Hepatomegaly is an enlarged liver. It is an abnormal clinical finding with a large number of causes




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




May be none

Abdominal pain and distension


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



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





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



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