CME Article

A Nine-Year-Old Girl with Liver Enlargement

Marilyn Brown, MD; Prita Mohanty, MD; Vibha Sood, MD

  • Pediatric Annals
  • June 2012 - Volume 41 · Issue 6: 7-10
  • DOI: 10.3928/00904481-20120525-09
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Abstract

CME Educational Objectives

  1. Outline the differential diagnosis for liver enlargement.

  2. Describe the findings leading to the diagnosis of primary sclerosing cholangitis in a child.

  3. Describe the association between primary sclerosing cholangitis and inflammatory bowel disease.

A 9-year-old previously healthy girl was noted to have an enlarged liver by the pediatrician during her well-child checkup. No complaints of itching, bruising, bleeding, or appetite loss were noted. There was no history of jaundice, abdominal pain, fevers, or fatigue.

Her past medical history was remarkable for seasonal allergies, constipation, milk intolerance, elevated erythrocyte sedimentation rate (ESR), and peripheral eosinophilia. Upon review of systems, she had no weight loss, fevers, or chills. No unusual skin rash or itching was noted. She had no respiratory, cardiac, or gastrointestinal (GI) symptoms. She had no bowel or bladder incontinence, and there was no history of drug intake. The patient was up to date with all vaccines. Her development and milestones were normal. Family history was significant for maternal grandmother having “spotted liver” and questionable twisted colon per family.

Upon examination, her height and weight were at the 75th and 50th percentile, respectively. Abdominal examination was remarkable for liver edge being palpable 3 to 4 cm below the costal margin, and the spleen tip was palpable as well. No jaundice or skin rash was noted. The remainder of the examination was normal.

AUTHORS

Vibha Sood, MD, is a Fellow, Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, University of Rochester Medical Center, Rochester, NY. Prita H. Mohanty, MD, is a Fellow, Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, University of Rochester Medical Center, Rochester, NY. Marilyn Brown, MD, is Professor of Clinical Medicine, Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, University of Rochester Medical Center, Rochester, NY.

Disclosure: The authors have disclosed no relevant financial relationships.

Address correspondence to: Vibha Sood, MD, Division of Pediatric Gastroenterology and Nutrition, University of Rochester Medical Center, 601 Elmwood Avenue, Box 667, Rochester, NY 14642; email: Vibha_Sood@urmc.rochester.edu

doi: 10.3928/00904481-20120525-09

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