🫀 Hepatomegaly · Liver Enlargement · Storage Disease · Hepatitis · Heart Failure

Schwartz Clinical Handbook — Chapter 42 · Infectious hepatitis · Metabolic storage (Gaucher, Niemann‑Pick) · Heart failure · Malignancy (neuroblastoma, leukemia) · Veno‑occlusive disease

Select liver size (span, consistency), associated findings (splenomegaly, jaundice, ascites, heart murmur, neurologic regression), and lab clues (transaminases, conjugated bilirubin) → differentiate hepatitis, metabolic storage disease, heart failure, malignancy, or veno‑occlusive disease.
⚠️ Red flags: encephalopathy, coagulopathy, hypoglycemia → acute liver failure, transfer to transplant center.

📋 Step 1 — Liver exam & systemic clues
📌 Diagnostic impressions
📖 Schwartz Ch 42

Select liver consistency (smooth vs firm vs nodular), spleen size, jaundice (conjugated/unconjugated), ascites, heart failure signs, developmental regression, and transaminase pattern → differential includes viral hepatitis, metabolic storage disease, congestive hepatopathy (heart failure), malignancy (neuroblastoma, leukemia), cholestasis, and veno‑occlusive disease.

✔️ Viral hepatitis: tender liver, jaundice, high ALT, prodrome.
✔️ Storage disease: hepatosplenomegaly, coarse facies, regression.
✔️ Heart failure: hepatomegaly + S3 gallop, JVD, peripheral edema.
✔️ malignancy: irregular, firm liver, pancytopenia, fever.
✔️ Cholestasis: conjugated hyperbilirubinemia, acholic stools.
📘 Schwartz pearls (Chapter 42)
• Normal liver span: neonates 4.5‑5 cm, 12y 7‑8 cm.
• Hypoalbuminemia + prolonged PT + encephalopathy → synthetic failure.
• Conjugated hyperbilirubinemia + normal gamma‑GT → progressive familial intrahepatic cholestasis (PFIC).
• Gaucher: hepatosplenomegaly, bone pain, glucocerebrosidase deficiency.
• Budd‑Chiari: painful hepatomegaly, ascites, hepatic vein thrombosis.