The lower edge of the liver normally comes just to the lower edge of the ribs (costal margin) on the right side. In its normal state, the edge of the liver is thin and firm, and it cannot be palpated (felt with the finger tips) below the edge of the costal margin.

If the liver becomes enlarged enough that it can be palpated below the costal margin, the patient may have hepatomegaly. The diagnosis must be confirmed by an imaging study of the liver.

The liver is involved in many bodily functions, and is affected by a variety of conditions, many of which result in hepatomegaly. General causes include infection (viral, bacterial, or parasitic), malignancy (cancer or tumors), anemias, storage diseases, heart failure, congenital heart disease, toxins, and metabolic disturbances.

• Alcohol
• Hepatitis A
• Hepatitis B
• Congestive heart failure
• Infectious mononucleosis
• Leukemia
• Tumor metastases
• Neuroblastoma
• Hepatocellular carcinoma
• Niemann-Pick disease
• Hereditary fructose intolerance
• Glycogen storage disease
• Primary biliary cirrhosis
• Sarcoidosis
• Sclerosing cholangitis
• Hemolytic-uremic syndrome (HUS)
• Reye's syndrome

The medical history will be obtained. This finding is usually discovered by the health care provider during a physical examination.

Medical history questions documenting hepatomegaly in detail include:

• When did you notice a fullness or lump in the abdomen?
• How much has it changed or enlarged?
• What other symptoms are also present?
• Is there any abdominal pain?
• Is there any yellowing of the skin (jaundice)?
• Is there any vomiting?
• Is there any unusual-colored or pale-colored stools?
• Have you had any fevers?
• What medications are you taking?
• How much alcohol do you consume?

• Abdominal x-ray
• Ultrasound of the liver
• CT scan of the abdomen
• Liver function tests, including blood clotting profiles
• Other tests for suspected causes