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Enlarged Liver

Overview

An enlarged liver results from an underlying disease or condition that may or may not be directly related to your liver. In medical terms, it is known as hepatomegaly. Your liver performs many vital functions, including digestion, storage, controlling blood clotting, and metabolism. Enlarged liver is not a disease itself but rather a sign of another issue. It can be accompanied by other symptoms depending on the type and severity of the underlying disease. Some cases of the enlarged liver can lead to life-threatening complications and need to be treated as a medical emergency. 

Causes

Enlarged liver can result due to several different causes. Cirrhosis is a liver disease that results in scarring of the liver tissues. The liver becomes enlarged in size and has a rough, bumpy surface. Viral hepatitis caused by hepatitis A, B, and C virus or infectious mononucleosis can also cause liver enlargement. The probability is higher in those with chronic hepatitis. Alcoholic fatty liver disease (AFLD) and non-alcoholic fatty liver disease (NAFLD) can also increase the size of the liver. This results due to excessive fat accumulation in the liver tissues.

Liver cancer or cancer that starts in any other body region and spreads to the liver (metastatic cancer) can also cause liver enlargement. Enlargement can also occur if there is any heart or blood vessel disease that blocks the blood supply or drainage of the liver. Other causes of enlarged liver include amyloidosis, Wilson’s disease, hemochromatosis, liver cysts, Gaucher’s disease, lymphoma, leukemia, Budd-Chiari syndrome, pericarditis, or obstruction of the bile ducts. 

Risk Factors And Epidemiology

Many medical conditions that affect the liver are linked with genetics. You may also be at risk if you have a positive family history of diseases that affect your liver, such as liver cancer. Chronic alcohol consumption is one of the most significant risk factors. Sharing contaminated needles, unprotected sex, and blood transfusions can increase the risk of hepatitis B and C. People who take certain medications, supplements, or herbal medications in large dosages also put their liver at risk. Obesity or unhealthy eating habits can increase the risk of non-alcoholic fatty liver disease.

In United States, alcohol consumption and obesity are the most common causes of an enlarged liver. This condition can affect people of any age, but older people are commonly affected. The prevalence among men and women can vary depending on the underlying cause. 

Signs And Symptoms

In many cases, an enlarged liver itself is a sign of another medical condition. If your liver tissues are affected, you may notice different signs and symptoms, which include jaundice, abdominal pain, weakness, fatigue, nausea /vomiting, loss of appetite, generalized itching, swelling around the abdomen and in the feet, weight loss, muscles aches and impaired clotting time. The abdominal pain usually occurs in the upper right corner of the abdomen, where your liver lies. These symptoms can vary in different people and may not be noticeable if you have a mild disease. 

Diagnosis

History and physical examination are done first to determine the cause and extent of liver enlargement. History can include important clues that are relevant for a correct diagnosis. During a physical examination, your doctor will palpate the liver region to look for enlargement. To find out the exact cause, multiple tests may be required, which include complete blood count (CBC), liver function tests (LFTs), INR, hepatitis tests, transient elastography, etc. Imaging tests are also done, including abdominal x-ray, ultrasound of the liver, CT scan, and MRI. Liver biopsy is recommended in cases where a serious liver disease such as liver cancer is suspected. 

Differential Diagnosis

Hepatomegaly needs to be differentiated from other diseases that can cause abdominal pain. These diseases can occur if other organs in the abdomen or the body are affected. They include primary biliary cholangitis, primary sclerosing cholangitis, pancreatic cancer, Whipple’s disease, myeloma, constrictive pericarditis, or heart failure. Differentiation can be done on the basis of history, symptoms, and diagnostic tests. 

Treatment

Treatment of hepatomegaly depends on its underlying cause. If enlarged liver results from a viral infection, suitable antiviral medications and treatment options are given to relieve symptoms. Lifestyle changes are recommended in case of alcoholic or non-alcoholic fatty liver disease. The recommended changes include avoiding alcohol and illegal drugs, eating a balanced diet, and exercising regularly to maintain a healthy weight. Liver cancer requires more aggressive treatment options, including chemotherapy, radiotherapy, or surgery. In severe cases where it is impossible to save your liver, a liver transplant is recommended to extend your life span.

Medications are given according to the underlying condition. Your doctor may also prescribe supportive medications to reduce symptoms like fever, pain, itching, etc. Do not take any medicine or herbal supplement without your doctor’s consent, as it may further damage your liver. 

Prognosis

The prognosis of liver enlargement is worse in conditions such as cirrhosis, chronic hepatitis, or liver cancer. Medications and treatment options can stop the disease’s progress, but it is often impossible to revert the damage that has already been done. Acute conditions such as viral hepatitis have a better prognosis if appropriate treatment is given on time. 

Prevention

Prevention of enlarged liver can be done by avoiding its common causes. Avoid excessive alcohol consumption and drug use. Get hepatitis vaccinations and avoid unprotected sex or sharing needles with unknown people. Eat a balanced diet, exercise regularly, and maintain a healthy weight to reduce the stress on your liver. Consult your doctor before using any medication or herbal supplement for an extended period.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 17, 2023.

 

References

Enlarged liver - Symptoms and causes

https://www.mayoclinic.org/diseases-conditions/enlarged-liver/symptoms-causes/syc-20372167#:~:text=An%20enlarged%20liver%20is%20one,the%20cause%20of%20the%20condition.

Hepatomegaly (enlarged liver): Symptoms, causes, and treatment

https://www.medicalnewstoday.com/articles/hepatomegaly-enlarged-liver

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