Hepatomegaly

Definition

Hepatomegaly is a condition where the liver is enlarged beyond its limit.

The liver is the largest organ in your body and is responsible for many functions such as¹

• Manufactures proteins and hormones
• Curbs blood clotting process
• Defends the body against infections
• Digests fats
• Breaks down harmful substances and medications
• Stores glycogen

Location of Liver

If you have an enlarged liver, your body is not able to perform the above functions properly.

Causes of Hepatomegaly

Hepatomegaly occurs as a result of many causes such as^{2, 4}

Cancer

Malignant growths that develop in your liver cause it to enlarge. Other cancers develops anywhere in your body and spreads to your liver causing it to increase in size. Some cancers that develop in your bone marrow, plasma cells and lymphatic system may also spread into your liver and cause it to enlarge.

Cirrhosis

This is an illness that damages or causes permanent scarring of your liver. Cirrhosis occurs as a result of prolonged intake of alcohol. This disease might also contribute to enlargement of your liver.

Image 3 – Cirrhosis of Liver

Hepatitis

Viruses can enter your body and reach the liver and cause an infection called hepatitis. There are different forms of hepatitis such as C, B and A. When you have any of these forms of hepatitis, your liver may be damaged or become enlarged.

Nonalcoholic fatty liver disease

This is condition where fats accumulate in your liver. A deposit of fat in your liver is associated with consumption of alcohol. This buildup of fat can cause your liver to enlarge beyond its limit.

Image 4 – Non Alcoholic Fatty Liver Disease (steatohepatitis)

Blood vessel and heart abnormalities

Abnormalities in your blood vessels may obstruct veins that take blood away or arteries that bring blood into the liver. This may cause your liver to enlarge.

Wilson’s disease

This is a condition where copper accumulates in your liver. Continued buildup of copper in your liver may cause it to enlarge.

Image 5 – Wilson’s Disease

Others

• Obstruction of your gallbladder or bile duct can cause your liver to become inflamed.
• Toxic substances in your body can damage your liver leading to its enlargement.

Risk Factors

There are several factors that can increase your risk of developing hepatomegaly. Your liver may increase in size if you²

• Drink excess alcohol
• Are overweight or obesity
• Have a history of liver cancer and autoimmune diseases that affect the liver
• Have sickle cell anemia
• Have inflammatory bowel disease
• Stay in a place where malaria is very common
• Engage in unprotected sex
• Undergo blood transfusion from a person who has HIV/AIDS

Symptoms

Symptoms of hepatomegaly depend on the underlying cause. An enlarged liver may cause the following symptoms⁴:

• Your skin and eyes becomes yellow, a condition known as jaundice. You also experience fatigue which is accompanied with muscle aches. People with enlarged liver complain of body itching and abdominal pain. In some cases, they may notice an increase in their abdomen size.
• Other symptoms of hepatomegaly are nausea and vomiting. Some people with this condition report loss of weight. Loss of appetite is another symptom of people with enlarged liver. You may also experience swellings in your legs and feet.

When to seek Treatment?

Seek urgent medical attention if you notice the following symptoms³:

You have jaundice which is accompanied with fever. You experience severe pain in your abdomen. You notice blood in your vomit. You experience shortness of breath.

Diagnosis

If you have an enlarged liver, your doctor will consider factors such as age, body shape, weight and gender to diagnose the condition. Your doctor will conduct a physical exam to understand the condition you are suffering from. Your doctor will want to know the symptoms you are experiencing and your medical history.^{1, 2}

Your doctor can order the following tests to confirm diagnosis of hepatomegaly:

Ultrasound

Powerful sound waves are released in your abdomen to check for any abnormalities in the liver and abdomen.

Magnetic Resonance Imaging

MRI scan is used to observe your liver to find out if it is enlarged or there are other issues.

Computed tomography scan

CT scan is used to produce different pictures of your liver and abdomen. These pictures are evaluated by the doctor to determine if the liver is enlarged.

X-rays

Your doctor may order non invasive x-rays on your abdomen to assess the liver to check for any problems.

Complete blood count

Complete blood count is vital because it helps to determine the quantity of abnormal blood cells. In this test, your doctor collects blood and takes a sample of it for analysis in the laboratory.

Liver function test

Your doctor can order an evaluation of the enzymes in the liver to assess the function of the liver.

Biopsy

Liver biopsy can be ordered to help find out the cause of liver enlargement. In this procedure, your doctor performs surgery on your liver to remove a sample of the liver tissue and observes it under a microscope for any abnormalities.

Treatment

Treatment for hepatomegaly is based on what is causing it. Some of the treatment options your doctor may recommend to treat an enlarged liver include²

Cancer therapy

If cancer is the cause of an enlarged liver, radiation and chemotherapy can be used to treat it. Chemotherapy involves use of drugs to destroy the cancer cells. Radiation therapy uses radiation to eliminate cancerous cells.

Medications

Your doctor will prescribe drugs to treat hepatitis infections and liver failure.

Surgery

In some cases, your doctor can order surgery to remove the enlarged liver. Once the liver is removed, your doctor can recommend liver transplant from a compatible donor.

Prevention

You can take the following lifestyle changes to manage hepatomegaly²:

• Stop drinking alcohol or limit its intake.
• Manage your weight by exercising and eating a healthy diet.
• Talk to your doctor before using vitamin supplements and herbs. because some of them may react with the liver and damage it.
• Talk to your doctor which drugs to avoid since some of them can cause malignant cells to form within your liver.

Reference List

1. Hepatomegaly – Symptoms, Causes, Treatment https://medlineplus.gov/ency/article/003275.htm
2. Enlarged Liver from https://www.healthline.com/symptom/liver-enlarged
3. Liver location – https://www.uptodate.com/contents/hepatomegaly-differential-diagnosis-and-evaluation
4. Hepatomegaly – http://www.nytimes.com/health/guides/symptoms/hepatomegaly/overview.html