Approach to Hepatomegaly.docx - Approach to Hepatomegaly...

Approach to Hepatomegaly
Congenital
 Riedel’s lobe
 Polycystic liver disease
Infective
 Viral
o EBV, CMV
o Hep A-E
 Bacterial
o Liver abscess
o Leptospirosis (Weil’s disease)
o Actinomycosis ( caused by actinomyces spp – painful abscess formed in
mouth, lungs, GI tract )
o Meliodosis
o Brucellosis
o TB
o Syphillitic gumma
 Protozoal
o Malaria
o Amoebic hepatitis and abscess
o Hydatid
Vascular
 R heart failure
 Venous obstruction – e.g. Budd-Chiari syndrome
 Tricuspid regurgitation
 AV Malformation
Neoplastic
 Primary tumour
 Secondary metastases
 Lymphoproliferative
 Myeloproliferative
 Adenoma from OCP
Infiltrative
 Sarcoid (look for erythema nodosum and lupus pernio)
 Amyloid
 Fatty infiltration
o Alcoholic
o Non-alcoholic steato hepatitis
Autoimmune
 Autoimmune hepatitis
 Collagen vascular disease
 Primary Biliary Cirrhosis
 Primary Sclerosing Cholangitis
Metabolic diseases
 Haemochromatosis
 Wilson’s disease
 Amyloid
 Glycogen storage diseases
Endocrine
 Acromegaly
Paul Tern Emmanuel College 2012-2018

 Hyperthyroid
Paul Tern Emmanuel College 2012-2018

Massive
 HCC/Secondaries/myeloproliferative
 RVF
 Alcoholic liver disease
Mild-moderate
 As above plus
 Infection
 Viruses – EBV, CMV, hepatitis A & B
 Bacteria – Weil’s disease (leptospirosis), meliodosis, abscesses, TB,
brucellosis, syphilitic gumma
 Protozoal – hydatid cysts, amoebic abscess
 Malignancy – lymphoproliferative, myeloproliferative, primary, secondary,
adenoma from OCP
 Infiltrative – sarcoid (erythema nodosum, lupus pernio), amyloid, fatty liver
 Endocrine – acromegaly, hyperthyroid
 Collagen Vascular disease
 Chronic hemolytic anaemia( AI, thalassemia, HS)
 Reidel’s lobe
 Possibility of minimal CLD signs with just hepatomegaly
 PBC
 Hemochromatosis
Tender
 Liver abscess/infective (viral/bacterial/parasitic)
 HCC/Secondaries
 Right Heart Failure/Budd chiari
Pulsatile
 TR
 HCC
 AVM
Hard/Irregular
 Mitotic (primary/Secondary)
 Macronodular cirrhosis ie >3mm (post hepatitis B, C, Wilson’s and AAT)
(Micronodular cirrhosis implies alcoholic liver cirrhosis)
 Amyloidosis/Hydatid cyst/granulomatous disease/gummatous disease/APCKD
Paul Tern Emmanuel College 2012-2018

Hepatomegaly