Hepatomegaly

Hepatomegaly is the condition of having an enlarged liver. It is a non-specific medical sign having many causes, which can broadly be broken down into infection, direct toxicity, hepatic tumors, or metabolic disorder. Often, hepatomegaly will present as an abdominal mass. Depending on the cause, it may sometimes present along with jaundice.

1. Hepatomegaly   Hepatomegaly  is the condition of having an 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. Often, hepatomegaly will present as an abdominal mass. Depending on the cause, it may sometimes present along with jaundice. Common causes Infective Glandular fever  (Infectious mononucleosis) This is caused by the Epstein-Barr virus (EBV). A similar condition ( pseudoglandular fever) may be caused by cytomegalovirus (CMV). Hepatitis  (Although not all hepatitis viruses cause hepatomegaly) Liver abscess  (pyogenic abscess and amoebic abscess) Malaria Amoeba  infections Hydatid cyst Leptospirosis Actinomycosis

2. …Causes Neoplastic Hepatocellular carcinoma Myeloma Leukemia Lymphoma hepatoma Cirrhotic Portal Biliary Cardio Haemochromatosis Metabolic Fatty infiltration Lysosomal acid lipase deficiency, also known as Wolman disease or cholesteryl ester storage disease

3. INVESTIGATIONS & DIFFERENTIAL DIAGNOSIS Investigations Blood tests FBC - raised WCC in infection, LFTs - albumin, evidence of hepatic dysfunction Clotting - functional hepatic impairment, CRP - increased in infection Radiological investigations- USS: define liver architecture, idea/size of liver, Contrast-enhanced CT   The differential diagnosis of hepatomegaly includes: Inflammation-- Autoimmune disease, Bile acid enzyme defects, Canalicular bile acid transport defects abscess, Idiopathic neonatal hepatitis, Kupffer cell hyperplasia – granulomatous hepatitis, sepsis, vitamin A toxicity, Medications, Toxins Infiltration-- Extramedullary hematopoiesis , erythroblastosis fetalis , Hemophagocytic syndromes Primary liver tumors – malignant and benign, Metastatic liver tumors – histiocytosis , leukemia, lymphoma, neuroblastoma , Wilm’s Storage abnormalities--Fat – cystic fibrosis, diabetes, fatty acid oxidation defect, malnutrition, mucopolysaccharidoses , parenteral nutrition, Reye syndrome diabetes, glycogen storage disease