Hepatomegaly: Symptoms, Causes, Diagnosis, and Treatment

Introduction

Hepatomegaly, also known as an enlarged liver, occurs when the liver swells beyond its normal size, indicating some health issues. It is not a disease in itself but it is often considered a symptom of underlying liver disease. The liver performs essential functions in the body, including filtering toxins from the blood and regulating cholesterol. An enlarged liver can indicate a potential problem with these functions, and prompt investigation is necessary to identify and address the underlying cause.^1,2

Let’s take a closer look at what is hepatomegaly, its causes, diagnosis and treatment.

Signs and Symptoms of Hepatomegaly

Hepatomegaly may not cause noticeable symptoms on its own. However, it may be accompanied by signs and symptoms like:

• Abdominal pain.
• Fatigue.
• Nausea, vomiting, and jaundice.
• Loss of appetite.
• Weight loss.
• Discomfort in the upper right abdomen.
• Hepatomegaly can also cause symptoms related to liver dysfunction, such as bruising, gynaecomastia (enlargement of breast tissue in men), spider nevi (small, red, spider-like blood vessels that can appear on the surface of the skin, especially near the stomach), and ascites (an accumulation of fluid in the abdominal cavity).

If you experience any of these symptoms, consult with your healthcare provider promptly for a timely diagnosis and appropriate treatment.^1-3

Fatty liver which a very common cause of hepatomegaly is on the rise primarily because of an increase in obesity, type 2 diabetes, and consumption of alcohol. Appropriate lifestyle changes and early diagnosis helps to beat it.

Dr. M.G. Kartheeka, MBBS MD

When to See a Doctor

If you suspect any swelling or tenderness in the liver area or have unusual symptoms, it is essential to seek medical attention. Don’t hesitate to contact your healthcare provider if you notice persistent fever, confusion or disorientation, weakness, lightheadedness, or yellowing of the eyes or skin. These signs may indicate a more severe underlying condition and require immediate evaluation and treatment. So, if you are concerned about any symptoms or changes in your body, it’s always better to consult with a medical professional right away.¹

Hepatomegaly with or without elevated liver function tests may be secondary to multiple causes, which include drug side effects, active lupus infection, fatty infiltration, hepatic vein or artery thrombosis, and congestion secondary to right heart failure.

Dr. Ashish Bajaj, M.B.B.S. M.D. in Clinical Pharmacology and Toxicology

Causes of Hepatomegaly

The causes of liver enlargement refer to the various medical conditions that lead to an increase in liver size. Several conditions can cause the liver to enlarge. The possible causes include:

• Infections – They include viral infections such as viral hepatitis, infectious mononucleosis, and cytomegalovirus and parasitic infections such as malaria and helminthic infections.
• Autoimmune liver diseases – such as autoimmune liver disease and primary biliary cirrhosis.
• Biliary diseases – including extra-hepatic obstruction, primary sclerosing cholangitis, and primary biliary cirrhosis.
• Tumours and infiltrative diseases – such as metastatic carcinoma, primary hepatic tumour,  leukaemia, lymphoma, and amyloidosis.
• Haematological disorders – including thalassemia, sickle cell disease, haemolytic anaemia, myeloma, and leukaemia.
• Metabolic disorders – such as hemochromatosis, Wilson’s disease, glycogen storage diseases, and porphyria.
• Liver diseases – Non-alcoholic fatty liver disease due to metabolic syndrome or diabetes mellitus and alcohol-associated liver disease including acute alcoholic hepatitis and alcoholic fatty liver.
• Drug-induced hepatitis – often due to medication overdose, such as with statins, macrolides, and amiodarone.
• Liver lesions – such as liver cysts, benign liver tumours, and liver cancer.
• Bile duct diseases and strictures – such as primary biliary cholangitis and primary sclerosing cholangitis.
• Heart and vascular causes – such as congestive heart failure (including right ventricular failure and congestive cardiac failure), pericarditis, and Budd-Chiari syndrome.
• Less common causes of hepatomegaly include genetic disorders, such as alpha-1 anti-trypsin disease and Niemann-Pick disease, as well as systemic diseases like sarcoidosis.^1-3

Risk Factors for Hepatomegaly

The causes of hepatomegaly may vary and are not the same as risk factors. Risk factors increase the likelihood of developing liver problems but do not necessarily cause liver enlargement. Hepatomegaly, or an enlarged liver, can be caused by a variety of factors, including:

• Alcohol consumption (in excess): Drinking large amounts of alcohol can be damaging to your liver and increase your risk of hepatomegaly.
• Overdosing on medications, vitamins or supplements: Taking more than the recommended dose of medications, vitamins, or supplements, such as acetaminophen, can also lead to an enlarged liver.
• Use of herbal supplements: Taking herbal supplements, such as black cohosh, ma huang, and valerian have been known to increase the risk of liver damage and hepatomegaly.
• Infections: Infectious diseases caused by viruses, bacteria, or parasites can also increase the risk of developing an enlarged liver.
• Hepatitis virus: Hepatitis A, B, and C are viruses that can cause liver damage and increase the risk of hepatomegaly.
• Eating habits: Unhealthy eating habits, such as consuming excess fat or sugar, and being overweight can also increase the risk of liver disease and hepatomegaly.²

Diagnosis of Hepatomegaly

To diagnose an enlarged liver, your doctor may perform the following procedures:⁴

Physical Exam

• Procedure: The doctor may examine the abdomen to feel the liver size, shape, and texture.
• Possible Outcome: May or may not be enough to confirm an enlarged liver.

Blood Tests

• Procedure: A blood sample is taken to check liver enzyme levels and identify viruses.
• Possible Outcome: Elevated liver enzymes or presence of viruses that can cause hepatomegaly.

Imaging Tests (CT scan, Ultrasound, MRI)

• Procedure: Images of the liver are taken to check for abnormalities.
• Possible Outcome: May show the presence of tumors, cysts, or other abnormalities.

Magnetic Resonance Elastography (MRE)

• Procedure: MRE is a non-invasive test done with the help of sound waves to create an elastogram showing liver tissue stiffness.
• Possible Outcome: May be done as an alternative to a liver biopsy.

Liver Biopsy

• Procedure: A small sample of liver tissue is removed using a needle and sent to a lab for testing.
• Possible Outcome: Confirms diagnosis of liver disease, identifies the underlying cause, determines the level of liver damage or inflammation, and helps identify the specific type and severity of liver disease.

Treatment of Hepatomegaly

The treatment for hepatomegaly depends on the underlying cause of the disease. Here are some key points regarding the treatment of hepatomegaly:

• An enlarged liver may require referral to a specialist (hepatologist) for further evaluation and testing.
• Treatment options will depend on the underlying cause of the condition, which may include blood tests, imaging tests, or a liver biopsy.
• The liver can repair and regenerate itself, as long as there is enough healthy tissue remaining.
• Lifestyle changes can often reverse hepatomegaly depending on the cause.

Treatment of Acute Hepatomegaly

• Viral Hepatitis: Supportive care, antiviral medications.
• Drug-Induced Liver Injury: Discontinuing the offending medication.
• Alcoholic Hepatitis: Abstinence from alcohol, medication, nutritional support.
• Toxic Liver Injury: Avoiding the toxin, supportive care.
• Ischemic Hepatitis: Treating the underlying vascular problem.

Treatment of Chronic Hepatomegaly

• Non-Alcoholic Fatty Liver Disease: Weight loss, healthy diet, exercise, medications.
• Alcoholic Liver Disease: Abstinence from alcohol, medication, nutritional support.
• Autoimmune Hepatitis: Corticosteroids, immunosuppressive medications.
• Primary Biliary Cirrhosis: Urso-deoxycholic acid, other medications, liver transplant.
• Hemochromatosis: Phlebotomy, iron chelation therapy.
• Wilson’s Disease: Chelation therapy, zinc supplementation, liver transplant.

Your healthcare provider will advise on the best course of treatment for your specific situation.^1,4

Prevention of Hepatomegaly

To prevent the risk of developing hepatomegaly, here are some do’s and don’ts to follow:

Do’s:

• Consume a healthy diet that includes a variety of fruits, vegetables, and whole grains.
• Follow the prescribed dosages for medications, vitamins, and supplements.
• Use chemicals in well-ventilated areas while wearing protective gear such as gloves, long sleeves, and a mask.
• Maintain a healthy weight by adopting a balanced diet and limiting the intake of sugary and fatty foods.
• Discuss the potential risks and benefits of using supplements, especially herbal supplements, with your doctor.

Don’ts:

• Alcohol consumption is a health hazard. Avoid alcohol as much as possible and replace it with other healthier beverages.
• Smoking and the use of substance is an absolute no-no.
• Never self-medicate with alternative medicine treatments without discussing their potential risks and benefits with your doctor.²

Complications of Hepatomegaly

Hepatomegaly, or an enlarged liver, can lead to several complications, especially if left untreated. Some of the common complications of hepatomegaly are:

• Acute Liver failure: If hepatomegaly is caused by an underlying condition that leads to extensive damage to the liver, it can lead to acute liver failure. This occurs when the liver is no longer able to perform its essential functions that can be life-threatening.
• Hepatic tuberculosis: It is a type of tuberculosis infection that affects the liver. Hepatic tuberculosis may occur due to the spread of tuberculosis bacteria from other infected sites in the body, such as the lungs or lymph nodes, to the liver. It may be a complication of hepatomegaly, as one of the clinical features of hepatic tuberculosis noted in various case series is hepatomegaly, which is present in 80-95% of cases.
• Malaria: Hepatomegaly and splenomegaly are common complications of malaria infection caused by Plasmodium falciparum or vivax. In fact, approximately 60% of patients with these types of malaria infections may experience hepatomegaly and/or splenomegaly.^5,6

Research Facts About Hepatomegaly

Here are some interesting facts about hepatomegaly, that you probably didn’t know:

• Hepatomegaly and abnormalities in liver enzymes occur in individuals with diabetes mellitus as a result of hepatic glycogen buildup. The prevalence of hepatomegaly in individuals with diabetes mellitus was found to be around 53%.
• Hepatomegaly may be an early sign used in the diagnosis of congestive heart failure. A study showed that in cases of CHF, hepatomegaly may occur in up to 90-95% of patients^.7-10

Frequently Asked Questions (FAQs):

References:

1. Hepatomegaly (enlarged liver): Symptoms, causes & treatment [Internet]. Cleveland Clinic. Available from: https://my.clevelandclinic.org/health/symptoms/17937-hepatomegaly-enlarged-liver 
2. Symptoms and causes [Internet]. Mayo Clinic. Mayo Foundation for Medical Education and Research; Available from: https://www.mayoclinic.org/diseases-conditions/enlarged-liver/symptoms-causes/syc-20372167
3. Knott DL. Hepatomegaly (causes, symptoms, and treatment) [Internet]. Patient.info. 2022. Available from: https://patient.info/doctor/hepatomegaly 
4. Enlarged liver [Internet]. Mayo Clinic. Mayo Foundation for Medical Education and Research; 2022. Available from: https://www.mayoclinic.org/diseases-conditions/enlarged-liver/diagnosis-treatment/drc-20372171 
5. Toma D, Lazar O, Bontas E. Acute liver failure. Liver Diseases: A Multidisciplinary Textbook. 2020:369-80. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7122204/ 
6. Talwani R, Gilliam BL, Howell C. Infectious diseases and the liver. Clinics in liver disease. 2011 Feb 1;15(1):111-30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3660095/ 
7. Chatila R, West BA. Hepatomegaly and abnormal liver tests due to glycogenosis in adults with diabetes. Medicine. 1996 Nov 1;75(6):327-33. Available from: https://pubmed.ncbi.nlm.nih.gov/8982149/ 
8. Malik A, Brito D, Vaqar S, Chhabra L. Congestive heart failure. InStatPearls [Internet] 2022 May 5. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430873/ 
9. Paschos P, Paletas K. Non alcoholic fatty liver disease and metabolic syndrome. Hippokratia. 2009 Jan;13(1):9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2633261/ 
10. Giallourakis CC. Liver complications in patients with congestive heart failure. Gastroenterology & Hepatology. 2013 Apr;9(4):244. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3977644/ 

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