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- Ann D. Wolf, MD*
- Joel E. Lavine, MD, PhD†
- *Chief Resident.
- †Associate Professor of Pediatrics and Chief, Joint Program in Gastroenterology and Nutrition, Department of Pediatrics, UCSD School of Medicine, San Diego, CA.
OBJECTIVES
After completing this article, readers should be able to:
Identify the possible causes of simultaneous hepatomegaly and splenomegaly.
List the important diagnostic considerations in patients who have hepatomegaly.
Delineate the most helpful initial radiographic test.
Describe what clinical findings occurring concomitantly in a patient who has hepatomegaly suggest metabolic or storage disease.
List the risk factors for infectious hepatitis.
Introduction
Hepatomegaly can represent intrinsic liver disease or may be the presenting physical finding of a generalized disorder. Early diagnosis and treatment of children who have liver disease is important because specific treatments are available for some diseases that can prevent disease progression or hepatic failure.
The presence of a palpable liver does not always indicate hepatomegaly. Normal liver size is based on normative values of liver span by percussion, degree of extension below the right costal margin, or length of the vertical axis estimated from imaging techniques. In general, a liver edge greater than 3.5 cm in newborns and greater than 2 cm in children below the right costal margin suggests enlargement. Liver span is determined by measuring the distance between the upper edge, determined by percussion, and the lower edge, determined by palpation, in the midclavicular line. The lower border also may be determined by auscultation. With the stethoscope placed below the xiphoid, the examiner should gently scratch superiorly, starting in from the right lower quadrant, and listen for sound enhancement as the finger passes over the liver edge. Liver span increases linearly with body weight and age in both genders and correlates more with weight than with height. The normal range for liver span by percussion at 1 week of age is 4.5 to 5 cm. At 12 years, the normal value for boys is 7 to 8 cm and for girls is 6 to 6.5 cm.
The liver …
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