II. Causes: Hepatomegaly
-
Liver displacement (Palpable liver, no Hepatomegaly)
- Obstructive Lung Disease (Asthma, COPD)
- Adjacent mass (Cholecystitis, abscess)
- Thin patient
- Infectious
- AIDS
- Hepatic Abscess (e.g. Amebiasis)
- Relapsing Fever
- Echinococcal cysts
- Schistosomiasis
- Kala Azar
- Hepatitis
- Congestive Hepatomegaly (often precedes edema)
- Congestive Heart Failure (systemic venous congestion)
- Constrictive Pericarditis
- Tricuspid stenosis
- Miscellaneous
- Wilson's Disease
- Fatty Liver
- Cirrhosis
- Hemochromatosis
- Primary Sclerosing Cholangitis
- Cholestasis
- Mixed cryoglobulinemia
- Congenital Hepatic Fibrosis
- Polycystic liver disease
- Hurler's Syndrome
- Gaucher's Disease
- Sarcoidosis
- Amyloidosis
- Malignancy
- Intraabdominal malignancy
- Pancreatic Cancer
- Hepatocellular Carcinoma
- Medication toxicity
- See Hepatotoxins
- NRTI (e.g. Stavudine)
III. Causes: Hepatosplenomegaly
- See Splenomegaly
- Babesiosis
- Chaga's Disease
- Mononucleosis
- Malaria
- Beta Thalassemia Major
- Essential-mixed cryoglobulinemia
- Viral Arthritis (e.g. Parvovirus)
- Severe congestive Hepatomegaly (see Hepatomegaly)
- Acute Lymphoblastic Leukemia
- Mast Cell disorders (Mastocytosis)
IV. Evaluation
- Step 1: Confirm Liver Enlargement versus displacement
- Step 2: Check Serum AST and Serum ALT
- If positive then go to step 3
- If negative then go to step 4
- Step 3: Check for Viral Hepatitis
- Step 4: Check Abdominal CT for Liver Lesion
- Step 5: Consider congestive Hepatomegaly (e.g. CHF)
- Step 6: Consider liver biopsy