Differential Diagnosis of Hepatomegaly.pptx

Basic clinical skills teaching

1. D.D of Hepatomegaly Professor : Abdel Rahman A Mokhtar

2. Most if not all of the normal liver is concealed by the right rib cage and is beyond the feel of the examiner's hand The normal liver is smooth, with no irregularities

3. When the liver can be felt, it is usually due to: increased diaphragmatic descent ; (2) presence of a palpable caudate or Riedel's lobe ; (3) presence of emphysema with an associated depressed diaphragm; (4) thin body habitus with narrow thoracic cage ; (5) fatty infiltration (enlarged with rounded edge) ; (6) active hepatitis (enlarged and tender) ; (7) cirrhosis (enlarged with nodular irregularity) (8) hepatic neoplasm (enlarged with rock-hard or nodular consistency) . (9) Congested whether with blood or bile.

4. Liver span It is vertical distance between uppermost and lower most points of liver dullness-in Rt mid clavicular line - Normal-12-15 cm

5. Determining the liver size is considered to be the “simplest” and “cheapest” liver function test and, chronologically speaking, it is also the “first”

6. The liver is enlarged Size, edge, surface, consistency, tender, bruit or pulsatile  

7. Massive Liver HCC/Secondaries/ myeloprolif RVF Alcoholic liver disease   Mild-moderate Liver As above plus Infection Viruses – EBV, CMV, hepatitis A & B Bacteria – Weil’s disease (leptospirosis), abscesses , TB, brucellosis, syphilitic gumma

8. 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

9. Tender Liver Liver abscess/infective (viral/bacterial/parasitic) HCC/Secondaries Right Heart Failure/Budd chiari   Pulsatile Liver TR HCC AVM   Hard/Irregular Liver Mitotic (primary/Secondary) Macronodular cirrhosis (post hepatitis B/C, Wilson’s ) Amyloidosis / Hydatid cyst/ granulomatous disease/ gummatous disease/APCKD