Enlarged liver, medically called Hepatomegaly, is a condition in which the liver is swollen or enlarged beyond its normal size. It is not a disease or condition in itself, but an indicator of an underlying disease or condition. If the underlying condition is treated quickly, the liver will go back to its original size and there is no long-term damage to the liver. However, if the underlying condition is severe or takes time to cure, the liver may or may not regain its original size, but there will be damage to the liver in the long run.
Symptoms
So how does one know there is an enlargement of the liver? Common symptoms include:
- Moderate to severe pain in the abdomen
- Fatigue and shortness of breath
- Yellowing of skin and whites of the eyes due to jaundice
- Nausea, vomiting and lack of appetite
- Urine that is dark in color and stools that are light in color
- Pruritis or Itchy skin
- Splenomegaly or enlarged spleen
- A feeling of fullness or discomfort in the belly
- Unexplained weight-loss
- Muscle aches, pains and spasms
- Swelling of the feet and legs
- Bruises that occur easily with minor injuries
- Swollen abdomen or increase in abdomen size
- Fever
- Vomit that is dark in color
- Stools that are black or bright red
- Change in bowel habits
Causes
Liver related conditions
- Alcoholic fatty liver disease
- Cirrhosis caused by excessive alcohol consumption
- Nonalcoholic fatty liver disease
- Viral Hepatitis including hepatitis A, B and C – is caused by a virus or infectious mononucleosis
- Amyloidosis – a condition in which there is abnormal protein accumulation in the liver
- Wilson’s disease – a genetic condition in which copper accumulates in the liver
- Hemachromatosis – a condition in which iron accumulates in the liver
- Gaucher’s disease – a condition in which fatty substances accumulate in the liver
- Liver cysts which are caused by fluid accumulation in the liver
- Hemangioma and adenoma –are non-cancerous tumors of the liver
- Toxic hepatitis which is inflammation of the liver from exposure to toxic chemicals
- Liver cancer – both primary and metastatic
- Steatosis – a condition in which the liver is storing too much fat
- The Niemann-Pick disease is a condition in which lipids start accumulating in the liver
Systemic cancers
Blood circulation related
- Hepatic vein thrombosis – which is a blockage in the large veins of the liver
- Veno-occlusive disease – which is a blockage in the small veins of the liver
- Budd-Chiari syndrome – a condition in which veins that drain the liver are blocked
- Congestive Heart failure – in which the heart does not pump blood normally
- Pericarditis is an inflammation of the tissue which surrounds the heart
Diseases and strictures of the Bile duct
- Primary sclerosing cholangitis: a condition in which there are fibrosis, strictures and inflammation of the bile duct in patches
- Primary biliary cholangitis: a chronic condition in which the bile ducts of the liver are gradually destroyed
- Inflammation within the liver and backup of bile due to an obstruction in the bile duct, generally from gallstones
Risk Factors
- Alcohol abuse
- Overdose of any medication, supplements or vitamins. For example, in the US, acetaminophen overdose is the culprit
- Herbal supplements: Not all of them are safe or sufficiently tested. For example, valerian, ma huang, comfrey, black cohosh and mistletoe increase the risk of liver damage.
- Infections: Viruses, bacteria or parasites can cause liver damage: for example, Hepatitis A, B and C.
- Obesity or being overweight
- Poor diet and nutrition: Binging on high-salt, high-sugar and high-fat diets increases the risk of liver enlargement
- Autoimmune disorders, especially those that directly affect the liver
- Inflammatory bowel disease
- Sickle cell anemia
- Chronic liver disease
- Liver cancers
- Unsafe tattooing, blood-transfusion and sex, all of which increase the risk of Hepatitis, HIV and hepatomegaly
- Traveling to countries where malaria is rampant
Diagnosis
- Physical exam: an enlarged liver can be felt on the side of the body by a trained physician
- Blood tests: This will reveal liver enzyme levels and identify the pathogen causing the condition
- Imaging tests: MRI, CT scan and ultrasound help confirm the condition and measure the enlargement
- Magnetic Resonance Elastography: This uses sound waves to create a visual representation of the liver tissue and how stiff it is. A non-invasive procedure that is an alternative to liver biopsy.
- Liver biopsy: A long, thin needle is inserted through the skin into the liver and some tissue is extracted, which is then sent to a lab for testing
Treatment
Treating Hepatomegaly involves treating the underlying cause or condition.
Hepatitis
- Hepatitis A: In general, there is no treatment specifically for hepatitis A. The person recovers eventually in a few weeks to a few months at the most.
- Hepatitis B: Again, no specific treatment for the acute version of this condition. However, for chronic Hepatitis B, antiviral medications are given to reduce damage to the liver and increase the chances of survival in the long run.
- Hepatitis C: Chronic Hepatitis C is treated with medicines called direct-acting antivirals. The course lasts 3 to 6 months, depending on the severity of liver damage.
- Hepatitis D: This is treated with a class of drugs called pegylated interferon-alpha. The aim is to slow down the progression of this disease. However, those with end-stage liver disease who develop Hepatitis D will require a liver transplant most often.
Alcoholic Fatty Liver Disease
- A de-addiction and detox therapy supervised by a doctor
- Treating mental health conditions that may be causing the alcoholism
- Other therapies such as cognitive behavioral therapy or CBT, family therapy, group therapy, and motivational enhancement therapy
Non-alcoholic Fatty Liver Disease
- Changing and monitoring the diet to reduce intake of fat and cholesterol
- Monitoring and maintaining blood-glucose levels
- Managing type 2 diabetes and increased insulin levels
Cancer
- Surgery to remove the tumor
- Radiation therapy
- Chemotherapy
- Immunotherapy
- If none of the above work out, a liver transplant must be done
Heart-failure
1. Medication
- diuretics
- angiotensin 2 receptor blockers
- beta-blockers
- angiotensin-converting enzyme inhibitors
2. Surgical interventions
- Coronary Artery Bypass Surgery or CABG – simply called ‘Bypass’
- Valve repair – Mitral valve repair or aortic valve surgery
- Implantable left ventricular assist device (LVAD)
- Aneurysm Repair Surgery
- Heart transplant
3. Lifestyle changes
- Quitting or limiting alcohol
- Quitting smoking
- Quitting or limiting caffeine
- Managing stress better through Yoga, meditation, hobbies, etc.
- Losing and maintaining weight
- Exercising regularly and being physically active in general
- Consuming a healthy diet rich in fresh fruits and vegetables, lean meat, low-fat diary, healthy fats and whole or unrefined grains
Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals
NOTE: Take medications only when prescribed by your doctors, self-medication must be avoided under any circumstances.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
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