Hepatomegaly causes🎥
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
- Suggests inflammation or congestion, as seen in:
- 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
- May indicate increased vascularity from:
- 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
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Jaundice – Suggests cholestasis or hepatocellular dysfunction.
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Splenomegaly – Often present in portal hypertension or haematological conditions.
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Ascites – Indicates decompensated liver disease or portal hypertension.
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Spider naevi and palmar erythema – Features of chronic liver disease.
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Caput medusae – Dilated periumbilical veins due to portal hypertension.
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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.