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Hepatomegaly

  • Common ddx

    • CHF, mono, hepatitis
  • Serious ddx

    • hepatobiliary cancer
  • Labs

    • Chem, LFTs (AST, ALT, bili, AP)
    • CBC
    • monospot test
    • BNP
    • hep panel
    • CT if suspect malignancy
    • US if suspect gallstone
    • consider ERCP
  • Pediactric ddx

    • glycogen, lysosomal storage dz
  • Cardio ddx

    • CHF, constrictive pericarditis, tricuspid regurgitation
  • Vascular ddx

    • hepatic vein thrombosis, IVC obstruction
  • Liver ddx

    • fatty liver, hepatitis, HCC, liver cyst, liver met, Wilson's disease (neuro sx), cirrhosis
  • Biliary ddx

    • cholecystitis, cholangitis, PBC, biliary cancer
  • Infectious ddx

    • mono (splenomegaly), hepatitis, cholecystitis, cholangitis
  • Cancer ddx

    • HCC, liver met, pancreatic cancer, biliary cancer
  • Glycogen storage ddx

    • von Gierke, Pompe (infant), Cori's
  • Lysosomal storage ddx

    • Gaucher's disease, Niemann-Pick, Hurler's
  • Other ddx

    • alpha1-antitrypsin deficiency, hemachromatosis, amyloidosis, hemolytic anemia
  • HPI

    • onset
    • associated pain
    • triggering events
  • ROS

    • fever, weight loss, fatigue
    • ENT: sore throat
    • cardio: chest pain, exertional dyspnea
    • pulm
    • GI: nausea, vomiting, diarrhea, abdominal pain
    • neuro: muscle weakness, ataxia, paresthesia
  • PMH

    • CHF
    • hepatitis
    • cancer
    • glycogen, lysosomal storage, hemachromatosis, hemolytic anemia
  • FH

    • Jewish ancestry
    • glycogen storage, lysosomal storage diseases
  • SH

    • foreign travel
    • EtOH
  • Meds

  • Allergies

  • Px

    • vitals
    • gen impression
    • jaundice
    • HEENT: cherry red macula, pharyngitis
    • cardio: JVD
    • pulm
    • abd: measure liver, Murphy sign, splenomegaly
    • neuro: finger-to-nose, ataxia, gait
    • ext: peripheral edema

  • Print | Citations

    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.