HEPATOMEGALY
Dr Lokesh AJ
Presenter:Supriya MV
126
18M6130
Segments of liver
HEPATOMEGALY:
Enlargement of liver is called
hepatomegaly.
Presence of a palpable liver does not always
represent hepatomegaly
May be mistaken for
• displacement of the liver by lung
pathologies.
• abdominal tumor
• spinal deformity
• The normal range for liver span at
• 1 week of age - 4.5 to 5 cm.
• At 5 yrs of age- 6 to 8 cms
• 12 years,
• boys - 7 to 9 cm
• girls - 6 to 8cm
• Functions of liver:
• Synthesis-albumin
• Gluconeogenesis
• Coagulation factors
• Metabolism-sugar
• Proteins, Fats
• Detoxification
• Storage-vitamin A(ito cells),B12 ,iron
copper
• Protective-RES (kuppfer cells)
Grades of hepatomegaly:
• mild- <4cms below Rt subCostal Margin.
• moderate- 5-7 cms
• mass >7cms
Large liver (hepatomegaly)
• Liver metastases
• Multiple or large hepatic cysts
• Cirrhosis (early): non-alcoholic fatty liver
disease, alcohol,
• haemochromatosis
• Hepatic vein outflow obstruction
• Infiltration; amyloid
• Small liver
• Cirrhosis (late)
Liver E/o:
[Link]/margin:
• sharp/regular - cirrhosis
• round with soft consistency- kwashiorkor.
2. Surface-
• smooth-congestion
• irregular- granular(portal cirrhosis)
• nodular(post necrotic cirrhosis)
• uneven- multiple hydatid cysts
• multiple liver abscess
Consistency
Soft- CF,acute hepatitis,anaemia
Firm- Chronic active hepatitis, cirrhosis
wilsons, galactosemia neonatal hepatitis.
Hard- CML,hepatoblastoma
Cystic- hemangioma
Tenderness:
is seen in acute enlargement of liver due to
stretching of Glisson's capsule.
in c/o cirrhosis or malignancy it will be
tender.
when capsule is infiltrated localised
tenderness is seen in c/o abscess/infected
cyst.
Causes of tender
hepatomegaly:
[Link]- viral hepatitis,
• infectious mononucleosis
• leptospirosis
• amoebiasis
[Link]- CCF
• Budd-chiari synd
• misc-hepatoma,
hydatid cyst
Pulsations:
S/1 A-V malformations
triscupid regurgitation(systolic)
tricuspid stenosis(diastolic)
aorticregurgitation(Rosenbach
sign)
Palpable findings of liver:
[Link],smooth,tender,enlarged -CCF
[Link] & nodular- cirrhosis of
liver,obstructive jaundice
[Link]-secondaries,hepatoma
[Link] lobe -tongue like projection of rt
lobe ofliver
General e/o findings in c/o
hepatomegaly
[Link] - flag sign(kwashiorkor)
[Link] -microcephaly([Link])
hydrocephalus(toxoplasmosis)
craniotabes(hypervitaminosisA)
[Link] -cataract (wilsons,galactosemia)
KF ring(wilsons)
Hazy cornea(hurler)
PALLOR -
● Infections - Malaria, kala-azar, bacteremia
●Haemolytic anaemia - Hereditary
spherocytosis,sickle cell anemia, thalassaemia,
autoimmune,hemolytic anaemia.
●Nutritional - Iron deficiency anaemia.
Leukaemia and lymphomas
• Fever - Infection - Malaria, kala-azar, enteric
fever,malignancy.
• Jaundice, anorexia, vomiting,haematemesis,malena
- liver disease especially cirrhosis with portal
hypertension
• Recurrent Jaundice - Liver disease, Hemolytic
anemia
• Dyspnoea / difficulty in feeding - cardiac causes
• Petechia, purpura, ecchymosis,
lymphadenopathy- Leukaemia
• Koilonychia, platynychia - Iron deficiency
• Mental retardation Mucopolysaccharoidoses
• Cytotoxic and cytostatic drugs • l-Asparaginase
• Azacitidine
• Azaserine
• Bleomycin
• Methotrexate • Puromycin
• Tetracycline • Doxycycline
• Metals
• Antimony
• Barium salts
• Chromates
• Phosphorus
• Rare earths of low atomic number • Thallium compounds
• Uranium compounds
• Other drugs and toxins
• Amiodarone
• 4,4′-Diethylaminoethoxyhexesterol • Ethionine
• Ethyl bromide
• Estrogens
• Glucocorticoids
• Highly active antiretroviral therapy • Hydralazine
• Hypoglycin
• Orotate
• Perhexiline maleate
• Safrole
• Tamoxifen
• Neck- engorged veins,raised
JVP(constrictivepericarditis)
• Chest-spider
naevi,gynecomastia(liver failure)
• Skin-scratch marks(cholestasis)
• CNS-tremors &
dystonia(wilsons),Mental
retardation(glycogen storage
Diseases)
• Skeletal-
rickets,cystinosis,tyrosinemia.
• Delayed development -
Carbohydrate / Lipid storage
disorders
Abdomen E/o:
- Firm consistency liver with sharp
edge - Cirrhosis,
constrictive pericarditis
- Just palpable soft spleen - Enteric
fever, infective
endocarditis,etc.
Ascites - Suggests cirrhosis with
portal hypertension,
malignancy, TB
REFERENCES
• HARRISONS MANUAL OF
MEDICINE
• DAVIDSON’S PRINICIPLES
AND PRACTICE OF MEDICINE
THANK YOU
