Hepatomegaly - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Hepatomegaly can affect liver functions and may lead to serious complications. Only the liver cells have the capacity to regenerate their cells. The liver is the largest gland in the human body. It is unique as an organ, as it has a dual blood supply system: it receives a majority of blood supply via the portal vein and a minority from the hepatic artery. The liver has multiple functions, including vital roles in metabolism (a set of chemical reactions involved in maintaining the body's functions), infection control, detoxification (elimination of toxins from the body), and elimination of by-products through excretion.

What Are the Functions of the Liver?

The important functions of the liver are as follows:

• It plays a vital role in nutrient metabolism (carbohydrate, lipid, and amino acid). It is also involved in the metabolism of drugs and toxins. Thus, the liver is known for regulating the body's response to feeding and starvation.

• The liver produces proteins that are essential for the coagulation cascade (clotting of blood).

• The liver is responsible for bile production and plays a central role in bilirubin metabolism.

• The liver acts as a reservoir for vitamins and minerals. The liver stores vitamins A, D, and B12 in large amounts and vitamins K and iron in smaller amounts. These are used by the body whenever dietary intake is reduced.

What Is Hepatomegaly?

The normal liver weighs around 2.64 to 3.08 pounds in women and 2.64 to 3.30 pounds in men. Hepatomegaly is an enlargement of the liver beyond its actual size. Hepatomegaly can result from general liver enlargement due to primary or secondary tumors or underlying liver diseases. Hepatomegaly can affect liver functions and may lead to serious complications. The most common liver tumor in western countries is liver metastasis (a condition in which cancer spreads to different organs). Chronic viral hepatitis (liver inflammation) complicates primary liver cancer. These tumors cause massive hepatomegaly along with severe symptoms. Hepatomegaly is most commonly seen in cirrhosis and alcoholic liver disease. An enlarged liver affects liver functions and can cause severe complications. Therefore, people should always consult a doctor if there are any signs and symptoms of hepatomegaly. Hepatomegaly can be treated; however, the prognosis is conditional on the severity of the cause.

What Are the Causes of Hepatomegaly?

Hepatomegaly can result from multiple causes, cirrhosis being the most common among all causes. Hepatomegaly is much more common in alcoholic liver diseases and hemochromatosis (a condition in which excess iron accumulates in the body). These are the following causes of the enlarged liver:

• Carcinoma (liver cancer).

• Cirrhosis (a liver disease in which the liver’s function gets impaired).

• Alcoholic liver diseases.

• Non-alcoholic fatty liver diseases.

• Large liver cysts (a condition in which fluid accumulates in the liver, causing enlarged liver).

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• Hemochromatosis (a condition in which excess iron accumulates in the body).

• Obstruction in the hepatic vein, which carries blood to the liver.

• Viral hepatitis (an inflammation of the liver).

• Systemic diseases (heart diseases, diabetes, high cholesterol levels).

• Obesity can cause fat deposition in the liver resulting in liver enlargement.

What Are the Signs and Symptoms of Hepatomegaly?

Sometimes, hepatomegaly can be asymptomatic and patients do not experience any symptoms. An underlying disease can cause enlarged liver, then a person can experience the following symptoms:

• Abdominal discomfort.

• Abdominal pain.

• Nausea and vomiting.

• Weight loss.

• Malaise (a state in which a person experiences a lack of energy).

• Weakness.

• Fatigue.

• Loss of appetite.

• Pain in muscles.

• Swelling in the limbs.

• Increased size of the belly.

• Yellowish eyes and skin.

• Fever.

• Shortness of breath.

• Pruritus (itching of the skin).

• Black and tarry stools.

• Blood in stools.

• Blood in vomit.

• Lethargy.

The signs are as follows:

• Jaundice.

• Weakness.

• Fever.

How Is Hepatomegaly Diagnosed?

There are various causative factors that can cause hepatomegaly. Therefore, patients need a variety of tests to get diagnosed. Technological advancements allow a doctor to visualize the liver size. Hepatomegaly should be diagnosed to rule out the underlying disease. Alcohol abuse can cause hepatomegaly. The investigations should aim to establish the severity of liver damage and misuse of alcohol. The doctors can take detailed patient history and habits to know the duration and severity of alcohol misuse. A physical examination can help the doctor palpate the enlarged liver. Healthcare professionals can also ask for the following investigations:

Blood Tests - Blood tests help find the abnormal number of white blood cells which are indicative of inflammation. Patients suffering from hepatomegaly have increased numbers of white blood cells in their blood. A complete blood count will show infection and allergy if present. Jaundice is the most common feature of hepatomegaly, and high bilirubin levels can confirm it.

Ultrasound - This technique helps in visualizing the abdomen. Ultrasound can measure the size of the liver. It can also be used to assess the adjacent organs affected by hepatomegaly.

Computed Tomography (CT Scan) - CT scan helps in assessing the exact dimensions of the liver by providing higher-resolution images of the abdomen.

Liver Blood Biochemistry - Liver blood biochemistry includes serum bilirubin, alkaline phosphatase, and albumin. It indicates the level of enzymes. Most analytes measured by LFTs are not truly function tests, instead are released by injured liver cells, and provide evidence of liver cell damage. In addition, bilirubin and albumin levels are related to the clinical outcomes in patients with severe liver disease.

Liver Function Test (LFT) - Abnormal LFT often indicates the underlying cause of the enlarged liver. The liver function test detects the cause of liver dysfunction by detecting the level of the enzymes.

When to See a Doctor?

If any person has symptoms of hepatomegaly, seek medical help immediately and contact any hospital for proper medical care. Regular visits to the doctor can help a person get diagnosed.

If hepatomegaly is left untreated, it can cause serious complications resulting in liver damage. A person should seek a doctor's help as soon as possible if they have the following symptoms:

• Black and tarry stools.

• Blood in stools.

• Blood in vomiting.

• Severe abdominal pain.

• Jaundice.

• High fever persists even after taking over-the-counter drugs.

What Are the Treatment Options for Hepatomegaly?

The treatment of hepatomegaly depends on the underlying causes of the enlarged liver. The primary concern is to find the cause of the enlarged liver. Based on the causes, the treatment options will include:

Cancer: If cancer is diagnosed as a cause of the enlarged liver, chemotherapy or radiotherapy is suggested.

Autoimmune Disease: If an auto-immune disease is a cause of hepatomegaly, Prednisolone and Azathioprine are used to treat the conditions.

Extensive Liver Damage: In case of liver damage, a liver transplant is the last resort.

Lifestyle modifications such as maintaining a healthy diet, exercising daily, losing weight if overweight, and quitting drinking can be suggested by the doctor in the case of hepatomegaly.

Conclusion

Hepatomegaly can be a life-threatening condition if left untreated. It is an uncommon condition in infants and children. If a child is suspected of hepatomegaly, immediate medical attention should be sought. The combination of diagnostic advancements can help in detecting the underlying hepatomegaly cause. Hepatomegaly can be resolved in patients with alcoholic fatty liver (cirrhosis) with the stopping of alcohol use. Cessation of alcohol is the best advice for a long and healthy life. Good nutrition, along with proper medicines, is very important for recovery. Maintaining a healthy diet with exercise is the key to keeping yourself fit.