The diagnosis
A physical examination is sufficient to diagnose an enlarged liver. The doctor can determine the size of the liver with a stethoscope and a finger (scratch auscultation), by tapping (percussion) or by palpation. If the examination reveals an enlarged liver, the underlying disease responsible for the enlarged liver must be found.
This can be done by examining the liver values in the blood and by ultrasound examination of the liver and other abdominal organs. Depending on the abnormalities, further examinations are then possible. The doctor will look at the so-called transaminases, which are produced by the liver cells and are elevated in many different liver diseases because they are released by the damage to the liver cells.
These include: However, LDH is also found in muscle cells or red blood cells. Other laboratory values are also called “cholestasis enzymes” because they are elevated in cholestasis (bile stasis). These include: Alkaline phosphatase (AP), it can also be elevated in bone changes or in pregnancy.
Gamma-glutamyl transferase (GGT) is produced in increased quantities even in cases of minor damage. In addition, the production capacity of the liver can be estimated on the basis of laboratory values for blood coagulation, the amount of protein in the blood and the cholinesterase level in the blood.
- BPT/ALT
- GOT/AST
- Glutamate dehydrogenase (GLDH)
- Lactate dehydrogenase (LDH)
The accompanying symptoms
Typical symptoms of an enlarged liver are a feeling of pressure or tension in the right upper abdomen, loss or reduction of appetite, and pressure pain in the liver area caused by the tightened organ capsule. Further accompanying symptoms are:
- Icterus: The icterus is also called jaundice and is characterized by yellowing of the eyes and in more severe cases of the skin. The cause is an increased bilirubin level in the blood.
Bilirubin is produced when the red blood pigment is broken down and must be further processed in the liver. If the liver is damaged, this process can be disrupted. In the case of jaundice, brown urine and a discolored, light-white stool often occur.
- Itching: In case of bile stasis, the bile acids cannot enter the digestive tract as usual.
Instead, their concentration in the blood rises and they deposit in the skin, causing itching.
- Ascites (“abdominal dropsy”): Ascites is the technical term for free fluid in the abdominal cavity. Patients notice that their abdomen is getting bigger and they gain weight. They often also suffer from flatulence or impaired breathing.
The most common cause is decompensated cirrhosis of the liver.
- Liver skin signs: Many different signs on the (mucous) skin and nails can occur in liver disease. These include spider nevi, whitish discolored fingernails, the so-called varnished tongue, a thinning of the skin, red palms, bald belly or a distinct vein pattern on the abdomen (Caput medusae).
- Bleeding: If the function of the liver is severely restricted, this can lead to disorders of blood clotting and bleeding in the skin.
- Edemas: If liver function is impaired, fewer proteins are produced, resulting in fluid leaking from the blood vessels and the formation of water retention
- Feminization: In men with limited liver function, the development of breasts and atrophy of the testicles can occur because the female sex hormones can no longer be sufficiently broken down.
With an enlarged liver, pain cannot usually be caused by damage to the liver cells themselves. This is because the liver itself does not contain any pain-conducting nerve fibers.
Pain can therefore only occur when pain fibers from the surrounding area are stimulated.This can be the case with an enlarged liver, for example, in the surrounding organs. Pain in an enlarged liver is also frequently reported as unspecific pain in the right upper abdomen. If the liver is particularly enlarged, the liver capsule can also be stretched. This capsule also contains pain-conducting nerve fibers and can thus transmit the signal of pain to the brain.
