Hepatomegaly is the condition of having an enlarged

liver The liver is a major Organ (anatomy), organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of proteins and biochemicals necessary for ...

. It is a non-specific

medical sign Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showin ...

having many causes, which can broadly be broken down into

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...

hepatic tumour Liver cancer (also known as hepatic cancer, primary hepatic cancer, or primary hepatic malignancy) is cancer that starts in the liver. Liver cancer can be primary (starts in liver) or secondary (meaning cancer which has spread from elsewhere to th ...

s, or

metabolic disorder A metabolic disorder is a disorder that negatively alters the body's processing and distribution of macronutrients, such as proteins, fats, and carbohydrates. Metabolic disorders can happen when abnormal chemical reactions in the body alter the ...

. Often, hepatomegaly will present as an

abdominal mass An abdominal mass is any localized enlargement or swelling in the human abdomen. Depending on its location, the abdominal mass may be caused by an enlarged liver (hepatomegaly), enlarged spleen (splenomegaly), protruding kidney, a pancreatic mass, ...

. Depending on the cause, it may sometimes present along with

jaundice Jaundice, also known as icterus, is a yellowish or greenish pigmentation of the skin and sclera due to high bilirubin levels. Jaundice in adults is typically a sign indicating the presence of underlying diseases involving abnormal heme meta ...

Signs and symptoms

The individual may experience many symptoms, including weight loss,

poor appetite Anorexia is a medical term for a loss of appetite. While the term in non-scientific publications is often used interchangeably with anorexia nervosa, many possible causes exist for a loss of appetite, some of which may be harmless, while others i ...

and

lethargy Lethargy is a state of tiredness, sleepiness, weariness, fatigue, sluggishness or lack of energy. It can be accompanied by depression, decreased motivation, or apathy. Lethargy can be a normal response to inadequate sleep, overexertion, overwo ...

(

and bruising may also be present).

Causes

Among the causes of hepatomegaly are the following:

Infective

Mechanism

The mechanism of hepatomegaly consists of

vascular The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away f ...

swelling,

inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...

(due to the various causes that are

infectious An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...

in origin) and deposition of (1) non-hepatic cells or (2) increased cell contents (such due to iron in

hemochromatosis Iron overload or hemochromatosis (also spelled ''haemochromatosis'' in British English) indicates increased total accumulation of iron in the body from any cause and resulting organ damage. The most important causes are hereditary haemochromatosi ...

hemosiderosis Hemosiderosis is a form of iron overload disorder resulting in the accumulation of hemosiderin. Types include: * Transfusion hemosiderosis * Idiopathic pulmonary hemosiderosis * Transfusional diabetes Organs affected: * Hemosiderin depositi ...

and fat in fatty liver disease).

Diagnosis

Liver size at the midclavicular line at 0 to 7 years

Suspicion of hepatomegaly indicates a thorough

medical history The medical history, case history, or anamnesis (from Greek: ἀνά, ''aná'', "open", and μνήσις, ''mnesis'', "memory") of a patient is information gained by a physician by asking specific questions, either to the patient or to other peo ...

and

physical examination In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the patien ...

, wherein the latter typically includes an increased

liver span The liver span is a measurement performed during physical examination to determine the size of the liver and identify possible hepatomegaly. It is the distance between the lower border of the liver in the mid-clavicular line obtained by palpation ...

. On

abdominal ultrasonography Abdominal ultrasonography (also called abdominal ultrasound imaging or abdominal sonography) is a form of medical ultrasonography (medical application of ultrasound technology) to visualise abdominal anatomical structures. It uses transmission a ...

, the liver can be measured by the ''maximum dimension'' on a

sagittal plane The sagittal plane (; also known as the longitudinal plane) is an anatomical plane that divides the body into right and left sections. It is perpendicular to the transverse and coronal planes. The plane may be in the center of the body and divid ...

view through the

midclavicular line {{short description, None Anatomical "lines", or "reference lines," are theoretical lines drawn through anatomical structures and are used to describe anatomical location. The following reference lines are identified in ''Terminologia Anatomica'' ...

, which is normally up to 18 cm in adults. It is also possible to measure the '' cranio-caudal dimension'', which is normally up to 15 cm in adults. This can be measured together with the '' ventro-dorsal dimension'' (or ''depth''), which is normally up to 13 cm. Also, the

caudate lobe In human anatomy, the liver is divided grossly into four parts or lobes: the right lobe, the left lobe, the caudate lobe, and the quadrate lobe. Seen from the front – the diaphragmatic surface - the liver is divided into two lobes: the right ...

is enlarged in many diseases. In the

axial plane The transverse plane (also known as the horizontal plane, axial plane and transaxial plane) is an anatomical plane that divides the body into superior and inferior sections. It is perpendicular to the coronal and sagittal planes. List of cli ...

, the caudate lobe should normally have a cross-section of less than 0.55 of the rest of the liver. Other

ultrasound Ultrasound is sound waves with frequency, frequencies higher than the upper audible limit of human hearing range, hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hea ...

studies have suggested hepatomegaly as being defined as a longitudinal axis > 15.5 cm at the hepatic midline, or > 16.0 cm at the

Workup

Blood test A blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a hypodermic needle, or via fingerprick. Multiple tests for specific blood components, such as a glucose test or a cholester ...

s should be done, importantly liver-function series, which will give a good impression of the patient's broad metabolic picture. A complete blood test can help distinguish intrinsic liver disease from extrahepatic bile-duct obstruction. An

of the liver can reliably detect a dilated biliary-duct system, it can also detect the characteristics of a cirrhotic liver. Computerized tomography (CT) can help to obtain accurate

anatomical Anatomy () is the branch of biology concerned with the study of the structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old science, having it ...

information, in individuals with hepatomegaly for the purpose of a complete diagnosis.

Treatment

Treatment of hepatomegaly will vary depending on the cause of the liver enlargement and hence accurate diagnosis is the primary concern. In the case of auto-immune liver disease,

prednisone Prednisone is a glucocorticoid medication mostly used to immunosuppressive drug, suppress the immune system and decrease inflammation in conditions such as asthma, COPD, and rheumatologic diseases. It is also used to treat high blood calcium ...

and

azathioprine Azathioprine (AZA), sold under the brand name Imuran, among others, is an immunosuppressive medication. It is used in rheumatoid arthritis, granulomatosis with polyangiitis, Crohn's disease, ulcerative colitis, and systemic lupus erythematosus, ...

may be used for treatment. In the case of lymphoma the treatment options include single-agent (or multi-agent)

chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemotherap ...

and regional radiotherapy, also surgery may be an option in specific situations. Meningococcal group C conjugate

vaccine A vaccine is a biological Dosage form, preparation that provides active acquired immunity to a particular infectious disease, infectious or cancer, malignant disease. The safety and effectiveness of vaccines has been widely studied and verifie ...

are also used in some cases. In primary biliary cirrhosis

ursodeoxycholic acid Ursodeoxycholic acid (UDCA), also known as ursodiol, is a secondary bile acid, produced in humans and most other species from metabolism by intestinal bacteria. It is synthesized in the liver in some species, and was first identified in bile of ...

helps the bloodstream remove bile which may increase survival in some affected individuals.

References

External links

Merck ManualHepatomegaly
{{Medicine Hepatology Symptoms and signs: Digestive system and abdomen