Hepatomegaly causes🎥

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Hepatomegaly causes

Introduction

Hepatomegaly refers to enlargement of the liver. It is a clinical sign rather than a diagnosis and can result from a wide range of systemic, hepatic, or infiltrative conditions. Detection is usually via abdominal palpation, and further investigation is guided by clinical context.


Normal Liver Findings on Examination

  • In healthy individuals, the liver edge is typically not palpable, except in thin individuals or children.
  • It may be felt 1–2 cm below the right costal margin during deep inspiration in such individuals.
  • The normal liver should feel smooth, with a soft and regular edge.
  • The consistency is usually firm but non-tender.

Abnormal Liver Findings on Examination

  • Liver edge palpable >2 cm below the costal margin
    • Suggestive of hepatomegaly.
  • Pulsatile hepatomegaly
    • Indicates right-sided heart pathology, particularly tricuspid regurgitation.
  • Tender hepatomegaly
    • Suggests inflammation or congestion, as seen in:
      • Viral, alcoholic, or autoimmune hepatitis
      • Liver abscess
      • Congestive cardiac failure
  • Nodular liver surface
    • Highly suggestive of cirrhosis or malignancy (e.g. metastases, hepatocellular carcinoma).
  • Bruit over the liver
    • May indicate increased vascularity from:
      • Hepatocellular carcinoma
      • Arteriovenous malformations
  • Ascites with hepatomegaly
    • Points to portal hypertension or liver failure.
    • Confirmed by shifting dullness or fluid thrill on percussion.

Causes of Hepatomegaly

Infectious Causes

  • Viral hepatitis (A, B, C, D, E)
  • Pyogenic liver abscess
  • Parasitic infections (e.g. amoebiasis, schistosomiasis)

Inflammatory Causes

  • Autoimmune hepatitis
  • Primary biliary cholangitis (PBC)
  • Primary sclerosing cholangitis (PSC)

Congestive Causes

  • Right-sided heart failure
  • Constrictive pericarditis
  • Budd–Chiari syndrome (hepatic vein thrombosis)

Metabolic Causes

  • Non-alcoholic fatty liver disease (NAFLD)
  • Alcoholic liver disease
  • Haemochromatosis
  • Wilson’s disease
  • Glycogen storage disorders

Neoplastic Causes

  • Hepatocellular carcinoma
  • Metastatic liver disease
  • Lymphoma

Infiltrative Causes

  • Amyloidosis
  • Sarcoidosis
  • Leukaemia

Associated Signs

  • Jaundice – Suggests cholestasis or hepatocellular dysfunction.

  • Splenomegaly – Often present in portal hypertension or haematological conditions.

  • Ascites – Indicates decompensated liver disease or portal hypertension.

  • Spider naevi and palmar erythema – Features of chronic liver disease.

  • Caput medusae – Dilated periumbilical veins due to portal hypertension.

  • Asterixis – Flapping tremor seen in hepatic encephalopathy.

FAQ from our users

What is the pathophysiology of hepatomegaly?
  • The mechanism of hepatomegaly consists of vascular welling, inflammation, and and deposition of (1) non-hepatic cells or (2) increased cell contents (such as that due to iron in haemochromatosis or haemosiderosis and fat in fatty liver disease).

Common pitfalls in a clinical setting

Common pitfalls in a clinical setting
  • Remember hepatomegaly is not in itself a diagnosis, but a sign of underlying liver disease.