The medical term hepatomegaly refers to an abnormal enlargement of the liver. Hepatomegaly is often caused by liver disease. However, diseases of other organs can also result in liver swelling.
What is hepatomegaly?
The liver is the central metabolic organ of the human body. It is important for the breakdown and excretion of various substances, produces vital proteins, and utilizes many food components. The organ is located in the right upper abdomen and weighs between 1.4 and 1.9 kilograms in adult humans. In a healthy state, the liver has a soft structure and is easily palpable under the right costal arch in slender people. In hepatomegaly, the liver is enlarged. Depending on the extent, the liver can then even become visible or is palpable even in obese patients. Hepatomegaly can have many causes and is therefore not a disease, but an examination finding.
Causes
Liver enlargement can have many causes. In general, the liver can become enlarged if it is inflamed. Inflammation of the liver is called hepatitis. For example, hepatitis with liver enlargement can be caused by viral infections. Viruses are responsible for hepatitis A to hepatitis E. Infection with Pfeiffer’s glandular fever, a disease caused by the Epstein-Barr virus, can also lead to liver swelling due to inflammation of the liver. Other viruses that can cause liver enlargement are the cytomegalovirus or Coxsackie viruses. Of course, infections with bacteria can also lead to hepatomegaly. In particular, leptospires, brucella and salmonella are possible causes. In the case of liver swelling, parasite infestation should also be considered. Liver swelling often occurs in connection with amoebic dysentery or malaria infection. Toxic hepatitis is usually caused by alcohol. As a result of excessive alcohol consumption, the liver incorporates more and more fats into its cells. Gradually, a fatty liver develops. If the fatty liver cells become inflamed, this is called alcohol-related fatty liver hepatitis. However, fatty liver hepatitis can also occur in connection with other diseases such as diabetes mellitus or obesity. Even without inflammation, fatty liver causes liver enlargement due to heavy fat storage. Furthermore, storage diseases such as the iron storage disease hemochromatosis or special forms of the metabolic disease porphyria can cause hepatomegaly. Bile acid is formed in small ducts in the liver. This then flows via the draining bile ducts into the gallbladder and intestine. If the outflow is obstructed, for example by gallstones, during pregnancy or by a pancreatic head carcinoma that presses on the bile ducts, this results in a backlog of bile acids into the liver. This can result in hepatomegaly. Hepatomegaly can also be a symptom of right heart failure. In this case, the right ventricle is no longer able to pump the venous blood coming from the body further into the lungs. As a result, the blood backs up into the systemic circulation. This can lead to a so-called congested liver with enlargement of the liver. Occlusions of the inferior vena cava or bulging of the hepatic artery also cause blood stasis resulting in liver enlargement. Hepatomegaly should always be considered in the presence of a primary liver tumor or liver metastases.
Typical and common liver diseases
- Cirrhosis of the liver
- Liver failure
Symptoms, complaints and signs
Hepatomegaly can be manifested by very different symptoms. In the area of the liver, there are the typical signs of jaundice, that is, a yellowish discolored skin, brittle fingernails and an increasing feeling of illness. In most cases, skin itching is also present, which can spread to the entire body in the course of the disease. In the late stages of the disease, redness can develop, which hurts when touched and in some cases causes bleeding. In addition, there may be sensory disturbances and other problems in the area of the skin. Accompanying this, most patients complain of a feeling of pressure in the right upper abdomen and uncharacteristic upper abdominal pain that occurs suddenly and increases in intensity as the disease progresses.The above-mentioned symptoms usually occur in conjunction with classic signs of illness such as fever, exhaustion and malaise. Patients are also frequently tired and fatigued. After meals, a strong feeling of fullness sets in almost immediately. In the course of the disease, various other symptoms may occur, depending on the cause. If congestion-related complaints are the cause, severe pain occurs in the book room, accompanied by constipation or urinary retention. If a fatty liver is causative, hepatomegaly often occurs in conjunction with cardiovascular complaints and symptoms of intoxication.
Diagnosis and course
To make the diagnosis, the physician first palpates the abdomen to assess the extent of liver enlargement. In doing so, he or she may also assess the consistency of the liver. In hepatitis or a congested liver, the consistency tends to be soft; in a tumor, it tends to be coarse. A yellowing of the skin, visible dilatation of vessels or reddened palms indicate liver disease, whereas swollen legs, for example, tend to indicate right heart failure. The physical examination is followed by an analysis of the blood. The blood cell sedimentation rate (ESR), liver enzymes (e.g., GOT and GPT), and blood coagulation are determined. A differential blood count is also obtained. Routine evaluation of hepatomegaly also includes sonography of the abdomen. If specific diseases such as tuberculosis or sarcoidosis are suspected as triggers of the hepatomegaly, a liver biopsy may be necessary. In this case, tissue is removed during a liver puncture and examined in the laboratory.
Complications
Hepatomegaly causes severe enlargement of the liver. This can cause displacement or squeezing of the other organs, so they are damaged as well. Usually, hepatomegaly does not occur as a single symptom, but is a complaint of liver cirrhosis or liver failure. Due to the discomfort of the liver, jaundice occurs in most cases and the inner surfaces of the patient’s hands turn red in the process. The legs may also swell and hurt due to the disease. The patient’s quality of life is limited by this disease. However, it is not possible to make a general prediction of the complications or symptoms, as these depend on the type and severity of the enlargement. However, it is not uncommon for the kidneys to be affected by hepatomegaly. The disease is treated without complications with the help of antibiotics. The disease progresses positively after only a few weeks. No further complaints occur. If necessary, the affected person must avoid the consumption of alcohol. With proper and early treatment, hepatomegaly does not result in a reduced life expectancy.
When should you see a doctor?
When signs of jaundice are noticed, often associated with skin itching and pain in the right upper abdomen, hepatomegaly may underlie the condition. Medical advice is needed if the symptoms persist for more than a week and increase in intensity as they progress. If further symptoms occur, a visit to the doctor is also advisable. General symptoms such as a rapid feeling of fullness, fatigue or a general feeling of malaise must be clarified in any case. If hepatomegaly remains untreated, serious complications such as contusions of other organs or chronic pain can develop. Individuals suffering from fatty liver and other diseases of the liver are particularly at risk. Hepatomegaly can also develop as a result of congestion-related conditions such as right heart failure or tumors. Anyone who belongs to these risk groups should have the symptoms mentioned clarified quickly. In addition to the family doctor, a specialist in liver diseases (hepatologist) or specialists in internal medicine can be consulted. If symptoms are severe, it is best to go directly to a specialist or the nearest hospital.
Treatment and therapy
Therapy for hepatomegaly involves treatment of the underlying disease. Acute viral hepatitis usually heals on its own. Care should be taken to maintain a liver-sparing diet and adequate rest. However, hepatitis C in particular tends to become chronic. Therefore, interferon and other virus-inhibiting drugs are used here. Bacterial liver inflammation is treated with antibiotics. If the liver inflammation is caused by alcohol abuse, alcohol is strictly prohibited.In the case of an enlarged fatty liver that is not caused by alcohol, the cause must be found and treated. Obese patients should lose weight, and patients with diabetes mellitus must have their blood glucose levels optimally adjusted. If the liver enlargement is due to right heart weakness, ACE inhibitors, diuretics or beta-blockers are used to relieve the heart. Smoking and alcohol should be taboo, and stress and weight should be reduced.
Outlook and prognosis
The prognosis of hepatomegaly depends, among other factors, on the size of the liver or the rate at which it grows, as well as its sensitivity to touch. The underlying disease also has a significant impact on whether and to what extent the liver enlargement can be treated. If hepatomegaly is recognized quickly, the growth of the organ can be slowed or even stopped by dietary and drug measures. There is a chance of complete recovery if the causative condition can be cured. A far advanced disease, in which cirrhosis of the liver may already have developed, can no longer be treated causally and can only be treated symptomatically to a limited extent. Therapy focuses on preventing further complications such as a liver infarction or the development of liver cancer, or on detecting these secondary diseases at an early stage. Liver transplantation may still be able to treat advanced hepatomegaly. However, there is a risk that the body will reject the donor organ. An enlarged liver that is already in the terminal stage can no longer be treated. Typically, therapy is then limited to pain relief. Eventually, palliative medical measures are initiated.
Prevention
Hepatomegaly can be prevented only to a limited extent. Vaccinations are available to protect against hepatitis A and hepatitis B. Other viral or bacterial infections are difficult to prevent. A stable immune system is certainly helpful. Alcohol-related fatty liver hepatitis can be prevented by abstaining from alcohol. To prevent fatty liver, regular monitoring of blood glucose levels and adequate exercise are recommended, as is a healthy diet to prevent obesity.
Follow-up
In most cases, those affected by hepatomegaly have no or very few follow-up care measures available to them. Therefore, they are primarily dependent on a quick and, above all, an early diagnosis in this disease, so that no further complications occur and also no further worsening of these symptoms. A doctor should therefore be consulted at the very first symptoms and signs of hepatomegaly. In this case, treatment is usually carried out by taking medications, primarily antibiotics. Attention should be paid to a correct dosage with a regular intake in order to relieve the symptoms permanently and properly. Furthermore, it should also be noted that the antibiotics should not be taken together with alcohol, otherwise their effect is greatly weakened. If you have any questions or if you are unsure, always consult a doctor. In general, a healthy lifestyle with a healthy diet also has a positive effect on the course of the disease. The affected person should also refrain from smoking and achieve a healthy weight. In some cases, this disease reduces the life expectancy of affected individuals.
This is what you can do yourself
Hepatomegaly cannot be treated directly through self-help means. Sufferers must rely on the help and treatment of a doctor. In some cases, the disease can also be prevented by hepatitis A and B vaccinations. However, this does not guarantee complete protection. Likewise, a strong immune system can have a very positive effect on the further course of the disease. If the affected person suffers from alcohol dependence, this must be stopped immediately. This may also require withdrawal, which can be carried out in a clinic. In this case, the support of friends and family has a positive effect on the success of the withdrawal. Regular control of blood sugar levels and a healthy lifestyle with a healthy diet can also prevent the disease. Medical treatment is carried out with the help of antibiotics and other medications.Possible interactions with other medications should be clarified by the physician. Furthermore, regular checks and examinations of the liver and other organs are necessary.
