📏 Defining Hepatomegaly
• Liver edge >2 cm below R costal margin (or >3.5 cm in newborns)
• Liver span by percussion (6-8 cm in older children)
• Can be normal variant (midline, palpable edge) vs true enlargement
🩺 Causes by Category
• Infectious: hepatitis (viral, EBV, CMV), abscess
• Metabolic: glycogen storage diseases, Gaucher, Niemann-Pick
• Vascular: CHF, Budd-Chiari, hepatic vein thrombosis
• Infiltrative: leukemia, lymphoma, neuroblastoma, histiocytosis
• Biliary: biliary atresia, choledochal cyst
⚠️ Red Flags (Urgent)
• Fulminant hepatic failure: jaundice + coagulopathy + encephalopathy
• Liver mass + thrombocytopenia + anemia → malignancy (hepatoblastoma)
• Asymmetric hepatomegaly or nodular surface → tumor or cirrhosis
• Signs of portal hypertension: splenomegaly, ascites, varices
📋 Diagnostic Approach
• LFTs: AST/ALT (hepatocellular), GGT/ALP (cholestasis), albumin/PT (synthetic function)
• CBC: pancytopenia (hypersplenism), blasts (leukemia)
• Ultrasound: first-line imaging (cystic vs solid, vascular flow)
• Liver biopsy for infiltrative or storage disorders
📌 Decision strategy: Determine if truly enlarged (edge >2 cm). Conjugated hyperbilirubinemia + hepatomegaly → biliary atresia until proven otherwise. Nodular liver + splenomegaly → cirrhosis/portal hypertension.