Hepatomegaly - Revision history

Danbot: Strip excess bold

2026-03-22T09:29:52Z

Strip excess bold

Danbot: Expanded with EM-focused content: mechanism-based DDx, red flags, evaluation strategy, acute liver failure management, disposition

2026-03-20T23:51:54Z

Expanded with EM-focused content: mechanism-based DDx, red flags, evaluation strategy, acute liver failure management, disposition

Show changes

Ostermayer: Prepared the page for translation

2026-01-04T23:02:40Z

Prepared the page for translation

← Older revision		Revision as of 23:02, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

	[[File:Sobo 1906 389.png\|thumb\|Inferior view of the liver with surface showing lobes and impressions.]]		[[File:Sobo 1906 389.png\|thumb\|Inferior view of the liver with surface showing lobes and impressions.]]
	*Big liver		*Big liver
	*Caused by infection, tumours, metabolic disorders, drugs		*Caused by infection, tumours, metabolic disorders, drugs


	==Clinical Features==		==Clinical Features==

	[[File:PMC3830333 IJEM-17-283-g003.png\|thumb\|Hepatomegdaly palpable on exam in a pediatric patient.]]		[[File:PMC3830333 IJEM-17-283-g003.png\|thumb\|Hepatomegdaly palpable on exam in a pediatric patient.]]
	[[File:Hepatomegaly4.jpg\|thumb\|Hepatogedaly on exam in an adult patient.]]		[[File:Hepatomegaly4.jpg\|thumb\|Hepatogedaly on exam in an adult patient.]]
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	*+/- stigmata of hepatic dysfunction		*+/- stigmata of hepatic dysfunction
	*+/- signs of causative pathology		*+/- signs of causative pathology


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{Hepatomegaly DDX}}		{{Hepatomegaly DDX}}
			<translate>


	==Evaluation==		==Evaluation==

	[[File:Liver measurements on ultrasonography.jpg\|thumb\|Evaluating liver size on ultrasound.]]		[[File:Liver measurements on ultrasonography.jpg\|thumb\|Evaluating liver size on ultrasound.]]
	[[File:Liver size at the midclavicular line at 0 to 7 years.png\|thumb\|Pediatric liver size percentiles.]]		[[File:Liver size at the midclavicular line at 0 to 7 years.png\|thumb\|Pediatric liver size percentiles.]]
	[[File:Se000.jpg\|thumb\|\|Hepatomegaly on CT.]]		[[File:Se000.jpg\|thumb\|\|Hepatomegaly on CT.]]
	*Evaluate for etiology; depending on presentation, workup may include:		*Evaluate for etiology; depending on presentation, workup may include:
	**[[LFTs]], coags		**[[Special:MyLanguage/LFTs\|LFTs]], coags
	**CBC, BMP		**CBC, BMP
	**[[RUQ US]]		**[[Special:MyLanguage/RUQ US\|RUQ US]]
	**[[Acute hepatitis]] serologies, other infectious workup as indicated		**[[Special:MyLanguage/Acute hepatitis\|Acute hepatitis]] serologies, other infectious workup as indicated
	**[[Acetaminophen toxicity\|Acetaminophen]] levels, tox panel		**[[Special:MyLanguage/Acetaminophen toxicity\|Acetaminophen]] levels, tox panel
	**[[CHF]] workup if suspect right heart failure		**[[Special:MyLanguage/CHF\|CHF]] workup if suspect right heart failure
	**GI consult		**GI consult


	==Management==		==Management==

	*Treat underlying condition		*Treat underlying condition
	*Treat [[hepatic dysfunction]], if present		*Treat [[Special:MyLanguage/hepatic dysfunction\|hepatic dysfunction]], if present


	==Disposition==		==Disposition==

	*Dependant on presentation; consider GI follow up if discharging and hepatomegaly not previously noted		*Dependant on presentation; consider GI follow up if discharging and hepatomegaly not previously noted


	==See Also==		==See Also==


	==External Links==		==External Links==


	==References==		==References==

	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]
	[[Category:Symptoms]]		[[Category:Symptoms]]
			</translate>

Rossdonaldson1 at 22:57, 13 November 2024

2024-11-13T22:57:37Z

← Older revision		Revision as of 22:57, 13 November 2024
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	==Background==		==Background==
	[[File:Sobo 1906 389.png\|thumb\|~~TInferior~~ view of the liver with surface showing lobes and impressions.]]		[[File:Sobo 1906 389.png\|thumb\|Inferior view of the liver with surface showing lobes and impressions.]]
	*Big liver		*Big liver
	*Caused by infection, tumours, metabolic disorders, drugs		*Caused by infection, tumours, metabolic disorders, drugs

Rossdonaldson1 at 22:57, 13 November 2024

2024-11-13T22:57:15Z

← Older revision		Revision as of 22:57, 13 November 2024
Line 1:		Line 1:
	==Background==		==Background==
			[[File:Sobo 1906 389.png\|thumb\|TInferior view of the liver with surface showing lobes and impressions.]]
	*Big liver		*Big liver
	*Caused by infection, tumours, metabolic disorders, drugs		*Caused by infection, tumours, metabolic disorders, drugs

Rossdonaldson1: /* Clinical Features */

2024-11-13T22:53:35Z

Clinical Features

← Older revision		Revision as of 22:53, 13 November 2024
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	==Clinical Features==		==Clinical Features==
	[[File:PMC3830333 IJEM-17-283-g003.png\|thumb\|Hepatomegdaly palpable on exam in a pediatric patient.]]		[[File:PMC3830333 IJEM-17-283-g003.png\|thumb\|Hepatomegdaly palpable on exam in a pediatric patient.]]
			[[File:Hepatomegaly4.jpg\|thumb\|Hepatogedaly on exam in an adult patient.]]
	*Palpable (or radiologically appreciated) enlarged liver		*Palpable (or radiologically appreciated) enlarged liver
	*+/- stigmata of hepatic dysfunction		*+/- stigmata of hepatic dysfunction

Rossdonaldson1: /* Evaluation */

2024-11-13T22:50:54Z

Evaluation

← Older revision		Revision as of 22:50, 13 November 2024
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	[[File:Liver measurements on ultrasonography.jpg\|thumb\|Evaluating liver size on ultrasound.]]		[[File:Liver measurements on ultrasonography.jpg\|thumb\|Evaluating liver size on ultrasound.]]
	[[File:Liver size at the midclavicular line at 0 to 7 years.png\|thumb\|Pediatric liver size percentiles.]]		[[File:Liver size at the midclavicular line at 0 to 7 years.png\|thumb\|Pediatric liver size percentiles.]]
			[[File:Se000.jpg\|thumb\|\|Hepatomegaly on CT.]]
	*Evaluate for etiology; depending on presentation, workup may include:		*Evaluate for etiology; depending on presentation, workup may include:
	**[[LFTs]], coags		**[[LFTs]], coags

Rossdonaldson1: /* Evaluation */

2024-11-13T22:48:33Z

Evaluation

← Older revision		Revision as of 22:48, 13 November 2024
Line 14:		Line 14:
	==Evaluation==		==Evaluation==
	[[File:Liver measurements on ultrasonography.jpg\|thumb\|Evaluating liver size on ultrasound.]]		[[File:Liver measurements on ultrasonography.jpg\|thumb\|Evaluating liver size on ultrasound.]]
			[[File:Liver size at the midclavicular line at 0 to 7 years.png\|thumb\|Pediatric liver size percentiles.]]
	*Evaluate for etiology; depending on presentation, workup may include:		*Evaluate for etiology; depending on presentation, workup may include:
	**[[LFTs]], coags		**[[LFTs]], coags

Rossdonaldson1: /* Evaluation */

2024-11-13T22:46:58Z

Evaluation

← Older revision		Revision as of 22:46, 13 November 2024
Line 13:		Line 13:

	==Evaluation==		==Evaluation==
			[[File:Liver measurements on ultrasonography.jpg\|thumb\|Evaluating liver size on ultrasound.]]
	*Evaluate for etiology; depending on presentation, workup may include:		*Evaluate for etiology; depending on presentation, workup may include:
	**[[LFTs]], coags		**[[LFTs]], coags

Rossdonaldson1: /* Differential Diagnosis */

2022-09-07T20:46:44Z

Differential Diagnosis

@@ Line 10: / Line 10: @@
 ==Differential Diagnosis==
-===Hepatomegaly===
+{{Hepatomegaly DDX}}
 ==Evaluation==

← Older revision		Revision as of 09:29, 22 March 2026
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	===By Mechanism===		===By Mechanism===
	*~~'''~~Congestion~~'''~~: right heart failure, Budd-Chiari syndrome, constrictive pericarditis, IVC obstruction		*Congestion: right heart failure, Budd-Chiari syndrome, constrictive pericarditis, IVC obstruction
	*~~'''~~Inflammation~~'''~~: viral hepatitis (A, B, C, EBV, CMV), alcoholic hepatitis, autoimmune hepatitis, drug-induced hepatotoxicity, hepatic abscess (pyogenic, amebic)		*Inflammation: viral hepatitis (A, B, C, EBV, CMV), alcoholic hepatitis, autoimmune hepatitis, drug-induced hepatotoxicity, hepatic abscess (pyogenic, amebic)
	*~~'''~~Infiltration~~'''~~: fatty liver (NAFLD/NASH), amyloidosis, sarcoidosis, glycogen storage diseases		*Infiltration: fatty liver (NAFLD/NASH), amyloidosis, sarcoidosis, glycogen storage diseases
	*'''Malignancy''': hepatocellular carcinoma, metastatic disease (colon, breast, lung most common), lymphoma, leukemia		*'''Malignancy''': hepatocellular carcinoma, metastatic disease (colon, breast, lung most common), lymphoma, leukemia
	*~~'''~~Biliary~~'''~~: biliary obstruction, primary biliary cholangitis, primary sclerosing cholangitis		*Biliary: biliary obstruction, primary biliary cholangitis, primary sclerosing cholangitis

	==Evaluation==		==Evaluation==
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	===Laboratory===		===Laboratory===
	*'''[[LFTs]]''': AST, ALT (hepatocellular injury), alkaline phosphatase, GGT (cholestatic), bilirubin		*'''[[LFTs]]''': AST, ALT (hepatocellular injury), alkaline phosphatase, GGT (cholestatic), bilirubin
	*~~'''~~Coagulation studies (PT/INR)~~'''~~: marker of synthetic function — elevated in acute liver failure		*Coagulation studies (PT/INR): marker of synthetic function — elevated in acute liver failure
	*~~'''~~Albumin~~'''~~: marker of synthetic function		*Albumin: marker of synthetic function
	*[[CBC]]: thrombocytopenia (portal hypertension/hypersplenism), elevated WBC (infection, leukemia)		*[[CBC]]: thrombocytopenia (portal hypertension/hypersplenism), elevated WBC (infection, leukemia)
	*[[BMP]]: renal function (hepatorenal syndrome), glucose		*[[BMP]]: renal function (hepatorenal syndrome), glucose
	*~~'''~~[[Acetaminophen toxicity\|Acetaminophen level]]~~'''~~ and toxicology screen if acute liver injury suspected		*[[Acetaminophen toxicity\|Acetaminophen level]] and toxicology screen if acute liver injury suspected
	*[[Acute hepatitis]] serologies (HAV IgM, HBsAg, HBc IgM, HCV Ab) for acute hepatocellular pattern		*[[Acute hepatitis]] serologies (HAV IgM, HBsAg, HBc IgM, HCV Ab) for acute hepatocellular pattern
	*[[Lactate]] if concern for sepsis or shock liver		*[[Lactate]] if concern for sepsis or shock liver
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	===Imaging===		===Imaging===
	*~~'''~~[[RUQ US]]~~'''~~: first-line imaging — evaluates liver size, echotexture, masses, biliary dilation, ascites, hepatic vein patency		*[[RUQ US]]: first-line imaging — evaluates liver size, echotexture, masses, biliary dilation, ascites, hepatic vein patency
	*~~'''~~[[POCUS]]~~'''~~: rapid assessment for ascites, hepatic congestion, IVC dilation (right heart failure)		*[[POCUS]]: rapid assessment for ascites, hepatic congestion, IVC dilation (right heart failure)
	*~~'''~~CT abdomen with contrast~~'''~~: mass characterization, abscess identification, vascular evaluation		*CT abdomen with contrast: mass characterization, abscess identification, vascular evaluation
	*Doppler ultrasound if Budd-Chiari suspected (hepatic vein thrombosis)		*Doppler ultrasound if Budd-Chiari suspected (hepatic vein thrombosis)

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	==Management==		==Management==
	*Treat underlying condition		*Treat underlying condition
	*~~'''~~Acute liver failure~~'''~~: ICU admission, hepatology/transplant consultation, [[N-acetylcysteine]] if acetaminophen toxicity suspected, correct coagulopathy only if actively bleeding or procedural need		*Acute liver failure: ICU admission, hepatology/transplant consultation, [[N-acetylcysteine]] if acetaminophen toxicity suspected, correct coagulopathy only if actively bleeding or procedural need
	*~~'''~~Hepatic abscess~~'''~~: IV antibiotics, IR-guided drainage, ID consultation		*Hepatic abscess: IV antibiotics, IR-guided drainage, ID consultation
	*~~'''~~Budd-Chiari~~'''~~: anticoagulation, IR consultation for TIPS, hepatology		*Budd-Chiari: anticoagulation, IR consultation for TIPS, hepatology
	*~~'''~~Congestive hepatopathy~~'''~~: treat underlying heart failure		*Congestive hepatopathy: treat underlying heart failure
	*~~'''~~Hepatic decompensation~~'''~~: manage ascites, encephalopathy (lactulose), GI bleeding as indicated		*Hepatic decompensation: manage ascites, encephalopathy (lactulose), GI bleeding as indicated
	*Treat [[hepatic dysfunction]] if present		*Treat [[hepatic dysfunction]] if present