II. Evaluation: Hepatomegaly with Direct Hyperbilirubinemia

  1. Splenomegaly
    1. TORCH Virus Infection
    2. Bacterial Infection (e.g. Spirochetes) or Sepsis
    3. Disordered carbohydrate metabolism
      1. Galactosemia
      2. Hereditary Fructose Intolerance
  2. No Splenomegaly
    1. Causes found on right upper quadrant Ultrasound
      1. Hepatoma or Hemangioma and other tumor
      2. Choledochal cyst
    2. Causes found on biliary scan
      1. Biliary atresia
    3. Causes found on liver biopsy
      1. Neonatal hepatitis
      2. Toxin exposure
      3. Parenteral nutrition

III. Evaluation: Hepatomegaly with Indirect Hyperbilirubinemia

  1. Causes
    1. Congestive Heart Failure
    2. Toxin Exposure
    3. Hemolytic Anemia
      1. Hereditary spherocytosis
      2. Thalassemia
  2. Studies
    1. Right Upper Quadrant Ultrasound

IV. Evaluation: Hepatomegaly without Hyperbilirubinemia

  1. Studies
    1. Abdominal Ultrasound
  2. Causes with Splenomegaly
    1. Vascular obstruction
    2. Liver tumor (e.g. Hepatoblastoma)
    3. Metabolic disease
  3. Causes without Splenomegaly
    1. Tumor
    2. Mother with Gestational Diabetes
    3. Malnutrition

V. References

  1. Cloherty (1991) Neonatal Care, p. 449
  2. Wolf (2000) Pediatr Rev 21(9):303-10 [PubMed]

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