Introduction
The liver is the largest organ in the human body and normally weighs 1200-1500 grams. During the physical examination, the doctor can determine the size of the liver by means of tapping or scratching auscultation (using a stethoscope and a finger). A size of more than 12 centimeters in the medioclavicular line is called an enlarged liver (hepatomegaly).
Normally, the liver is palpable at a maximum of 1-2 centimeters below the costal arch. In an enlarged liver, the liver can also be palpated several centimeters below the costal arch. A relatively precise determination of the size of the liver is also possible using ultrasound.
The causes
An enlargement of the liver can have various causes. For example, the liver can be damaged relatively easily by substances that are absorbed via the gastrointestinal tract because the liver is so well supplied with blood and the substances absorbed in the digestive tract arrive in high concentrations in the liver cells. Thus, alcohol reaches high concentrations in the liver and damages the liver cells.
Especially with regular alcohol consumption, the structure of the liver can therefore be changed and the liver can become enlarged. An incorrect diet that is too rich in fats, high blood pressure and diabetes lead to the storage of fats in the liver, which then increases in size. The liver can also be attacked by various pathogens, the hepatitis viruses trigger relatively specific inflammations of the liver, but the liver can also be affected by another infectious disease and therefore become enlarged.
Diseases of the heart, e.g. cardiac insufficiency, can lead to a congestion of blood in front of the heart. This congestion can extend into the liver and cause an enlargement of the liver. A liver that is enlarged due to blood congestion is also called congested liver.
Blood congestion in the liver also occurs in the rare Budd-Chiari syndrome, in which the draining blood vessels of the liver are completely or partially blocked by blood clots or by pressure from a tumor. Both benign and malignant tumors of the liver also lead to an enlarged liver. If the outflow of bile acids produced in the liver is “blocked”, for example by a gallstone in the large bile duct, they accumulate back into the liver and can cause an enlargement of the liver.
Chronic alcohol abuse is the most common cause of liver disease in Central Europe. The disease begins with an enlarged liver due to fatty liver cells. This results in a fatty liver.
In later stages of the disease, alcoholic fatty liver inflammation (ASH = alcoholic steatohepatitis) and liver cirrhosis are common. Fatty liver and ASH can usually be reversed by abstaining from alcohol, but once the disease has reached the stage of liver cirrhosis, the liver is irreversibly damaged.
- The fatty liver
- Cirrhosis of the liver
Drugs can generally be processed in the body by two main mechanisms and then excreted.
One way of excreting them is via the kidneys (these substances must combine well with water, therefore they are called hydrophilic substances). The excretion of drugs via the liver takes place with hydrophobic substances, which bind better with fatty substances and therefore cannot be excreted in urine. If the liver is too heavily loaded with such drugs, the organ can be damaged and the liver can become enlarged.
The metabolism of many medications also takes place in the liver, where an overload of substances can also lead to enlargement. Typical drugs that can lead to liver enlargement when taken in too large doses are paracetamol, many antibiotics, immunosuppressive drugs (drugs that weaken the immune system), chemotherapeutic drugs, etc. Whistling glandular fever (also called kissing disease) is a disease caused by the Epstein-Barr virus (EBV).
The viruses can be transmitted via saliva. They are mainly found in the lymphatic system, lymph nodes and the lymphatic organs (spleen and liver). In most cases there is also tonsillitis with severe sore throat.
Swelling of the lymph nodes (especially in the neck) is very common, and the liver and spleen are also swollen in up to 50% of cases. Leukemias are diseases of the blood-forming system. The formation of leukocytes, i.e. white blood cells, is affected.There is a strong increase of leukocytes in the bone marrow, then the cells enter the blood.
A basic distinction is made between acute (suddenly occurring) and chronic (creeping) leukemia. Depending on which cells are exactly affected, the leukemias can also be divided into leukemic and myeloid leukemias. Due to the infiltration of white blood cells into various organs, the size of the organs increases. The spleen and liver are particularly affected, as are the lymph nodes.
