Definition:
Hepatomegaly is an enlarged liver. It is an abnormal clinical finding with a large number of causes
Signs:
Mass in RUQ which moves inferiorly with respiration, no notch palpable, unable to get above, dull to percussion and is not ballotable
Signs depend on the underlying cause:
If there is an underlying malignancy the patient may be cachectic, there may be associated lymphadenopathy, abdominal scars may be present representing previous tumour resection, tar staining or finger clubbing may be present
Raised JVP and peripheral oedema, pulsatile hepatomegaly may be present in CCF
Signs of chronic liver disease may be present such as palmar erythema, spider naevi, gynaecomastia, testicular atrophy
There may be abdominal distension suggesting organomegaly or ascites
Lymphadenopathy may be present in infection or malignancy
Tattoos, piercings and injection marks may suggest viral hepatitis
Symptoms:
May be none
Abdominal pain and distension
Jaundice
Drowsiness suggesting encephalopathy
The patient may present with symptoms of underlying malignancy such as weight loss, lethargy or symptoms specific to a primary tumour e.g. cough, haemoptysis, change in bowel habit
Causes:
Most commonly:
Malignancy either hepatocellular carcinoma or more commonly secondary metastatic deposits in the liver
Right heart failure/CCF
Cirrhosis of any cause (but most likely to be alcohol, viral hepatitis or non-alcoholic fatty liver disease (NAFLD)
Infections such as viral hepatitis, hydatid cyst, amoebic liver abscess, pyogenic liver abscess
Investigations:
Full liver screen should be sent (see CLD document)
In addition:
Abdominal USS
CT T/A/P or MRCP or Echo according to most likely aetiology
Ascitic tap if ascites present
Management:
Depends on the underlying cause
Malignancy will need staging imaging and discussing with oncology team and at appropriate oncology MDT
RHF should be treated with diuretic therapy and medications tailored to improving RHF
If an underlying cause of chronic liver disease has been identified, specific treatment for this should be initiated
Top tip: When examining patients with hepatomegaly try to assess the size of the liver. When presenting to the examiners state the size of hepatomegaly as centimetres below costal margin rather than as finger breadths as everybody has different sized fingers and this is therefore not an accurate description.
Palpating spleens and livers can be extremely uncomfortable for patients. Remember to keep an eye on the patient’s face for discomfort and try to be gentler or even stop altogether if the patient is in too much distress. Candidates that cause pain and do not pick up on this will almost certainly lose valuable marks.
Written by Jo Corrado
Resources used to write this document are listed in the references section of this webpage