Hepatomegaly Definition and Meaning
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 in 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 upper right abdomen and weighs between 1.4 and 1.9 kilograms in adult humans.
In a healthy state, the liver has a soft structure and can easily be felt under the right costal arch in slim people. In hepatomegaly, the liver is enlarged. Depending on the extent, the liver can then even become visible or can even be felt in obese patients. Hepatomegaly can have many causes and is therefore not a disease but an examination finding.
Liver enlargement can have many causes. In general, the liver can enlarge when it is inflamed. Inflammation of the liver is called hepatitis. For example, hepatitis with enlarged liver can be caused by viral infections.
Viruses are responsible for hepatitis A to hepatitis E. Infection with 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. Leptospira, Brucella and Salmonella in particular are possible here.
In the case of liver swelling, a 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 builds more and more fats into its cells. Gradually, a fatty liver develops. If the fatty liver cells become inflamed, this is referred to as 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, the fatty liver causes liver enlargement due to the heavy accumulation of fat. 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 efferent bile ducts into the gallbladder and intestines.
If the flow is obstructed, for example by gallstones, during pregnancy or by a carcinoma of the head of the pancreas, which presses on the bile ducts, this results in a backlog of bile acids up to the liver. This can result in hepatomegaly.
Hepatomegaly can also be a symptom of right heart failure or right heart failure. The right ventricle is no longer able to pump the venous blood from the body into the lungs. This causes the blood to back up into the systemic circulation.
This can lead to what is known as congestion with liver enlargement. Blockages of the inferior vena cava or bulges in the hepatic artery also cause blood to congest, resulting in liver enlargement. In the case of hepatomegaly, a primary liver tumor or liver metastases should always be considered.
Typical & common liver diseases
- liver cirrhosis
- liver failure
Symptoms, Ailments & Signs
Hepatomegaly can manifest itself through a wide variety of symptoms. The typical signs of jaundice occur in the liver area, i.e. yellowish discolored skin, brittle fingernails and an increasing feeling of illness. Skin itching is usually added, which can spread to the entire body as the disease progresses.
In the late stages of the disease, redness can develop that hurts when touched and, in some cases, causes bleeding. Sensitivity disorders and other skin problems can also occur. Accompanying this, most patients complain of a feeling of pressure in the upper right abdomen and uncharacteristic upper abdominal pain that occurs suddenly and increases in intensity over time.
The symptoms mentioned usually occur in connection with classic signs of illness such as fever, exhaustion and malaise. Patients are also often tired and exhausted. A strong feeling of fullness sets in almost immediately after meals. Depending on the cause, various other symptoms can occur as the disease progresses.
If congestion-related complaints are the cause, severe pain occurs in the book space, accompanied by stool or urinary retention. If fatty liver is the cause, hepatomegaly often occurs in connection with cardiovascular problems and symptoms of poisoning.
Diagnosis & History
To make the diagnosis, the doctor first scans the abdomen to assess the extent of liver enlargement. He can also assess the consistency of the liver. In the case of hepatitis or a congested liver, the consistency is rather soft, in the case of a tumor it is rather firm. A yellow discoloration of the skin, visible enlargement of blood vessels or reddened palms of the hands indicate liver disease, whereas swollen legs, for example, are more likely to indicate right heart failure.
The physical examination is followed by an analysis of the blood. The blood cell sedimentation rate (ESR), the liver enzymes (e.g. GOT and GPT) and blood coagulation are determined. A differential blood count is also made.
Routine clarification of hepatomegaly also includes abdominal sonography. A liver biopsy may be necessary if specific diseases such as tuberculosis or sarcoidosis are suspected to be the cause of hepatomegaly. Tissue is removed during a liver puncture and examined in the laboratory.
Hepatomegaly causes the liver to become enlarged. This can cause the other organs to be displaced or crushed, causing them to be damaged as well. As a rule, hepatomegaly does not appear as a single symptom, but is a complaint of liver cirrhosis or liver failure. In most cases, the liver problems cause jaundice and the palms of the patient’s hands turn red.
The legs can also swell and hurt as a result of the disease. The quality of life of the patient is reduced by this disease. However, no general prediction of the complications or symptoms is possible, as these depend on the type and strength of the enlargement. Not infrequently, however, the kidneys are also affected by hepatomegaly.
Treatment of the disease is carried out without complications with the help of antibiotics. A positive course of the disease occurs after just a few weeks. There are no other complaints. If necessary, the person concerned must avoid the consumption of alcohol. With correct and early treatment, hepatomegaly does not lead to a reduced life expectancy.
When should you go to the doctor?
If signs of jaundice are noticed, often associated with skin itching and pain in the upper right abdomen, hepatomegaly may be the underlying cause. Medical advice is required if the symptoms persist for more than a week and increase in intensity over time. If you have other symptoms, you should also see a doctor. General symptoms such as a rapid feeling of fullness, tiredness or a general feeling of being unwell must be clarified in any case.
If left untreated, hepatomegaly can result in serious complications such as bruising of other organs or chronic pain. People suffering from fatty liver and other liver diseases are particularly at risk. Hepatomegaly can also develop from congestion-related symptoms such as right heart failure or tumors.
Those who belong to these risk groups should have the symptoms mentioned quickly clarified. In addition to the family doctor, a specialist in liver diseases (hepatologist) or specialists in internal medicine can be consulted. In the case of severe symptoms, it is best to go straight to a specialist or the nearest hospital.
Treatment & Therapy
Hepatomegaly is treated by treating the underlying disease. Acute viral hepatitis usually heals on its own. A liver-friendly diet and adequate rest should be ensured. However, hepatitis C in particular tends to become chronic. Interferon and other virus-inhibiting drugs are therefore used here.
Bacterial liver inflammation is treated with antibiotics. If the liver inflammation is caused by alcohol abuse, there is a strict ban on alcohol. 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, in patients with diabetes mellitus the blood sugar level must be optimally adjusted.
If the liver enlargement is due to right heart failure, ACE inhibitors, diuretics or beta-blockers are used to relieve the heart. Smoking and alcohol should be taboo, stress and weight should be reduced.
Outlook & Forecast
The prognosis of hepatomegaly depends, among other things, on the size of the liver or the rate of growth of the liver and its sensitivity to touch. The underlying disease also has a significant influence on whether and to what extent the enlarged liver can be treated. If hepatomegaly is recognized quickly, the growth of the organ can be slowed down or even stopped by dietary and medicinal measures.
There is a chance of a full recovery if the condition that caused it can be cured. A very advanced disease, in which cirrhosis of the liver may have already developed, can no longer be treated causally and only to a limited extent can be treated symptomatically.
The therapy focuses on avoiding further complications such as a liver infarction or the development of liver cancer or on recognizing these secondary diseases at an early stage. Under certain circumstances, even advanced hepatomegaly can still be treated with a liver transplant . However, there is a risk that the body will reject the donor organ.
An enlarged liver that is already in the end-stage can no longer be treated. Typically, therapy is then limited to relieving the pain. Finally, palliative care measures are initiated.
Hepatomegaly can only be prevented 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 disease can be prevented by abstaining from alcohol. Regular monitoring of blood sugar levels, sufficient exercise and a healthy diet to prevent obesity are recommended to prevent fatty liver.
In most cases, those affected by hepatomegaly have no or only very few follow-up measures available. Therefore, they are primarily dependent on a quick and, above all, early diagnosis of this disease, so that there are no further complications and also no further deterioration of these symptoms. A doctor should therefore be consulted as soon as the first symptoms and signs of hepatomegaly appear.
The treatment is usually carried out by taking medication, with antibiotics being used in the first place. Care should be taken to ensure a correct dosage with regular intake in order to relieve the symptoms permanently and correctly. Furthermore, it should also be noted that the antibiotics should not be taken together with alcohol, otherwise their effect will be greatly weakened.
If you have any questions or are unclear, always consult a doctor. In general, with hepatomegaly, a healthy lifestyle with a healthy diet also has a positive effect on the course of the disease. The person concerned should also give up smoking and achieve a healthy weight. In some cases, the life expectancy of those affected is reduced by this disease.
You can do that yourself
Hepatomegaly cannot be treated directly by self-help means. Those affected are dependent on the help and treatment of a doctor.
In some cases, the disease can also be prevented by hepatitis A and B vaccinations. However, full protection is not guaranteed. A strong immune system can also have a very positive effect on the further course of the disease. If the person concerned suffers from alcohol dependence, this must be stopped immediately.
A withdrawal may also be necessary, which can be carried out in a clinic. The support of friends and family has a positive effect on the success of the withdrawal. Regular monitoring of blood sugar levels and a healthy lifestyle with a healthy diet can also prevent the disease.
Medical treatment consists of antibiotics and other medications. Possible interactions with other medications should be clarified by the doctor. Furthermore, regular checks and examinations of the liver and other organs are necessary.