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