Hepatomegaly

Hepatomegaly


Introduction

• Is liver englargement
• The lower edge of the liver normally comes just to the lower edge of the ribs (costal margin) on the right side. 

Clinical Presentation

• Pain 
• Jaundice
• Abdominal mass
• Tenderness
• 
  

Causes 

1. Liver displacement (Palpable liver, no Hepatomegaly)
1. Obstructive lung disease (Asthma, COPD)
2. Adjacent mass (Cholecystitis, abscess)
3. Thin patient
2. Infectious
1. AIDS
2. Hepatic Abscess (e.g. Amebiasis)
3. Relapsing Fever
4. Echinococcal cysts
5. Schistosomiasis
6. Kala Azar
3. Hepatitis
1. Alcoholic Hepatitis
2. Autoimmune Hepatitis
3. Viral Hepatitis
4. Congestive Hepatomegaly (often precedes edema)
1. Congestive Heart Failure (systemic venous congestion)
2. Constrictive Pericarditis
3. Tricuspid stenosis
5. Miscellaneous
1. Wilson's Disease
2. Fatty Liver
3. Cirrhosis
4. Hemochromatosis
5. Primary Sclerosing Cholangitis
6. Cholestasis
7. Mixed cryoglobulinemia
8. Congenital hepatic fibrosis
9. Polycystic liver disease
10. Hurler's Syndrome
11. Gaucher's Disease
12. Sarcoidosis
13. Amyloidosis
6. Malignancy
1. Intraabdominal malignancy
2. Pancreatic Cancer
3. Hepatocellular Carcinoma
7. Toxic/Drug-related
1. Alcoholic liver disease: acute alcoholic hepatitis and alcoholic fatty liver
2. Drug induced hepatitis, e.g. statins,macrolides, amiodarone, paracetamol (indicates significant damage).

Causes (important n why?)

• Alcohol abuse. Abusing alcohol may cause an enlarged liver.
• Nonalcoholic fatty liver disease. This includes a range of conditions — such as fat accumulation in the liver followed by inflammation of the liver and the formation of fibrous tissue in the liver — which can affect people who drink little or no alcohol. 
• Hepatitis. Hepatitis A, hepatitis B and hepatitis C are all contagious viral infections that affect your liver.
• Heart failure. Also called congestive heart failure, this condition means your heart can't pump enough blood to meet your body's needs.
• Liver cancer. Cancer of the liver is often metastatic cancer, which occurs when tumors from other parts of the body spread (metastasize) to the liver.
• Infections such as mononucleosis. Mononucleosis (mono) is an infection with the Epstein-Barr virus.
• Excessive iron in the body (hemochromatosis). This condition causes your body to absorb too much iron from the food you eat. The excess is stored in your organs, especially your liver, heart and pancreas. Sometimes the stored iron damages these organs, leading to life-threatening conditions such as cancer, heart problems and liver disease.
• Blood disorders such as leukemia. Leukemia is cancer of the white blood cells

Risk Factors

1. Alcohol abuse
2. Obese 
3. Diabetes
4. Abnormal cholesterol levels
5. Heart failure. Various factors increase the risk of heart failure, including high blood pressure, coronary artery disease, diabetes, kidney failure and congenital heart defects.
6. Smoking
7. Hepatitis A,B,C

Question to Patient

1. Did you notice a fullness or lump in the abdomen?
2. What other symptoms do you have?
3. Is there any abdominal pain?
4. Is there any yellowing of the skin (jaundice)?
5. Is there any vomiting?
6. Is there any unusual-colored or pale-colored stools?
7. Have you had any fever?
8. What medications are you taking?
9. How much alcohol do you drink?

Ultrasound

• Measurement at mid-clavicular line:   >15.5cm