Hepatomegaly is enlargement of the

liver The liver is a major metabolic organ (anatomy), organ exclusively found in vertebrates, which performs many essential biological Function (biology), functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of var ...

. It is a non-specific

medical sign Signs and symptoms are diagnostic indications of an illness, injury, or condition. Signs are objective and externally observable; symptoms are a person's reported subjective experiences. A sign for example may be a higher or lower temperature ...

, having many causes, which can broadly be broken down into

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

, hepatic tumours, and

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 presents as an abdominal mass. Depending on the cause, it may sometimes present along with

jaundice Jaundice, also known as icterus, is a yellowish or, less frequently, 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 ...

Signs and symptoms

The patient may experience many symptoms, including weight loss, poor appetite, 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, overw ...

;

and bruising may also be present.

Causes

Among the causes of hepatomegaly are the following:

Infective

Mechanism

The mechanism of hepatomegaly consists of

vascular Vascular can refer to: * blood vessels, the vascular system in animals * vascular tissue Vascular tissue is a complex transporting tissue, formed of more than one cell type, found in vascular plants. The primary components of vascular tissue ...

swelling,

inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...

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

hemochromatosis Iron overload is the abnormal and increased accumulation of total iron in the body, leading to organ damage. The primary mechanism of organ damage is oxidative stress, as elevated intracellular iron levels increase free radical formation via the ...

or hemosiderosis 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 a set of information the physicians collect over medical interviews. It involves the patient, and ev ...

and

physical examination In a physical examination, medical examination, clinical examination, or medical checkup, a medical practitioner examines a patient for any possible medical signs or symptoms of a Disease, medical condition. It generally consists of a series of ...

, wherein the latter typically includes an increased liver span. On abdominal ultrasonography, 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 divi ...

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 is enlarged in many diseases. In the

axial plane A transverse plane is a plane that is rotated 90° from two other planes. Anatomy The transverse plane is an anatomical plane that is perpendicular to the sagittal plane and the dorsal plane. It is also called the axial plane or horizontal ...

, 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 with frequency, frequencies greater than 20 Hertz, kilohertz. This frequency is the approximate upper audible hearing range, limit of human hearing in healthy young adults. The physical principles of acoustic waves apply ...

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 medical laboratory, 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 ...

s should be done, especially liver-function tests, which 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 A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...

(CT) can give accurate

anatomical Anatomy () is the branch of morphology concerned with the study of the internal 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 scien ...

information for a complete diagnosis.

Treatment

Treatment of hepatomegaly varies with the cause, so accurate diagnosis is the first concern. In 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 may be used for treatment. In lymphoma the treatment options include single-agent (or multi-agent)

chemotherapy Chemotherapy (often abbreviated chemo, sometimes CTX and CTx) is the type of cancer treatment that uses one or more anti-cancer drugs (list of chemotherapeutic agents, chemotherapeutic agents or alkylating agents) in a standard chemotherapy re ...

and regional radiotherapy, and surgery is 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 verifi ...

is used in some cases. In primary biliary cirrhosis, ursodeoxycholic acid helps the bloodstream remove bile, which may increase survival.

References

External links

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