Soft but Non-Tender Hepatomegaly

CLINICAL DIAGNOSTIC MANUAL

Soft but non-tender hepatomegaly refers to an enlargement of the liver that does not cause pain when palpated. This sign can be associated with a variety of chronic and systemic conditions affecting the liver.

Non-tender hepatomegaly often indicates chronic or infiltrative liver diseases that cause a gradual increase in liver size without acute inflammation. Accurate diagnosis and management require a thorough clinical evaluation and the use of various complementary tests.

Condition	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmatory Diagnosis
Cirrhosis	Hepatomegaly, jaundice, ascites, oesophageal varices, hepatic encephalopathy, fatigue, weight loss, spider angiomas, palmar erythema	Clinical history, clinical symptoms	Liver function tests, abdominal ultrasound, liver biopsy
Lymphoma	Hepatomegaly, fever, night sweats, weight loss, fatigue, lymphadenopathy, splenomegaly	Clinical history, clinical symptoms	Lymph node biopsy, abdominal CT/MRI, haematological tests
Leukaemia	Hepatomegaly, fatigue, fever, pallor, bruising, petechiae, recurrent infections, lymphadenopathy, splenomegaly	Clinical history, clinical symptoms	Complete blood count, bone marrow aspiration/biopsy
Haemochromatosis	Hepatomegaly, fatigue, arthralgias, diabetes mellitus, skin hyperpigmentation, loss of libido, heart failure	Clinical history, clinical symptoms	Iron overload test, ferritin levels, liver biopsy
Primary biliary cirrhosis	Hepatomegaly, pruritus, jaundice, fatigue, xanthomas, xanthelasmas, skin hyperpigmentation	Clinical history, clinical symptoms	Liver function tests, autoantibodies, liver biopsy
Amyloidosis	Hepatomegaly, fatigue, weight loss, oedema, peripheral neuropathy, macroglossia, carpal tunnel syndrome	Clinical history, clinical symptoms	Affected tissue biopsy, serum protein electrophoresis