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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%) ---- --- ------- - - ---- - ~-------- 214 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~; ---------------- - - ----------- 215 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 -_.-- -------------------- -- - --- - -- - --- ----- 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 --------- -------- 217 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. ------- - - ---- - -- --- ----- - 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. |