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Is there jaundice? Hepatomegaly with jaundice may make one think of hemolytic anemias; toxic or infectious hepatitis; bile duct obstruction due to stones, carcinoma of the pancreas, or ampulla of Vater; and biliary cirrhosis ... DIAGNOSTIC WORKUP
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Is the jaundice associated with hepatomegaly? There is little or no hepatomegaly associated with hemolytic anemias, pernicious anemia, Gilbert's disease, and Dubin-Johnson syndrome.
Is the hepatomegaly massive? ... DIAGNOSTIC WORKUP
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Hepatomegaly, or enlargement of the liver, usually refers to a liver span of larger than 12 cm at the right midclavicular line or a palpable left lobe in the epigastrium. However, liver size on physical exam is only an approximation and should be accurately... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Yellow skin pigmentation caused by elevated serum bilirubin level is termed jaundice. Bilirubin is the major breakdown product of hemoglobin that is released from dying or damaged erythrocytes. The normal serum bilirubin is less than 1 mg/dL, less than... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Hepatomegaly represents the clinical appearance of liver enlargement and can occur via five mechanisms, including inflammation, excessive storage, infiltration, congestion, and obstruction. The presence of a palpable liver does not always represent hepatomegaly and is... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Jaundice refers to the presence of a yellow hue of the skin, sclerae, or mucous membranes. Direct, or more specifically, conjugated hyperbilirubinemia represents a pathologic condition of cholestasis. It is defined as a direct bilirubin fraction... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Jaundice is the presence of a yellow hue of the skin, sclerae, or mucous membranes due to elevation of serum bilirubin; it usually becomes apparent at a total serum bilirubin level of 5 mg/dL. It is present in approximately 60% of term infants... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... Two key words to think of here are histology and obstruction. The analysis of the differential diagnosis of hepatomegaly is best begun with a histologic breakdown of the liver tissue ( Table 37 ). Thus, there are parenchymal cells that can be
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... Jaundice is not to be confused with xanthochromia, in which the skin turns orange from carotene deposits but the sclerae remain normal in appearance. Carotenemia is often seen in hypothyroidism and diabetes mellitus, but jaundice is not usually a
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... Hepatomegaly, an enlarged liver, indicates potentially reversible primary or secondary liver disease This sign may stem from diverse pathophysiologic mechanisms, including dilated hepatic sinusoids (in heart failure), persistently high venous pressure leading to... History and physical examination ... Medical causes ... Special considerations ... Pictures
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...Icterus
A yellow discoloration of the skin, mucous membranes, or sclera of the eyes, jaundice indicates excessive levels of conjugated or unconjugated bilirubin in the blood. In fair-skinned patients, it’s most noticeable on the face,... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... Palpable Liver without Hepatic Pathology
Normal variant
Thin or flaccid abdominal wall
Depressed right diaphragm (e.g., emphysema)
Subdiaphragmatic lesion (e.g., abscess)
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... Primarily Unconjugated Hyperbilirubinemia
Increased production
Hemolysis, intravascular or extravascular
Ineffective erythropoiesis
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... Hepatomegaly, an enlarged liver, indicates potentially reversible primary or secondary liver disease. This sign may stem from diverse pathophysiologic mechanisms, including dilated hepatic sinusoids (in heart failure), persistently high venous pressure... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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... A yellow discoloration of the skin, mucous membranes, or sclera of the eyes, jaundice indicates excessive levels of conjugated or unconjugated bilirubin in the blood. In fair-skinned patients, it’s most noticeable on the face, trunk, and sclera; in dark... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Darryl G. White and Bruce A. Leibert
Approach Hepatomegaly is a physical sign noted on abdominal examination that is present in hepatobiliary disease but is not specific or sensitive to one cause. Defining hepatomegaly... History ... Physical examination ... Testing ... Diagnostic assessment ... Summary ... Pictures
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... James M. Brian and Cara K. Fox
The hepatobiliary system removes bilirubin, a byproduct of hemoglobin metabolism, from the blood stream. Jaundice, a yellowing of the skin and sclera, results from tissue build-up of bilirubin when the hepatobiliary... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Differential Overview
❑ Acute hepatitis
❑ Chronic hepatitis
❑ Cirrhosis
❑ Right heart failure
&... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
Conjugated
❑ Viral hepatitis
❑ Gallstone obstruction
❑ Drugs
❑ Carotinemia ... Diagnostic Approach ... Clinical Findings ... Pictures
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... Hepatomegaly (an enlarged liver) indicates potentially reversible primary or secondary liver disease. This sign may stem from diverse pathophysiologic mechanisms, including dilated hepatic sinusoids (in heart failure), persistently high venous... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... A yellow discoloration of the skin, mucous membranes, or sclerae of the eyes, jaundice indicates excessive levels of conjugated or unconjugated bilirubin in the blood. Also known as icterus, jaundice is most apparent in natural sunlight. In fact, it may be undetectable in... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Liver sizemay be estimated by degree of extension of liver edge below costalmargin or by span of liver dullness to percussion. In children liver edge may be normallypalpable up to 2 cm below right costal margin. However, this assessmentof liver size may be unreliable if... Principal Causes of Hepatomegaly ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Jaundice,yellow discoloration of skin and sclera, is produced by depositionof bilirubin in these tissues. Increase in unconjugated or conjugatedbilirubin or both produce jaundice, which is visible when totalserum bilirubin is >2 mg/dL. Conjugated hyperbilirubinemia... Principal Causes of Unconjugated Hyperbilirubinemia ... Clinical Features and Diagnosis: Unconjugated Hyperbilirubinemia(Neonatal Onset) ... Clinical Features and Diagnosis: Unconjugated Hyperbilirubinemia(Postneonatal Onset) ... Diagnostic Approach: Unconjugated Hyperbilirubinemia ... Principal Causes of Conjugated Hyperbilirubinemia (NeonatalOnset) ... Clinical Features and Diagnosis: Conjugated Hyperbilirubinemia(Neonatal Onset) ... Principal Causes of Conjugated Hyperbilirubinemia (PostneonatalOnset) ... Clinical Features and Diagnosis: Conjugated Hyperbilirubinemia(Postneonatal Onset) ... Diagnostic Approach: Conjugated Hyperbilirubinemia ... References
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... Hepatomegaly, an enlarged liver, indicates potentially reversible primary or secondary liver disease. This sign may stem from diverse pathophysiologic mechanisms, including dilated hepatic sinusoids (in heart failure), persistently high venous... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
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... A yellow discoloration of the skin, mucous membranes, or sclera of the eyes, jaundice indicates excessive levels of conjugated or unconjugated bilirubin in the blood. In fair-skinned patients, it's most noticeable on the face, trunk, and sclera; in dark-skinned patients, on the hard... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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Two key words to think of here are histology and
obstruction. The analysis of the differential diagnosis of hepatomegaly is
best begun with a histologic breakdown of the liver tissue (Table
37). Thus, there are ... Pictures
... READ EXCERPTS »
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Jaundice is not to be confused with xanthochromia, in which the skin
turns orange from carotene deposits but the sclerae remain normal in
appearance. Carotenemia is often seen in hypothyroidism and diabetes
mellitus, but jaundice is not usually a complication of these... Pictures
... READ EXCERPTS »
Liver problems may be difficult to avoid when taking HIV medicines. But most problems are relatively mild and do not prevent people with HIV from...
Hepatitis B is a viral infection of the liver often spread through sexual contact. But people are usually unaware they carry the virus. Find out if...
Many people with viral hepatitis don't know they are infected. Listen as experts discuss who should be tested and review the causes, prevention...