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Enlarged liver

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Definition

Epidemiology

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Pathophysiology

Either, the there is venous congestion pushing the liver down or there is something attacking the liver itself (more common but venous congestion is still common) causing inflammation (i.e. hepatitis).

Clinical and Associated Features

Venous

Infection

Symptoms of hepatitis - anything from asymptomatic to fulminant liver failure. Symptoms include: malaise, muscle and joint ache, fever, nausea, vomiting, diarrhoea, jaundice, loss of appetite, abdominal pain.

Biliary tract disease

This essentially an obstructive jaundice - hepatomegaly, jaundice, colicky (classcially central) abdominal pain, rebound tenderness, shoulder tip pain.

Cancer

Hepatocellular carcinoma generally occurs in sufferers of hepatitis A; secondaries are more. However, both are usually asymptomatic until a late stage. Symptoms include: loss of appetite, weight loss, nausea, tiredness, upper abdominal discomfort.

Haematological

Metabolic

Drugs

Everybody's favourite, alcoholic liver disease, is the biggest culprit here - high alcohol intake, jaundice, possibly a tender and painful abdomen. Other drugs: statins, macrolides, amiodarone.

Differential Diagnosis

I hate livers. Why does stuff have to go wrong with them?

Investigations

You almost always do LFTs and often, if there's something to see, imaging is best done with ultrasound.