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Hepatomegaly: Causes, Clinical Presentation, and Diagnostic Approach

Hepatomegaly = liver span > normal (midclavicular line >12–15 cm adult). A sign, not a diagnosis.

Major Etiologic Categories

CategoryKey Causes
HepatocellularViral hepatitis (A/B/C/E), alcoholic hepatitis, NAFLD/NASH, autoimmune hepatitis, drug-induced (DILI), Wilson's, α1-antitrypsin
CholestaticPrimary biliary cholangitis, PSC, biliary obstruction, drug-induced cholestasis
Infiltrative/StorageAmyloidosis, sarcoidosis, hemochromatosis, Gaucher, glycogen storage diseases
Vascular/CongestiveRight heart failure, Budd-Chiari, sinusoidal obstruction syndrome
NeoplasticMetastases (colon, breast, lung), HCC, lymphoma, angiosarcoma
InfectiousAbscess, malaria, echinococcus, TB, syphilis

Symptoms

  • RUQ fullness/pain, early satiety, nausea, fatigue, weight loss.
  • Jaundice, ascites, encephalopathy if decompensated.

Workup

  1. LFTs, INR, albumin, CBC, viral serologies, iron studies, ANA, immunoglobulins.
  2. Ultrasound ± Doppler (first-line imaging).
  3. CT/MRI if mass/vascular lesion suspected.
  4. Biopsy if etiology unclear after non-invasive workup.

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