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Common hepatomegaly exam questions for medical finals, OSCEs and MRCP PACES

 

Questions on the aetiology of hepatomegaly

What are the commonest causes of hepatomegaly in the UK?

  • Alcoholic liver disease
  • Cancer (metastases are the commonest) or HCC
  • Congestive cardiac failure

What is the full differential diagnosis when finding an enlarged liver

  • Hepatitis
    • Infections
      • Viral hepatitis (acute and chronic)
      • EBV and CMV
      • Malaria
      • Abscesses – Amoebic or Pyogenic
    • Autoimmune hepatitis
  • Alcoholic liver disease
  • Non-alcoholic fatty liver disease (previously known as NASH)
  • Tumours
    • Metastases
    • Hepatocellular carcinoma (HCC)
    • Hepatoma
  • Haematological Disorders
    • Leukaemia (CML and CLL)
    • Lymphoma
    • Haemolytic anaemias
      • Thalassaemia; red cell defects; sickle cell anaemia
  • Infiltration
    • Amyloidosis
    • Sarcoidosis
  • Drugs
    • Statins
    • Amiodarone
    • Macrolides
  • Metabolic
    • Haemochromatosis
    • Wilson’s disease
    • Glycogen storage disorders
    • Porphyria
  • Biliary Disease
    • Extra-hepatic obstruction
      • Pancreatic cancer; cholangiocarcinoma
    • Primary Biliary Cirrhosis
    • Primary Sclerosing Cholangitis
  • Congestive
    • Right ventricular failure
    • Congestive cardiac failure
    • Constrictive pericarditis
  • Budd-Chiari