Hepatomegaly
Causes of hepatomegaly
- Hepatitis
- Infections
- Viral hepatitis (acute and chronic)
- EBV and CMV
- Malaria
- Abscesses – Amoebic or Pyogenic
- Autoimmune hepatitis
- Alcoholic liver disease
- Non-alcoholic fatty liver disease (previously known as NASH)
- Tumours
- Metastases
- Hepatocellular carcinoma (HCC)
- Hepatoma
- Haematological Disorders
- Leukaemia (CML and CLL)
- Lymphoma
- Haemolytic anaemias
- Thalassaemia; red cell defects; sickle cell anaemia
- Infiltration
- Drugs
- Statins
- Amiodarone
- Macrolides
- Metabolic
- Haemochromatosis
- Wilson’s disease
- Glycogen storage disorders
- Porphyria
- Biliary Disease
- Extra-hepatic obstruction
- Pancreatic cancer; cholangiocarcinoma
- Primary Biliary Cirrhosis
- Primary Sclerosing Cholangitis
- Congestive
- Right ventricular failure
- Congestive cardiac failure
- Constrictive pericarditis
- Budd-Chiari
History in hepatomegaly
- Presenting complaint – very varied and depends on cause
- Abdominal distension
- Nausea
- Pruritus
- Weight loss
- Pyrexia
- Pale stool/dark urine
- Change in bowel habit
- Past medical history
- Autoimmune disease
- Inflammatory bowel disease
- Medications
- Statins
- Amiodarone
- Antibiotic use
- Family history
- Malignancy
- Chronic liver disease
- Sickle cell disease
- Autoimmune disease
- Social history
- Travel history
- Alcohol consumption
- Tattoos; blood transfusions; risky sexual behaviour
Examination of hepatomegaly
- Signs of chronic liver disease (see chronic liver disease section)
- Hepatomegaly – smooth/tender/craggy
- Cachexia
- Abdominal scars
- Lymphadenopathy
Initial investigations of hepatomegaly
- Blood tests:
- Full blood count
- Urea and electrolytes
- Liver function tests
- Clotting
- Inflammatory markers
- Blood film
- Full liver screen (see chronic liver disease section)
- Ultrasound abdomen
Further investigations and management of hepatomegaly
- Depends on cause (see other hepatology gastroenterology pages)
Common hepatomegaly exam questions for medical students, finals, OSCEs and MRCP PACES
Click here to download free teaching notes on hepatomegaly: Hepatomegaly
Perfect revision for medical students, finals, OSCEs and MRCP PACES
