Hepatomegaly

Background

Inferior view of the liver with surface showing lobes and impressions.

• Big liver
• Caused by infection, tumours, metabolic disorders, drugs

Clinical Features

Hepatomegdaly palpable on exam in a pediatric patient.

Hepatogedaly on exam in an adult patient.

• Palpable (or radiologically appreciated) enlarged liver
• +/- stigmata of hepatic dysfunction
• +/- signs of causative pathology

Differential Diagnosis

Hepatic Dysfunction

Infectious

• Hepatitis
  • Viral hepatitis
• Malaria
• HIV (present in 50% of AIDS patients)
• EBV
• Babesiosis, leptospirosis
• Typhoid
• Hepatic abscess, amebiasis

Neoplastic

• Metastases
• Hepatocellular carcinoma
• Multiple myeloma
• Leukemia
• Lymphoma
• Myeloproliferative disorders

Metabolic

• Hemochromatosis
• Wilson's disease
• Non-alcoholic steatohepatitis
• Inborn errors of metabolism

Biliary

• Biliary cirrhosis

Drugs

• Alcoholic cirrhosis
• Alcoholic hepatitis
• Hepatotoxic drugs

Miscellaneous

• Other causes of cirrhosis
• Autoimmune hepatitis
• Veno-occlusive disease
• CHF (right heart failure)

Evaluation

Evaluating liver size on ultrasound.

Pediatric liver size percentiles.

Hepatomegaly on CT.

• Evaluate for etiology; depending on presentation, workup may include:
  • LFTs, coags
  • CBC, BMP
  • RUQ US
  • Acute hepatitis serologies, other infectious workup as indicated
  • Acetaminophen levels, tox panel
  • CHF workup if suspect right heart failure
  • GI consult

Management

• Treat underlying condition
• Treat hepatic dysfunction, if present

Disposition

• Dependant on presentation; consider GI follow up if discharging and hepatomegaly not previously noted