Diagnosis of the swollen liver

An increase in the size of the liver may be noticed during a physical examination, but this depends on the degree of enlargement. A slight enlargement can often not be palpated. If the liver is greatly enlarged, the edge of the liver, which is normally located below the right costal arch, may be displaced significantly downward.

If the enlargement is pronounced, the edge of the liver can extend into the pelvic region. With an ultrasound examination of the abdomen, an enlargement of the liver can usually be easily recognized, and the size of the liver can be measured approximately. However, how well this works depends on how well the patient can be sonicated.

In very corpulent people, the ultrasound examination may not provide sufficient information. In this case, further imaging diagnostics can be carried out, for example with a computer tomography (CT) or magnetic resonance imaging of the abdomen (MRI), in which the liver is clearly visible. The healthy, non-expanded liver is usually not palpable during normal breathing.

In order to be able to palpate a healthy liver, the doctor asks the patient to lie on his back and breathe out deeply and then breathe in deeply. The doctor now palpates with his fingers just below the right costal arch. Here the edge of the liver can be felt from bottom to top while inhaling.

An enlarged liver can be felt in many cases without the deep inhalation. Depending on how much it is enlarged, the lower edge of the liver can in extreme cases reach deep into the lower abdomen. The above mentioned technique for palpating the liver can also be used on yourself, but it is easier if someone else performs it.

Palpating a healthy liver is not always successful. Swelling of the liver itself does not necessarily cause changes in liver values. However, due to the triggering disease, there is often both a swollen liver and a deterioration in liver values, which are included in the blood count.

Typical liver values include the so-called transaminases: These values can be elevated in many liver dysfunctions, so that changes in these liver values are often accompanied by swelling of the liver. Other laboratory values that indicate liver damage include coagulation and bile values.

ALT (alanine aminotransferase) and
AST (aspartate aminotransferase).