Hepatomegaly

Question 1

Causes of tender Hepatomegaly

Answer 1

• Malignancy - primary or secondary - must look for clues clinically in the exam
• Alcoholic hepatitis
• Infective hepatitis
• Budd Chiari
• Congestion from fluid overload (CCF)

Note - suggests recent liver capsule stretch

Question 2

Cause of hepatic bruit

Answer 2

Alcoholic hepatitis
Hepatic carcinoma (primary or secondary)
Haptic AVMs
Hemangiomas
TIPS

Question 3

Causes of hepatomegaly without spelnomegaly

Answer 3

Any cause cirrhosis
NAFLD
PBC
Alcoholic liver disease

Malignancy primary and secondary

Infectious

• Viral hepatitis
• EBV
• CMV
• Toxoplasmosis
• Hydatid disease
• Pyogenic liver abcess
• Tertiary syphyllis

Infiltrative

• Sarcoidosis
• Amyloidosis
• Glycogen storgae disorders

Vascular

• Budd-Chiari
• Sickle cell disease

Other

• Polycystic liver disease
• Obstetric liver disease

Question 4

What is the mean liver span when percussing the liver

Men
Women

Answer 4

Men 10.5 cm

Women 7cm

Question 5

If you palpate an umbilical nodule and hepatomegaly which cancers could this represent

Answer 5

Gastric adenocaricnoma
Colon adenocarcinoma
HCC
Lymphoma

Question 6

Which solid organ cancers metastasise to the liver

Answer 6

Colorectal cancer - majority

Oesophageal
Gastric
Lung
Breast
Renal
Endometreial
Neuroendocrine
Sarcomatous
Bone tumours

Question 7

Name some benign liver tumours

Answer 7

Cavernous hemangiomas - most common - affects women of childbearing age

Hepatic adenoma - associated with oestrogen containing contraception

Focal nodular hyperplasia

Nodular regenerative hyperplasia - affects elderly, associated with autoimmune disease

Question 8

What are the hepatic manifestations of sickle cell disease

Answer 8

Gall stone disease - due to haemolysis

Sickle cell crisis - Sickle thrombosis causes sinusoidal obstruction

Intrahepatic cholestasis - also due to Sickle thrombosis causes sinusoidal obstruction