Hepatomegaly
Background
- Big liver
- Caused by infection, tumours, metabolic disorders, drugs
Clinical Features
- Palpable (or radiologically appreciated) enlarged liver
- +/- stigmata of hepatic dysfunction
- +/- signs of causative pathology
Differential Diagnosis
Infectious
- Hepatitis
- Malaria
- HIV (present in 50% of AIDS patients)[1]
- EBV
- Babesiosis, leptospirosis
- Typhoid
- Hepatic abscess, amebiasis
Neoplastic
Metabolic
Biliary
- Biliary cirrhosis
Drugs
- Alcoholic cirrhosis
- Alcoholic hepatitis
- Hepatotoxic drugs
Miscellaneous
- Veno-occlusive disease
- CHF (right heart failure)
Evaluation
- Evaluate for etiology; depending on presentation, workup may include:
- LFTs, coags
- CBC, BMP
- RUQ US
- Acute hepatitis serologies, other infectious workup as indicated
- Acetaminophen levels, tox panel
- CHF workup if suspect right heart failure
- GI consult
Management
- Treat underlying condition
- Treat hepatic dysfunction, if present
Disposition
- Dependant on presentation; consider GI follow up if discharging and hepatomegaly not previously noted
References
- Tintanelli's
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