Hepatomegaly

Hepatomegaly is a technical name for “enlarged liver.” As the name implies, it’s a condition in which the liver is enlarged or swollen. Rather than a disease in itself, hepatomegaly is a symptom or complication of other liver conditions, some of them life-threatening. For this reason, hepatomegaly is something to take seriously, as it points to an underlying problem that could be quite serious.

Liver disease can develop for years with no overt symptoms at all. Usually, if it’s detected early, liver disease is first diagnosed from blood tests for liver enzymes rather than from symptoms. When symptoms like hepatomegaly do show up, this usually means that the illness has progressed to a more serious and dangerous stage.

For this reason, the appearance of hepatomegaly is always a cause for significant medical concern, and efforts to diagnose the precise cause of the symptom are highly recommended.

Causes

There are a lot of different causes of hepatomegaly –– that is, it arises as a symptom of a number of different liver diseases. Included in this list is fatty liver disease, cirrhosis of the liver, both infectious and non-infectious hepatitis, fibrosis of the liver, and cancer of the liver. There are also other causes such as right-sided heart failure and myeloproliferative disorders which are not liver diseases as such. Hepatomegaly doesn’t always occur as a symptom when significant impairment of liver function is present, but it commonly does.

Liver disease in turn has underlying causes. The single most common cause of liver disease is alcohol abuse. Other causes include infections (especially the viral infections that cause infectious hepatitis), obesity, diabetes, hereditary factors, and the effects of drugs, both medicinal and non-prescription. Treatment of a symptom such as heptomegaly involves treating the liver disease that causes it, and in turn this involves treatment of the underlying cause of the disease.

Diagnosis

Hepatomegaly is initially diagnosed either by visible or tangible swelling in the upper abdominal area, indicating a swollen liver, or by medical imaging which allows the swollen liver to be clearly seen. Such testing often follows after a preliminary diagnosis of possible liver disease arising from a liver enzyme blood test.

Differential Diagnosis

When hepatomegaly is identified, the degree of swelling is identified as mild, moderate, or massive, with possible causes grouped under each heading.

Possible causes of massive hepatomegaly include cancer (either primary in the liver or metastasized from elsewhere in the body), right-sided heart failure, myeloproliferative disorders (a disease of the red blood cells), and severe alcoholic or non-alcoholic liver disease.

Moderate hepatomegaly can result from any of the same causes as massive hepatomegaly (i.e., the same underlying impairment can produce less pronounced swelling of the liver), and also from hemochromatosis (excess iron in the body), fatty liver, and more moderate stages of liver diseases such as cirrhosis.

Mild hepatomegaly can result from any of the above causes, and also from hepatitis, biliary obstruction (obstruction of the bile ducts), tapeworm (hydatid disease), and HIV infection.

Hepatosplenomegaly

Hepatosplenomegaly refers to a condition in which both the liver and the spleen are enlarged simultaneously. This can happen as a result of acute viral hepatitis, infectious mononucleosis, a lung-based fungus infection called histoplasmosis, and lysosomal storage disorder. If the spleen is enlarged as well, this helps to rule out some of the common causes of hepatomegaly.

Treatment Of Hepatomegaly

Treatment of hepatomegaly always involves treatment of the underlying condition. In most cases, this in turn involves lifestyle changes, although in the case of liver cancer the proper treatments may include chemotherapy and other treatments for cancer. Alcoholic liver disease is treated by cessation of drinking alcohol. Non-alcoholic liver disease is treated by addressing the causes of the disease, the most common of which are obesity and diabetes. Correct diagnosis of exactly what is causing the symptom of hepatomegaly is crucial in prescribing treatment.

The final stages of liver disease can result in so much damage to liver function that the only way the patient can survive is with a liver transplant. This is true of end-stage cirrhosis, for example.

Hepatomegaly In Children

Although usually a disease of adults, hepatomegaly can also occur in children. The causes are sometimes the same as with adult  hepatomegaly but others are different. Hereditary factors, viral infections, and cancer can occur in children as well as adults. Alcohol abuse is much less likely as a cause in children than in adults. There are some causes of hepatomegaly which only occur in childhood. One of these is Reye’s syndrome, which is a potentially fatal form of fatty liver disease caused by the use of aspirin to treat childhood fevers. Because of the danger of Reye’s syndrome, a substitute fever-reducing medication such as acetaminophen is usually recommended for children suffering from a disease including high fevers.