Exam

Hepatomegaly

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Hepatomegaly, Liver Enlargement, Hepatosplenomegaly

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