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{{SK}} Enlarged liver, Liver enlargement
{{SK}} Enlarged liver, Liver enlargement


==Overview==
==[[Hepatomegaly overview|Overview]]==


'''Hepatomegaly''' is the condition of having an enlarged [[liver]]. It is a nonspecific [[sign (medicine)| 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]].
==[[Hepatomegaly historical perspective|Historical Perspective]]==


==Palpable Liver without Hepatic Pathology==
==[[Hepatomegaly classification|Classification]]==


*Normal variant
==[[Hepatomegaly pathophysiology|Pathophysiology]]==
*Thin or flaccid abdominal wall
*Depressed right diaphragm (e.g., [[emphysema]])
*Subdiaphragmatic lesion (e.g., [[abscess]])
*Riedel's lobe


==True Hepatic Enlargement==
==[[Hepatomegaly causes|Causes]]==


===Inflammatory liver disease===
==[[Hepatomegaly differential diagnosis|Differentiating Hepatomegaly from other Diseases]]==
*[[Hepatitis]]
:*Infectious
:*:*Bacterial
:*:*:*[[Glandular fever]] ([[Infectious mononucleosis]]) This is caused by the [[Epstein-Barr Virus]] ([[EBV]]).
:*:*:*[[Malaria]]
:*:*:*[[Hydatid cyst]]
:*:*:*[[Leptospirosis]]
:*:*:*[[Actinomycosis]]
:*:*Viral
:*:*:*[[Hepatitis A]]
:*:*:*[[Hepatitis B]]
:*:*:*[[HIV]]
:*:*[[Schistosomiasis]]
:*:*Others
:*Alcoholic hepatitis
:*Other toxins induced hepatitis
:*Drug-induced hepatitis
:*Autoimmune hepatitis
:*Steatohepatitis
:*[[Steatosis]]
:*Others
*Abscess
:*Pyogenic
:*Amebic
*[[Cholangitis]]
:*Suppurative
:*Sclerosing
*Pericholangitis (especially related to [[ulcerative colitis]])


===[[Chronic liver disease]] and [[cirrhosis]]===
==[[Hepatomegaly epidemiology and demographics|Epidemiology and Demographics]]==
*Alcoholic
*Posthepatitic
*Postnecrotic
*Cholestatic


===Cirrhotic===
==[[Hepatomegaly risk factors|Risk Factors]]==
*Portal
*Biliary
*Cardiac
:*[[Tricuspid insufficiency]]


===Metabolic disorders===
==[[Hepatomegaly screening|Screening]]==
*[[Hemochromatosis]]


===[[Alpha-1 antitrypsin deficiency]]===
==[[Hepatomegaly natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
*[[Wilson's disease]]
*[[Cystic fibrosis]]
 
===Other causes===
*Extrahepatic biliary obstruction
:*[[Choledocholithiasis]]
:*Biliary stricture
:*[[Pancreatitis]]
:*[[Carcinoma]]
:*:*[[Bile duct]]s ([[cholangiocarcinoma]])
:*:*Head of pancreas
:*:*[[Ampulla of Vater]]
:*External compression
*Hepatic congestion
:*[[Congestive heart failure]]
:*[[Constrictive pericarditis]]
:*[[Budd-Chiari syndrome]] (hepatic outflow obstruction, [[hepatic vein obstruction]])
:*:*Thrombosis
:*:*[[Tumor]]
:*:*Web ([[inferior vena cava]])
*Veno-occlusive disease
:*Jamaican herbal tea
:*After bone-marrow transplantation
*Infiltrative disorders, storage diseases
:*Lipid accumulation
:*:*[[Fatty liver]]
:*:*:*Alcohol
:*:*:*[[Diabetes mellitus]]
:*:*:*[[Obesity]]
:*:*:*Severe protein malnutrition ([[Kwashiorkor]]: dietary protein deficiency)
:*:*:*Nonalcoholic steatohepatitis
:*:*:*Jejunoileal bypass
:*:*:*Parenteral hyperalimentation
:*:*:*[[Corticosteroid]]s, [[Cushing's syndrome]]
:*:*:*Fatty liver of pregnancy
:*:*:*Massive [[tetracycline]] therapy
:*:*:*Toxins (e.g., [[carbon tetrachloride]], dichlorodiphenyl trichloroethane)
:*:*:*[[Reye's syndrome]]
:*:*[[Lipid storage disease]] (especially [[Gaucher's disease]], [[Niemann-Pick disease]])
:*Glycogen accumulation
:*:*[[Glycogen storage disease]]
:*:*Diabetic glycogenosis
:*Granulomatous infiltration (especially [[sarcoidosis]], [[miliary tuberculosis]], disseminated fungal diseases, some drug reactions)
:*Myeloproliferative and lymphoproliferative disorders
:*:*[[Lymphoma]]
:*:*[[Myeloid metaplasia]]
:*:*[[Multiple myeloma]]
:*:*[[Leukemia]]
:*[[Amyloidosis]]
:*[[Congenital hepatic fibrosis]]
:*[[Hemochromatosis]]
:*[[Wilson's disease]]
*[[Alpha-1 antitrypsin deficiency]]
:*[[Hurler's syndrome]]
*Neoplasms
:*Primary
:*:*Malignant
:*:*:[[Hepatocellular carcinoma]]
:*:*:[[Cholangiocarcinoma]]
:*:*:[[Angiosarcoma]]
:*:*Benign
:*:*:[[Hepatic adenoma]]
:*:*:[[Hemangioma]]
:*:*:[[Focal nodular hyperplasia]]
:*:*:[[Adenoma]]
:*Metastatic
:*:*[[Pancreas]]
:*:*[[Colon]]
:*:*[[Lung]]
:*:*[[Breast]]
:*:*[[Stomach]]
:*:*[[Kidney]]
:*:*[[Esophagus]]
:*:*[[Carcinoid]]
*Cysts
:*Congenital
:*:*Solitary
:*:*Polycystic
:*Acquired (especially echinococcal)
*[[Hunter syndrome]]
*[[Zellweger's syndrome]]
*[[Carnitine palmitoyltransferase I deficiency]]
*[[Carnitine palmitoyltransferase II deficiency]]
*[[Carnitine-acylcarnitine translocase deficiency]]


==Diagnosis==
==Diagnosis==
After a thorough [[medical history]] and [[physical examination]], [[blood test]]s should be drawn. An important series of blood tests are the [[liver function test]]s, which give a good impression of the patient's broad metabolic picture.
An [[ultrasound]] of the liver can reliably detect a dilated [[biliary duct]] system, which helps distinguish [[parenchyma]]l liver disease from extrahepatic bile duct obstruction. Ultrasound can also detect the characteristic texture of a [[liver cirrhosis|cirrhotic liver]], and can guide [[fine needle aspiration]] of [[cyst]]s, [[abscess]]es and tumors.
[[Computed tomography]] (CT) can help obtain more accurate [[anatomy|anatomical]] information, and is unaffected by the [[obesity]] or the presence of bowel gases.
==Mnemonics for Hepatomegaly==


'''V I N D I C A T E'''
[[Hepatomegaly diagnostic criteria|Diagnostic Criteria]] | [[Hepatomegaly history and symptoms|History and Symptoms]] | [[Hepatomegaly physical examination|Physical Examination]] | [[Hepatomegaly laboratory findings|Laboratory Findings]] | [[Hepatomegaly electrocardiogram|EKG]] | [[Hepatomegaly CT|CT]] | [[Hepatomegaly MRI|MRI]] | [[Hepatomegaly echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Hepatomegaly other imaging findings|Other Imaging Findings]] | [[Hepatomegaly other diagnostic studies|Other Diagnostic Studies]]


[[Image:Vindicate.jpg|center|thumb|700px]]
==Treatment==


[[Hepatomegaly medical therapy|Medical Therapy]] | [[Hepatomegaly surgery|Surgery]] | [[Hepatomegaly primary prevention|Primary Prevention]] | [[Hepatomegaly secondary prevention|Secondary Prevention]] | [[Hepatomegaly cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hepatomegaly future or investigational therapies|Future or Investigational Therapies]]


==Case Studies==
[[Hepatomegaly case study one|Case #1]]


==See also==
==Related Chapters==
* [[Hepatosplenomegaly]]
* [[Hepatosplenomegaly]]


Revision as of 15:45, 27 November 2012

Hepatomegaly
ICD-10 R16..0
ICD-9 789.1

Hepatomegaly Microchapters

Home

Patient Information

Overview

Causes

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Synonyms and keywords: Enlarged liver, Liver enlargement

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hepatomegaly from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria | History and Symptoms | Physical Examination | Laboratory Findings | EKG | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Related Chapters

External links


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