid onset of abdominal pain, nausea, and vomiting. The most significant findings at autopsy were massive hepatomegaly and steatosis. Ultrastructural examination of the liver and skeletal muscle showed slightly enlarged mitochondria in the liver but no mitochondrial changes in the skeletal muscle. The pathogenesis of mitochondrial toxicity associated with antiviral therapies is briefly discussed.
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PMID:Massive hepatic steatosis and lactic acidosis in a patient with AIDS who was receiving zidovudine. 864 49

In adults with diabetes mellitus, hepatomegaly and abnormalities of liver enzymes occur as a consequence of hepatocellular glycogen accumulation, as has been well described in children. During periods of hyperglycemia glucose freely enters the hepatocytes driving glycogen synthesis, which is augmented further by administration of insulin to supraphysiologic levels. The accumulation of excessive amounts of glycogen in the hepatocytes is a function of intermittent episodes of hyperglycemia and hypoglycemia and the use of excessive insulin. Hepatic glycogenosis occurs in patients with poorly controlled insulin-dependent type I or type II diabetes. The clinical manifestations of this phenomenon may include abdominal pain and obstructive symptoms such as early satiety, nausea, and vomiting. Ascites has rarely been reported. The typical biochemical findings are mildly to moderately elevated aminotransferases, with or without mild elevations of alkaline phosphatase. Liver synthetic function is usually normal. All these abnormalities, including the hepatomegaly, are readily reversible with sustained euglycemic control. The other major cause of hepatomegaly in patients with diabetes is steatosis. This is a function of the body habitus and state of insulin resistance rather than glycemic control. However, the distinction between steatosis and glycogenosis is important: whereas steatosis may progress to fibrosis and cirrhosis, glycogenosis does not, but reflects the need for better diabetic control. Glycogenosis and steatosis cannot be distinguished reliably on ultrasound examination. The histology, however, is definitive. In glycogenosis, as in primary glycogen storage diseases, there is excess glycogen in the cytoplasm, and often also in the nucleus, of hepatocytes. The hepatocytes throughout the lobule appear pale and swollen with clearly defined cell boundaries. Ultrastructural examination reveals cytoplasmic glycogen in clumps displacing organelles to the periphery of the cell, and there is little if any steatosis. We have shown that hepatomegaly due to glycogenosis in adults with diabetes is similar in all respects to the condition seen in children. As in children, liver enzyme abnormalities are unreliable in predicting the presence or the extent of glycogenosis. Hepatic glycogenosis can occur at any age, and therefore should be included in the differential diagnosis of hepatomegaly in all insulin-requiring diabetics.
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PMID:Hepatomegaly and abnormal liver tests due to glycogenosis in adults with diabetes. 898 49


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