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
  • Amyloidosis
  • Sarcoidosis
• 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)

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