Hepatomegaly enlarged liver causes, symptoms, and diagnosis. Differential diagnosis hepatomegaly doctor answers on. Aug 15, 2019 hepatomegaly is when you have an abnormally large liver. To be updated when it is complete please like us on facebook, follow us on twitter or subscribe on youtube using the follow us buttons. Hepatomegaly hepatomegaly is the condition of having an enlarged liver. Since these organs are so situated that on enlarging they soon become palpable, definite enlargements become helpful in differential diagnosis. Early diagnosis and treatment of children who have liver disease is important because specific treatments are available for some diseases that can prevent disease progression or hepatic failure.
Jun 18, 2007 a diagnosis of hepatic amyloidosis was made. Differential diagnosis of fever with hepatomegaly download here free healthcaremagic app to ask a doctor all the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. Differential diagnosis in pediatrics pp 177183 cite as. Sep 17, 2019 there are other ways your doctor can look for the cause of your enlarged liver. Hepatomegaly refers to an increase in size or enlargement of the liver. Hepatomegaly is enlargement of the liver beyond its normal size. Approach to hepatomegaly, splenomegaly and hepatosplenomegaly free download as powerpoint presentation. The lower edge of the liver normally comes just to the lower edge of the ribs costal margin on the right side and it cannot be palpated. It can be caused by excessive insulin doses or recurrent ketoacidosis episodes. Inflammation autoimmune disease bile acid enzyme defects canalicular bile acid transport defects infections virus, abscess idiopathic neonatal hepatitis. He is also the innovation lead for the australian centre for health innovation at alfred health, a clinical adjunct associate professor at monash university, and the chair of the australian and new zealand intensive care society anzics education committee he is a cofounder of the australia and new zealand. Hepatic glycogenosis is characterized by excessive glycogen accumulation in hepatocytes and represents a complication of poor controlled type 1 diabetes. The differential diagnosis of hepatomegaly and splenomegaly.
Certain conditions such as infection, parasites, tumors, anemias, toxic states, storage diseases, heart failure, congenital heart disease, and metabolic disturbances may all cause an enlarged liver. Massachusetts general hospital, boston, massachusetts 02114 hepatomegaly an approach to differential diagnosis w. Diagnosis of hepatomegaly and splenomegaly transmission experiments with human volunteers have been invaluable in recognizing these two forms of hepatitis and establishing the epidemiology of the two diseases but are not practicable for the study. See chapter, peritoneal abdominal paracentesis for more details. Hepatomegaly can represent intrinsic liver disease or may be the presenting physical finding of a generalized disorder. In fact, special attention was called to this phenomenon in children with severe uncontrolled diabetes mellitus as long ago as 1938. Let us share with you people a famous series diagnosis book churchills pocketbook of differential diagnosis pdf 4th edition pdf free along with download link. In cirrhotics with severe alco holic hepatitis, hepatomegaly or spleno megaly may be the dominant feature. Telega, in nelson pediatric symptombased diagnosis, 2018. Anicteric hepatitis cirrhosis of the liver other viral infections infectious mononucleosis cholangitis sepsis syphilis tuberculosis infections caused by worms. Churchills pocketbook of differential diagnosis third. Of note, the liver may be displaced downward by the diaphragm or thoracic contents leading to false impression of hepatomegaly. It is important to realize that the liver is easily palpated in most children at 12 cm below the right costal margin.
Hepatomegaly is enlargement of the liver beyond its normal size and occurs mainly as a consequence of pathologic conditions. How you get treated for your enlarged liver depends on. Hepatomegaly may be found during physical examination or on imaging studies. When the pediatrician encounters a patient with an enlarged liver, he must carefully evaluate that patient in order to determine the necessary approach to establishing a diagnosis. What is a presumptive and differential diagnosis for influenza. Differentials of gross hepatomegaly include leukaemia and other reticulo. Churchills pocketbook of differential diagnosis pdf 4th. Gold standard in the diagnosis is the histological evaluation by means of liver biopsy, which cannot be carried. Hepatomegaly pediatrics clerkship the university of chicago. However, massive enlargementssplenomegaly and especially hepatomegalyare caused by relatively few diseases, and the knowledge of this fact will greatly aid in arriving at a correct differential diagnosis by precluding from consideration a large group of diseases that could scarcely be the basis of such enlargement. The best way to assess size is by percussion a normalsized liver can appear. It is smooth, uniform, nontender and descends to meet the palpating fingers on inspiration. Medline abstracts for references 24 of hepatomegaly. Differential diagnosis of fever with hepatomegaly doctor.
Hepatomegaly can represent intrinsic liver disease or may be the present ing physical finding of a generalized disorder. Hepatomegaly, also known as an enlarged liver, isnt considered a disease, but its usually a sign something is wrong with the liver. Before liver biopsy, clinicians considered amyloidosis in the differential diagnosis for only 14 patients 26%. Hepatic vein thrombosis, a blockage of veins in your liver. A normal liver should feel soft and is easily moveable upon inspiration. Hepatomegaly in neonates and children american academy of. Rather than a disease in itself, hepatomegaly is a symptom or complication of other liver conditions, some of them lifethreatening. Identify the possible causes of simultaneous hepatomegaly and splenomegaly. Chris is an intensivist and ecmo specialist at the alfred icu in melbourne. Click here to download free teaching notes on hepatomegaly. Diagnosis and treatment of alcoholic liver disease and its. Presentation hepatomegaly causes of hepatomegaly hepatitis o 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 o metastases. Presentation hepatomegaly causes of hepatomegaly hepatitis o 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 o metastases o hepatocellular carcinoma hcc. Churchills pocketbook of differential diagnosis is the best differential diagnosis book for medical students who are working or are looking forward to more of the clinical approach to the field.
Hepatosplenomegaly can occur as the result of acute viral hepatitis, infectious mononucleosis, and histoplasmosis or it can be the sign of a serious and. Differential diagnosis of hepatosplenomegaly homeopathy. The liver edge is normally palpable in children and thin adults and some patients may have a palpable right lobe of the liver. Hepatomegaly, splenomegaly, petechiae, purpura, jaundice, microcephaly, encephalopathy, ocular abnormalities, anemia. However, diagnosis and the decision to initiate treatment are mainly clinical based. Associate professor of pediatrics and chief, joint program in gastroenterology and nutrition, department of pediatrics, ucsd school of medicine, san diego, ca. Pdf a 21yearold woman with hepatomegaly researchgate. Use the serum albumin to ascitic albumin difference serum albumin minus ascites albumin to help differentiate the cause of ascites. The differential diagnosis of hepatomegaly includes. There are other ways your doctor can look for the cause of your enlarged liver.
It is a non specific medical sign having many causes, which can broadly be broken down into infection, direct toxicity, hepatic tumours, or metabolic disorder. Laboratory tests in the differential diagnosis of liver. Venoocclusive disease, which is a blockage in the small veins in your liver. The individual may experience many symptoms, including weight loss, poor appetite and lethargy. Click here to download free teaching notes on hepatosplenomegaly. Common and important causes of hepatomegaly for doctors and medical students this page is currently being written and will be available soon. Hepatomegaly pediatrics clerkship the university of. For differential diagnosis medical students must have churchills pocketbook of differential diagnosis on their study table. Hepatomegaly can result from a vast range of pathology including, but not limited to, the following. Hepatomegaly or an enlarged liver can be a symptom or a complication of many different diseases which arise within or outside the liver and the most common is alcohol liver disease. May 05, 2016 hepatomegaly is enlargement of the liver. Churchills pocketbook of differential diagnosis third edition pdf download churchills pocketbook of differential diagnosis third edition is good book to read and comes with all the essential information that we need for our medical school to solve the cases. Ultrasound of the liver efsumb european course book pdf.
Hepatomegaly is not an uncommon occurrence in infancy and childhood. An enlarged liver is often found in patients with diabetes mellitus, particularly those with severe or poorly controlled diabetes, mainly as a. The differential diagnosis of edema includes a broad spectrum of illnesses, such as cardiac, lung, renal, endocrine, and hepatic diseases. May 4, 2020 alphabetical repertory of nail disorders based on herings guiding symptoms of our materia medica homeopathic repertory may 4, 2020 calcarea fluorica pathologial approach in remedy selection homeopathy general may 4, 2020 contact dermatitis cases managed with homoeopathy case presentations. An enlarged liver is often found in patients with diabetes mellitus, particularly those with severe or poorly controlled diabetes, mainly as a result.
A large lesion, measuring 12 cm in diameter, is seen in the right lobe of the liver. Hepatomegaly is when you have an abnormally large liver. Churchills pocketbook of differential diagnosis 4th. Initial laboratory tests showed severe anaemia with an increased reticulocyte count corrected for the degree of anaemia and red cell distribution width, predominantly direct hyperbilirubinaemia, modest elevations in transaminases and alkaline phosphatase, hypoalbuminaemia, and mild renal. He may use an ercp, a scope that checks for problems in the ducts tubes that carry bile. Diarrhoea differential diagnosis dizziness emergencies examination fatigue. There is peripheral vascular enhancement of the mass, which has a primarily necrotic center. Enlarged liver definition hepatomegaly, otherwise known as an enlarged liver, is a clinical finding in which the liver is found to be larger than is normal, either by the physical exam from a physician or by imaging such as ct scan or ultrasound. The continuing development of sub specialties in pediatrics may be justifiably considered to be progress. Imaging is more accurate in determining liver size. Subnormal concentrations of seromucoid strongly suggest hepatocellular disease, while in this series most patients with hepatitis or cirrhosis had normal or raised concentrations. Hepatomegaly and mild elevations of aminotransferase levels and bilirubin are common in hypothyroidism and are occasionally observed in hyperthyroidism. It is a nonspecific medical sign having many causes, which can broadly be broken down into infection, hepatic tumours, or metabolic disorder.
After completing this article, readers should be able to. Churchills pocketbook of differential diagnosis 4th edition. Often, hepatomegaly will present as an abdominal mass. What is the differential diagnosis of hepatomegaly. The diagnosis is usually made after an incidental discovery of unexplained elevation of liver enzyme levels or when steatosis is noted on imaging e. As the name implies, its a condition in which the liver is enlarged or swollen. The differential diagnosis for hepatomegaly includes inflammation infections, toxins, autoimmune diseases, inappropriate storage of different materials like lipids or glycogen, primary or metastatic liver malignancies and hepatic vascular congestion venoocclusive disease, heart failure, hepatic vein thrombosis. For this reason, hepatomegaly is something to take seriously, as it points to an underlying problem that could be quite. May 4, 2020 alphabetical repertory of nail disorders based on herings guiding symptoms of our materia medica homeopathic repertory. Oct, 2008 hepatomegaly is caused by inflammation, infiltration, obstruction, storage abnormalities and vascular congestion. Unusual cause of fever, jaundice, and hepatomegaly in a. The border of the liver can be found by palpation, percussion, and auscultation.
This patient had a subacute febrile illness with constitutional symptoms and progressive jaundice. Hepatomegaly is the condition of having an enlarged liver. The average liver span is 45 cm in newborns and 68 cm in children at 12 years of age. Making a correct diagnosis is one of the key aspects of every medical students and junior. Hepatomegaly causes, symptoms, diagnosis, treatment. Hepatomegaly is a technical name for enlarged liver. Mauriacs syndrome is a rare disease, which includes short stature, growth maturation delay, dyslipidemia, moon facies, protuberant abdomen, hepatomegaly with. Hepatomegaly differential diagnosis things you didnt know. Hepatitis a vaccine is also recommended for most cases of postexpo sure prophylaxis, although immunoglobulin is an acceptable alterna tive in some situations. The liver frequently is increased in size in diabetics. To be updated when it is complete please like us on facebook, follow us on. Apr 18, 2020 let us share with you people a famous series diagnosis book churchills pocketbook of differential diagnosis pdf 4th edition pdf free along with download link. Hepatomegaly in neonates and children american academy. In addition, we present the thought process involved in the differential diagnosis and workup done for our patient leading to the final diagnosis.