Hepatomegaly Flashcards
In which conditions might you hear a bruit over the liver
Hepatocellular carcinoma
Alcoholic hepatitis
What are the causes of hepatomegaly
Physiological:-
Hyper expanded chest
Reidel’s lobe
Infections:- Viral hepatitis TB Liver abscess Malaria
Toxins:-
Alcoholic fatty liver
Metabolic disease:-
Wilson’s disease
Haemochromatosis
Malignancy:-
Secondary tumours more common than primary
Lymphoma
Leukaemia
Cardiac:-
Right heart failure
Tricuspid regurgitation
Budd-Chiari syndrome
Haem: Lymphoma Leukaemia Myeloproliferative disorders Sickle cell disease
What is a venous hum over the liver associated with
Portal hypertension
What is the definition of portal hypertension
Portal vein pressure of more than 10 mmHg (normal = 5-10)
Portal blood flow through the liver is greatly reduced ( or reversed in severe cases)
What are some causes of portal hypertension
Extrahepatic - increased resistance to flow:-
Portal or splenic vein thrombosis
Intrahepatic:- Cirrhosis Right heart failure Sarcoidosis Schistosomiasis
How does schistosomiasis cause portal hypertension
Ova of the parasite colonize and obstruct the portal venules
On percussion, where would you expect the upper edge of the liver to be (when the percussion note becomes dull)
At the level of the 5th rib
How would you know that you are palpating an enlarged liver?
Dull PN
Can’t get above it
Moves inferiorly on respiration
What are significant negatives on presenting a patient with hepatomegaly?
Splenomegaly
ALF/decompensation
Signs of a cause: CLD, raised JVP, pallor, bruising, LNs
What are common causes of hepatomegaly?
Hepatitis: ETOH, viral, NAFLD
CLD
Congestion secondary to cardiac failure
What can you look for on urine dip in a patient with hepatomegaly to exclude causes?
Bilirubin, urobilinogen (jaundice, conjugated)
Proteinuria (amyloid)
What imaging can be used to investigate the liver?
Abdo USS and hepatic duplex- size, texture, lesions, ascites, portal and hepatic vein flow (thrombosis)
CT: Malignancy
MRI: Liver parenchyma
