24. Hepatomegaly: causes, diagnosis and differential diagnosis.

Page created on February 15, 2022. Last updated on March 3, 2022 at 13:22


The liver margin may be palpated physiologically 1 – 2 cm below the right costal margin. It should be soft and smooth; firm or nodular liver suggests liver disease. It should also be nontender; if tender, liver inflammation or congestion may be present.

Differential diagnosis of hepatomegaly

Etiology Typical features
Leukaemia/lymphoma Generalised, malaise, infections, skin bleeding, lymphadenopathy, B symptoms
Heart failure Tachycardia, SOB, poor weight gain, tender liver on palpation.
Hepatoblastoma Abdominal distension, elevated AFP
Neuroblastoma Irregular mass, crosses midline. Anaemia, periorbital ecchymoses, bone pain, ill child
Viral hepatitis Tender liver on palpation, jaundice
Mononucleosis Bilateral cervical lymphadenopathy, exudate on tonsils, splenomegaly
Biliary atresia Neonate, direct hyperbilirubinaemia, pale stool, greenish jaundice
Inborn error of metabolism Hypoglycaemia, muscle pain, exercise intolerance, cardiomyopathy
Sickle cell disease/thalassaemia African/Mediterranean ethnicity, jaundice, anaemia
Chronic liver disease (cirrhosis) Jaundice, altered mental status, ascites, oedema
Congenital TORCH Congenital malformations
Wilson disease Kayser-Fleischer rings, neuropsychiatric symptoms