Hepatomegaly is an enlarged liver which has many potential causes that can be broadly categorized as infection, toxicity, tumors, or metabolic disorders. Common infectious causes include mononucleosis, hepatitis, malaria, and amoebic infections. Neoplastic causes include liver cancer, myeloma, leukemia, and lymphoma. Cirrhosis, portal hypertension, and metabolic disorders like fatty infiltration can also result in hepatomegaly. Investigations include blood tests of liver function and imaging scans, while differential diagnosis considers inflammation, infiltration, storage abnormalities, and primary or metastatic liver tumors.

1. Hepatomegaly
Hepatomegaly is the condition of having an enlarged liver. It is a non-
specific medical sign having many causes, which can broadly be broken
down into infection, direct toxicity, hepatic tumours, or metabolic
disorder. Often, hepatomegaly will present as an abdominal mass.
Depending on the cause, it may sometimes present along with jaundice.
Common causes
Infective
Glandular fever (Infectious mononucleosis) This is caused by the
Epstein-Barr virus (EBV). A similar condition (pseudoglandular fever)
may be caused by cytomegalovirus (CMV).
Hepatitis (Although not all hepatitis viruses cause hepatomegaly)
Liver abscess (pyogenic abscess and amoebic abscess)
Malaria
Amoeba infections
Hydatid cyst
Leptospirosis
Actinomycosis

2. …Causes
Neoplastic
 Hepatocellular carcinoma
 Myeloma
 Leukemia
 Lymphoma
 hepatoma
Cirrhotic
 Portal
 Biliary
 Cardio
 Haemochromatosis
Metabolic
 Fatty infiltration
 Lysosomal acid lipase deficiency, also known as Wolman
disease or cholesteryl ester storage disease

3. INVESTIGATIONS & DIFFERENTIAL DIAGNOSIS
Investigations
Blood tests FBC - raised WCC in infection, LFTs - albumin, evidence of
hepatic dysfunction
Clotting - functional hepatic impairment, CRP - increased in infection
Radiological investigations- USS: define liver architecture, idea/size of
liver, Contrast-enhanced CT
The differential diagnosis of hepatomegaly includes:
Inflammation-- Autoimmune disease, Bile acid enzyme defects,
Canalicular bile acid transport defects
abscess, Idiopathic neonatal hepatitis, Kupffer cell hyperplasia –
granulomatous hepatitis, sepsis, vitamin A toxicity, Medications, Toxins
Infiltration-- Extramedullary hematopoiesis , erythroblastosis fetalis,
Hemophagocytic syndromes
Primary liver tumors – malignant and benign, Metastatic liver tumors –
histiocytosis, leukemia, lymphoma, neuroblastoma, Wilm’s
Storage abnormalities--Fat – cystic fibrosis, diabetes, fatty acid oxidation
defect, malnutrition, mucopolysaccharidoses, parenteral nutrition, Reye
syndrome diabetes, glycogen storage disease