Brief overview
- Treatment: Depending on the trigger, for example in the case of fatty liver, abstinence from alcohol and change of diet; according to the underlying disease, possibly medicinal or surgical therapy.
- Causes: Alcohol abuse, overeating, viral diseases, metabolic diseases, cholestatic diseases, vascular diseases, certain drugs, liver cysts, tumors.
- When to see a doctor: In case of a feeling of fullness and pressure in the upper abdomen, but also regular preventive check-ups.
- Diagnostics: Medical history, physical examination, blood test, ultrasound of the liver
- Prevention: Healthy lifestyle (balanced diet, little alcohol and other toxins), vaccination against viral hepatitis if necessary.
What is hepatomegaly?
The term hepatomegaly refers to an enlargement of the liver. The liver is a wedge-shaped, bilobed organ located in the right upper abdomen just below the diaphragm. It is the central metabolic organ and, weighing about 1.5 kilograms, the largest gland in the body.
If the liver is pathologically enlarged, it is usually a fatty liver. Rarely, other diseases are the cause of hepatomegaly. In many cases, the enlargement of the liver is accompanied by an enlargement of the spleen. Physicians then speak of hepatosplenomegaly.
Hepatomegaly: How can it be treated?
- Abstain from alcohol
- Reduce excess weight (slowly and steadily!)
- Become more physically active
In addition, it is advisable to discontinue or change any medications that are harmful to the liver in consultation with the doctor in order to counteract hepatomegaly.
If other underlying diseases are behind the enlargement of the liver, correct diagnosis and targeted therapy are crucial. For example, in some forms of viral hepatitis, antiviral therapy is useful. In the case of bile stasis (cholestasis), drug therapy or surgery may be recommended, depending on the cause.
What can be the cause of an enlarged liver?
Hepatomegaly occurs as a concomitant of various diseases. The most common cause of liver enlargement is fatty liver (steatosis hepatis). However, other liver diseases as well as diseases of other organs may also cause hepatomegaly:
Metabolic or toxic liver diseases.
The liver reacts to various harmful influences with fatty degeneration, such as:
- Chronic alcohol consumption
- Overeating (obesity)
- Viral or metabolic diseases (such as diabetes mellitus or elevated blood lipid levels)
- @ Certain medications and chemicals
Other metabolic or toxic liver diseases that may lead to hepatomegaly include storage diseases (such as the iron storage disease hemochromatosis) and certain forms of the metabolic disease porphyria. Liver involvement with subsequent hepatomegaly also occurs in the context of other metabolic diseases and hormonal disorders.
Inflammatory liver diseases
Inflammatory liver diseases are other possible causes of hepatomegaly. In this case, the inflammation is caused, for example, by viruses, a faulty reaction of the immune system (autoimmune disease), alcohol or toxins.
Examples of inflammatory liver diseases that are sometimes accompanied by hepatomegaly include acute or chronic liver inflammation (hepatitis), liver cirrhosis, and liver granulomas. Granulomas are nodular tissue formations caused by inflammation. They develop, for example, in the context of tuberculosis, AIDS or sarcoidosis.
Diseases with bile stasis
Diseases associated with bile outflow obstruction (cholestatic diseases) are also possible triggers of hepatomegaly.
- Bile duct obstruction (such as due to gallstones)
- Primary biliary cirrhosis
- Biliary obstruction due to medication
- Biliary obstruction during pregnancy
Diseases of the blood vessels
Sometimes hepatomegaly results from a disease affecting the blood vessels (vascular). An example of this is right heart failure (right ventricular failure): In this case, the right ventricle is no longer able to pump the venous blood coming from the body further into the pulmonary circulation. As a result, the venous blood backs up, which, in addition to congested neck veins, sometimes leads to a congested liver with liver enlargement.
Venous blood may also back up into the liver in cases of a faulty heart valve between the right atrium and right ventricle (tricuspid valve defect) and in cases of a so-called “armored heart” (constrictive pericarditis).
Other vascular diseases that potentially result in hepatomegaly include (in)complete occlusion of the large hepatic veins (Budd-Chiari syndrome), clot-related occlusion of the inferior vena cava (vena cava inferior thrombosis), and occlusion or aneurysm of the hepatic artery.
Infections
Cystic liver and liver cysts
Liver cysts are smooth-bordered, fluid-filled cavities in the liver that vary in size from a few millimeters to ten centimeters. They occur either singly or in multiples. If the liver is riddled with cysts, it is referred to as a cystic liver. In the case of very large cysts as well as a cystic liver, liver enlargement may develop.
Tumors
In some cases, benign or malignant liver tumors are the cause of hepatomegaly. In addition, malignant tumors in other parts of the body (such as colon, stomach or breast cancer) sometimes form daughter tumors in the liver (liver metastases), which then lead to liver enlargement.
When to see a doctor?
If you feel pressure and/or pain in the upper abdomen – possibly accompanied by other complaints – it makes sense to consult a doctor for clarification. It is possible that hepatomegaly is behind this.
In most cases, however, hepatomegaly is first noticed during a medical examination, for example during a preventive checkup or as an incidental finding during other examinations.
Hepatomegaly: What does the doctor do?
Also important for the clarification of hepatomegaly are details about your alcohol and medication consumption, (foreign) travel in the past and noticeable weight changes. The interview is followed by various examinations.
Physical examination
The doctor palpates the abdomen (palpation) to estimate the size of the liver and to obtain possible clues about the cause of the hepatomegaly. For example, in hepatitis and congested liver, the liver feels soft and smooth and may hurt when pressure is applied. In contrast, a hard, irregular to bumpy liver indicates cirrhosis or liver cancer, for example, as a possible cause of hepatomegaly.
Also by palpation, the physician examines the size of the spleen. This is because hepatomegaly (enlargement of the liver) often goes hand in hand with splenomegaly (enlargement of the spleen) – together then called hepatosplenomegaly.
In addition, the physician examines the skin for signs of jaundice (icterus) or the iron storage disease hemochromatosis (possibly dark skin pigmentation). So-called liver skin signs are also informative, i.e. characteristic skin changes in chronic liver diseases (such as cirrhosis). These include, for example, spider nevi (visible enlargement of skin arteries reminiscent of spider legs) and reddened palms (palmar erythema).
Blood tests
If the physical examination has confirmed hepatomegaly, a blood analysis is performed. For example, the differential blood count, blood cell sedimentation rate (ESR), various liver enzymes, iron and cholesterol levels, and blood coagulation (Quick value/INR) are determined.
If the hepatomegaly is accompanied by splenomegaly (hepatosplenomegaly), the physician may order additional blood tests (such as the Coombs test to detect antibodies to red blood cells).
Imaging procedures
An ultrasound examination of the abdomen (abdominal ultrasonography) is also part of the routine workup for hepatomegaly. Here, the physician examines the liver, spleen, bile ducts and the portal vein system – the venous vascular system that carries blood from the stomach, intestines and spleen via the portal vein first to the liver and then on to the inferior vena cava.
A chest x-ray may provide further clues as to the cause of the hepatomegaly. For example, if an enlarged heart or pleural effusion is noticed on x-ray, this indicates possible right heart failure. (Malignant) swollen lymph nodes (lymphomas) can also be detected on the X-ray.
Further examinations
Hepatomegaly: how to prevent it
In most cases, hepatomegaly is caused by a fatty liver. If it continues to be stressed by alcohol, medication or other influences, fatty liver inflammation (steatohepatitis) may develop or, over time, it may turn into dangerous, irreversible cirrhosis of the liver.
You have the opportunity to do something for the health of your liver yourself. A healthy lifestyle is crucial, because too much alcohol, too much and too fatty food, obesity and lack of exercise put a strain on the organ.
Appropriate vaccinations protect against certain forms of hepatitis. Your doctor will advise you on which vaccinations make sense for you. You should also have your liver values checked regularly so that you know in good time if your liver is suffering. Then hepatomegaly will not occur in the first place.
