Hepatomegaly: Symptoms, Causes, Risk Factors, Diagnosis, Treatments, Outlook and Prevention

It is associated with an enlarged liver. Your liver is the largest internal organ. Help your body to:

  • Digest fats
  • Store sugar in the form of glycogen.
  • Fight infection.
  • Produce proteins and hormones.
  • Control blood clotting.
  • Break down drugs and toxins.

The liver is also the only internal organ that can grow back after surgery, making liver donation possible.

If you donate a portion of your liver, it will regenerate to its original size. The transplanted part will also grow.

If you have an enlarged liver, it could mean that you have:

  • A liver disease.
  • Cancer, like leukemia.
  • A genetic disease.
  • Heart and blood vessel abnormalities.
  • An infection.
  • Toxin poisoning.

Many of the symptoms that cause hepatomegaly can affect how well your liver works and help your body.

While hepatomegaly is always a cause for medical evaluation, not all underlying conditions are considered medical emergencies. Make an appointment with your doctor if you have signs or symptoms of an enlarged liver.

What are the signs and symptoms of hepatomegaly?

An enlarged liver itself may not have any symptoms. But if a medical condition is causing you to have an enlarged liver, you may experience serious symptoms, such as:

  • Jaundice or yellowing of the skin and eyes.
  • Muscle pains.
  • Fatigue.
  • Itch.
  • Nausea.
  • Vomiting
  • Abdominal pain.
  • Poor appetite
  • Swelling of the feet and legs
  • Easy bruising.
  • Weightloss.
  • Increase in abdominal size.

Any of these symptoms requires evaluation by your doctor.

Call 911 or seek emergency medical attention immediately if you have:

  • Severe abdominal pain
  • Fever and jaundice
  • Bloody or brown vomit.
  • Difficulty breathing.
  • Black, tarry stools, or bright red blood in the stools.

These symptoms are considered medical emergencies.

What are the causes?

Hepatomegaly is often a sign that the tissue within the liver is not working properly. Taking certain medications, such as amiodarone and statins, can also cause liver damage.

Common causes include:

  • Metastatic cancer or cancer that begins in other organs and spreads to the liver.
  • Nonalcoholic fatty liver disease or accumulation of fat in the liver that is not due to alcohol.
  • Heart and blood vessel abnormalities, or conditions that block the veins that drain or carry blood to the liver.
  • Liver cancer or cancer that grows within the liver.
  • Cirrhosis , or advanced damage and scarring of the liver due to toxins such as alcohol.
  • Viral hepatitis (most commonly A, B, or C), or different liver infections each caused by a virus.
  • Alcoholic liver disease or a range of liver damage that includes fat deposits, inflammation, and scarring from alcohol use.

Congestive heart failure can also cause blood to back up into the liver veins .

These are the veins that help drain blood from the liver. When they recede, the liver will become congested and grow. This is called congestive hepatomegaly.

Less common causes of hepatomegaly include:

  • Lymphoma or blood cancer in the lymphatic system.
  • Leukemia, or a type of blood cancer of the bone marrow.
  • Multiple myeloma, or a type of cancer of the blood of the bone marrow specific to plasma cells.
  • Hemochromatosis or accumulation of iron in the liver.
  • Wilson’s disease , or accumulation of copper in the liver.
  • Gaucher disease, or a disorder that causes the accumulation of fatty substances in the liver.
  • Toxic hepatitis or inflammation of the liver from chemical poisoning.
  • Obstruction of the gallbladder or bile duct, or bile backup and inflammation within the liver, often from gallstones.
  • Liver cysts, or fluid-filled sacs within the liver from a variety of causes.

Some infections and certain medical conditions can cause liver tumors to form .

Growths in the liver can be benign (not cancer) or malignant (cancer). Usually any growth will cause your liver to enlarge.

What are the risk factors for hepatomegaly?

Some people are genetically at increased risk for hepatomegaly. You may be at higher risk if you or your family have a history of:

  • Autoimmune disorders, especially those that affect the liver.
  • Inflammatory bowel disease
  • Chronic liver disease.
  • Liver cancers
  • Sickle cell disease
  • Obesity .

Lifestyle factors can also increase a person’s risk for hepatomegaly. These lifestyle factors include:

  • Excessive alcohol consumption.
  • Tattoos, blood transfusions, and unprotected sex, which put you at risk for HIV and hepatitis B and C.
  • Travel to foreign countries associated with malaria risks.
  • Take herbs like ma huang, comfrey, and mistletoe.

Talk to your doctor for more information if you have questions about your risks for hepatomegaly. Always inform your doctor of any over-the-counter or herbal supplements you are taking.

How will your doctor diagnose hepatomegaly?

Your liver is a triangular organ. It is located below the diaphragm, below the lower border of the right rib cage.

You may have an enlarged liver if your doctor can feel it during a physical exam. A typical liver cannot be felt with the fingers.

The size and weight of your liver naturally increase with age. For children, the liver is usually measured by its length, through its thickest part from top to bottom. Adult livers are measured by length.

Average liver size varies by age and can be:

  • 6.4 cm for 1-3 months.
  • 7.6 cm for 4-9 months.
  • 8.5 cm for 1-5 years.
  • 10.5 cm for 5-11 years.
  • 11.5-12.1 cm for 12-16 years.
  • 13.5 cm, +/- 1.7 cm for adult women.
  • 14.5 cm, +/- 1.6 cm for adult men.

Body shape, weight, and gender can also affect the size of your liver. Your doctor will take these into account when examining your liver for possible signs of hepatomegaly.

To find out why you have hepatomegaly, your doctor may order a variety of tests, such as:

  • A complete blood count to check for an abnormal number of blood cells.
  • Liver enzymes, to assess liver function.
  • Abdominal radiography, a non-invasive x-ray study to evaluate the abdominal organs.
  • Computed tomography (CT) for high-resolution images of the abdomen.
  • Magnetic Resonance Imaging (MRI) for high resolution imaging of specific abdominal organs.
  • Ultrasound, the use of sound waves to evaluate the liver and other abdominal organs.

If a doctor suspects a more serious condition, he or she may recommend a liver biopsy. A liver biopsy is a surgical test where your doctor takes a small sample of your liver for microscopic examination.

What are the treatments for hepatomegaly?

Your treatment options depend on the underlying disorders causing your liver to enlarge. Some of the treatments your doctor will recommend may include:

  • Medications and treatments for liver failure or infections such as hepatitis C.
  • Chemotherapy, surgery, or radiation for liver cancer.
  • A liver transplant for liver damage.
  • Treat the source of the metastatic cancer.
  • Treatment for lymphoma or leukemia, depending on the type, extent of spread, and your general health.
  • Give up alcohol or any other drug.

Once your doctor confirms hepatomegaly, they will generally recommend lifestyle changes for the health of your liver. These include:

  • Refrain from drinking alcohol.
  • Eat a healthy diet.
  • Participate in regular exercise.
  • Lose weight if you are overweight.

What is the outlook for this condition?

The prospects for recovery and reduction of symptoms depend on the underlying cause of your hepatomegaly. You may have a better outcome if your doctor discovers hepatomegaly in its early stages.

Medications are available to reduce the symptoms of conditions such as congestive heart failure and liver failure.

Sometimes the symptoms of hepatomegaly do not appear until the later stages. Severe liver damage can lead to life-long complications.

How can hepatomegaly be prevented?

There are many lifestyle factors that can cause hepatomegaly. Controlling these factors can lower the risk of an enlarged liver.

Here are some things you can do:

  • Follow a healthy lifestyle and maintain a healthy weight.
  • Check your blood sugar level if you have diabetes.
  • Limit your alcohol intake or consider not drinking at all. Your doctor will be able to tell you if your intake is excessive.
  • Talk to your doctor before taking vitamin supplements, as they can interact with your liver.
  • Talk to your doctor about the herbal supplements you are considering.
  • Always follow your employer’s recommendations for safe handling if you work with chemicals, such as insecticides or aerosol cleaners.

What are the next steps after a diagnosis?

The likelihood of feeling an enlarged liver is unlikely. But because damage to your liver can cause fluid to build up inside your abdomen, you may notice that your stomach sticks out more than normal.

You may also experience other symptoms such as jaundice, loss of appetite, and stomach pain. Make an appointment with your doctor if you think you may have signs or symptoms of hepatomegaly.

Your liver is a vital organ. The best way to monitor the health of your liver is to follow your doctor’s instructions regarding healthy practices.

This could include exercising more, drinking less alcohol, and eating a balanced diet.