الفهرس 
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Abstract
213
SUMMARI AND CONCLUSION
Hepatomegaly is still one of the common ailment
of early childhood in unprvillged and developing countries
as Egypt.In the present work we aimed to find the
actual prevalence of the different causes of hepatomegaly
among Egyptian infants and childern in rural area.
In our study we examined all the infants and
children (3500;)of both sexes, their ages ranged between
one month and 12 years from rural health unit and primary ,-:
schools in rural village (Bata)beside Benha in Egypt.
We encountered 12n cases with hepatomegaly. The+ are admitted
to pediat.ric department,Benha University Hospital.
All the cases were subjected to full history ,detailed clinical
examination,routin laboratory investigation.liver
function tests and biupsy.
Out of 3500 infants and children , we found 120
cases of hepatomegaly with prevele~ance 3.5%.they were
diagnosed as such:
1. Cases of hepatitis: 37 cases (31%)
a) acute hepatis ”
b) chronic persistent hepatitis 15 cases(12.5%)
c) chornic active hepatitis 15 cases(12.5%)
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2) Cases of post hepatitic cirrhosis 9 cases (7.510)
3) Cases bilharzial hepatomegly
33 cases (271;)
A) pure bilharzial
23 cases (19%)
B) associated with hepatitis or cirrhosis
5) Cases of neonatal jaundice
22 cases(18%)
10 cases \tho)’
4 cases (310)
4) Cases of nutritional hepatomeglY
b) ~iliary obstruction
1 case(1%)
3 cases(2.5%)
:a) Neonatal hepatitis
2
cases(4%)
cases(2.5%)
cases (2%)
cases (2%)
Cases of hemolytic anaemia
5
6)
7)
8)
9)
Cases ef hepatic vein occlusion disease 3
Cardiac eases
Cases of metabolic liver disease
2
a) Diabetes mellitus one case
1 case (1%)
b) Glycogen stor’age disease
1 case (1%)
10) Cases of hepatic tumour, (harmartoma)
11) One case of malignant blood disease
(myelogenoUs leukaemia )
2 cases (2%).
1 case (1%)
We found that the most common cause was hepatitis and
post hepatitic cirrhosis (37%+ 7.5) followedby bilharziasis
(27%) then nturitionl (18%) and other cases:}~neonatal
jaundi~e3% ,hemolitic anaemia 4%,V.0.D. 2.5% Cardiac
2% metabolic 2%’,hamartoma,2%, .and leukaemia 1~;
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1. Cases of hepatitis
Total number of cases was 31(31%) representing the
largest group in this work ,categorized as such.
a) ll..ajo;fleascute hepatitis.They were 1 cases (6%); one male
(14%) and 6 females (86%); the females were more affected
than males .Their ages was 1 i2 - 12 years (6.8~4.6); it
was considered a disease of children.
b) Cases of chronic active heptitis. They were 15 cases
(12.5%); 10 males (66%) and 5 females(34%).Their ages
was 1-12 years (1.8~4Q). The majority of C.A.H. caces occurred
in older children. Past history of an unresolved acute
at tack and sometimes as an established chronic Li,ver
disease without antecedent history of an acute attack
which might be subicteric .Liver biopsy was of’importance
establishing the diagnosis
c) Cases of chronic persistent hepatitis: They were 15
cases (12.5%); 12 males (80%) and 3 females (20%).
Their ages ranged 1.5 -12 years (4.8~1.3).Liver biopsy
was essential for diagnosis.
2. Cases of post heeatiUc cirrhosis,
They were 9 cased (1.51) of total cases, comprised
1 males (111) and 2 females(23%). Their ages ranged between
51~ -12 years (8.5~2.5} .They had symptoms of relatively
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216
long duration and p ost;history of acute hepatitis in all
the cases.’
3. Cases of bilharzial hepatomegaly:
They were 33 cases (27%), 23 cases had pure •schistosom
lesion and 10 .cases associated with chronic hepatitis and
post hepati-tis cirrhosis. The disease was more common in males
24 cases (72.7%) than females 9 casee (27.3%) .Their ages
was 6-12 years reflecting the increased incidence among
older children. Past history of bilharziasis was positive
in all the cases. All of them except :;had received antibilhar~
ial treatment. Two cases had associated lesion as a
sequalae of hepatitis 6 virus infectien and autoimmune
basis for these changes.
4. Cases of nurtitional hepatomegaly:
They were 12 cases (18%) comprised 12 males (55%) and
5
10 females (45%) .Their a’.1esr-anged ;~ -3 vears.
5. Cases of neonatal jaundice.
They were 4 male cases (3%), 3 cases of biliary
obstruction their aged was 2_3.months.One case was diango
sed
neonatal
hepatitis, he was 2 months old.
6. Cases of hemolytill anaemia:
Thev were .. 5 cases(4%) ; 4 maeles (8e%)and one
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female (20~).All the cases had past history of repeated
attacksof hemolytic cri~is and repeated blood transfusion.
7. Cases of hepatic vein occlusion syndrome
They were 3 cases (2.5~ ).Their ages varied from
3-4.5 years. Two males and one female .The duration of
illness was 3-5 months. Liver biopsy was essential to
establish the diagnosis.
8. Cardiac cases
They were 2 cases (2~) .One case had cyanoticheart
disease,the other case had rheumatic valvular lesions and
gave past history of repeated attacks of heart failure.
9. Cases of metabolic liver diseases:
a) One .case of diabetic mellitus: she was a female
aged 6 years
b) One case of glycogen storage disease:He was a
male aged 6/12 years.He had marked hepatomegaly and cardiomegaly.
There was famiJ~ history. Liver bidpsy was done
to confirm the diagnosis.
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218
10. 2 cases of hamartoma (2%)
They were males. their ages was 3 i2 -8 years.
The main presenting symptoms were abdominal distension,
anorexia and less of weight. Liver biopsy was essential
for diagnosis.
11. One case of mielogenouS leukaemia(l%).
She was a female aged 2{2 years.
It is ;;lear that the causes of hepatomegaly in rural
area in Egypt in order of frequency are hepatitis and
post hepatitic cirrhosis, bilharziasis nutritional
followed by other causes.
The most common cause is hepatitis. Proper care
should be given to improve environmental sanitation to
change the unhygienic ~abits of our people, to avoid
as much as possible contaminated syrings and to examine
carefully blood donners before blood transfusions.
Special care should be given to control bilharziasis
through health education, raising our socioeconomic conditions,
snail control and inventing new drugs for treatment
of bilharzial patients.
The nutritional liver disease can be prevented
by health education of the mothers and health promotion
219
The liver is inv~lved in many haematologic disorder
including hemolytic anaemia and leukaemia. Metabolic liver
disease ,although they are rare can be controlledby means of
therapeutic diets. Also identification of genetic disease
permits geneti~ councelling in the family .Cholestatic
syndromes are of most important to be earl. diagnosed.
When hepawmegaly is detectedin a child,the paediatrician
should take a full history, perform careful clinical
examination and perform all the required investivations
to dia1nose the cause of this hepatomegaly. Liver biopsy
does not always provide a final or complete diangosis.
However if adequate and proper’ proced~re it is extremely
useful as a diagnostic test.