Basic clinical skills teaching

1. D.D of Hepatomegaly
Professor : Abdel Rahman A Mokhtar

2. Most if not all of the normal liver is concealed by the
right rib cage and is beyond the feel of the examiner's
hand
The normal liver is smooth, with no irregularities

7. When the liver can be felt, it is usually due
to:
(1) increased diaphragmatic descent ;
(2) presence of a palpable caudate or Riedel's lobe ;
(3) presence of emphysema with an associated depressed
diaphragm;
(4) thin body habitus with narrow thoracic cage ;
(5) fatty infiltration (enlarged with rounded edge) ;
(6) active hepatitis (enlarged and tender) ;
(7) cirrhosis (enlarged with nodular irregularity)
(8) hepatic neoplasm (enlarged with rock-hard or nodular
consistency) .
(9) Congested whether with blood or bile.

8. Liver span
It is vertical distance
between uppermost
and lower most
points of liver
dullness-in Rt mid
clavicular line-
Normal-12-15 cm

9. Determining the liver size is considered to be the
“simplest” and “cheapest” liver function test and,
chronologically speaking, it is also the “first”

10. The liver is enlarged
Size, edge, surface,
consistency, tender,
bruit or pulsatile

11. Massive Liver
HCC/Secondaries/myeloprolif
RVF
Alcoholic liver disease
Mild-moderate Liver
As above plus
Infection
Viruses – EBV, CMV, hepatitis A & B
Bacteria – Weil’s disease (leptospirosis), abscesses,
TB, brucellosis, syphilitic gumma

12. Protozoal – hydatid cysts, amoebic abscess
Malignancy – lymphoproliferative,
myeloproliferative, primary, secondary, adenoma
from OCP
Infiltrative – sarcoid (erythema nodosum, lupus
pernio), amyloid, fatty liver
Endocrine – acromegaly, hyperthyroid
Collagen Vascular disease
Chronic hemolytic anaemia( AI, thalassemia, HS)
Reidel’s lobe
Possibility of minimal CLD signs with just
hepatomegaly

13. Tender Liver
Liver abscess/infective (viral/bacterial/parasitic)
HCC/Secondaries
Right Heart Failure/Budd chiari
Pulsatile Liver
TR
HCC
AVM
Hard/Irregular Liver
Mitotic (primary/Secondary)
Macronodular cirrhosis (post hepatitis B/C, Wilson’s )
Amyloidosis/Hydatid cyst/granulomatous disease/gummatous
disease/APCKD