What causes to hepatomegaly?
Hepatomegaly means liver enlargement. The various liver components can be uniformly or unevenly enlarged. This is referred to as harmonic or disharmonic hepatomegaly. Often a liver disease is the cause of organ enlargement.
Sometimes, however, there are also diseases of other body organs that can be the cause of organ enlargement. Read more about causes, signs and treatment of hepatomegaly.
The term hepatomegaly means nothing other than liver enlargement. The liver is wedge-shaped, two-lobed organ. It is argely situated in the right upper abdomen, just below the diaphragm. It is the central metabolic organ and the largest gland of the body with approximately 1.5 kilograms.
If the liver is enlarged, it is usually a fatty liver. Other diseases are the cause of a hepatomegaly. In many cases there is an enlargement of the spleen, in addition to liver enlargement. Medical experts then speak of hepatosplenomegaly.
Hepatomegaly causes and possible diseases
Hepatomegaly can occur as an accompanying symptom of various diseases. The most frequent reason for liver enlargement is the fatty liver. Other hepatic diseases and diseases of other organs can also cause hepatomegaly:
Metabolic or toxic liver disease can cause hepatomegaly
The liver reacts to a variety of harmful influences with a fatty substance such as chronic alcohol consumption, hypertension, viral or metabolic diseases (such as diabetes mellitus or increased blood fat levels), as well as certain drugs and chemicals. However, a physician can only speak of a fatty liver when fat is stored in more than half of all liver cells. The strong fat intake leads to a liver enlargement.
Other metabolic or urticide-related liver diseases which can lead to hepatomegaly are memory diseases (such as the iron storage disease hemochromatosis) as well as certain forms of the metabolic disease porphyria. Also in the context of other metabolic disorders as well as hormonal diseases, liver involvement with subsequent hepatomegaly may occur.
Inflammatory liver diseases can cause hepatomegaly
Inflammatory liver diseases are other possible causes of hepatomegaly. The inflammation can be caused by viruses, a wrong reaction of the immune system (autoimmune disease), alcohol or toxins. Examples of inflammatory hepatic diseases which may be associated with hepatomegaly are acute or chronic hepatitis, liver cirrhosis, and liver granulomas. Granulomas are inflammation-induced, nodular tissue growths. They develop, for example, in the context of tuberculosis, AIDS or sarcoidosis.
Diseases with biliary obstruction can cause hepatomegaly
Diseases that are associated with a drainage disorder of the biliary fluid can also cause to hepatomegaly.
The biliary fluid is formed in the liver and released into the small intestine to aid fat digestion (with the gall-bladder as an intermediate store). In the case of a backflow of the bile, liver enlargement may occur. The cause of the congestion may be inside or outside of the liver.
Diseases of blood vessels can cause hepatomegaly
Sometimes hepatomegaly is caused by a vascular disease. An example of this is the right heart failure.
Here, the right heart chamber is no longer able to pump the venous blood coming from the body into the pulmonary circulation. As a result, the venous blood accumulates, which can lead to stagnation liver with liver enlargement. Even in the case of a defective heart valve between the right atrium and the right ventricular chamber, as well as in the case of an constrictive pericarditis, the venous blood can accumulate back into the liver.
Other vascular diseases that may result from hepatomegaly are, for example, a complete occlusion of the large liver veins (Budd-Chiari-Syndrome), a clot-related occlusion of the lower vena cava (inferior vena cava inferior thrombosis) leakage (aneurysm) of the liver artery.
Infections can cause hepatomegaly
Infections with various pathogens are also among the possible causes of hepatomegaly. For example, inflammation of the bile ducts, liver abscesses and parasitic hepatic diseases (such as echinococcosis or schistosomiasis) can cause an increase in the liver. In addition, hepatomegaly can also turn out to be a reactive liver disorder in infectious diseases.
Cyst liver and liver cysts can cause hepatomegaly
Liver cysts are smooth, fluid-filled cavities in the liver, the size of which can be a few millimeters to over ten centimeters. They may occur single or multiple. If the liver is infected by cysts, it is called cyst liver. For very large cysts and a cyst liver can result with liver enlargement.
Tumors can be cause of hepatomegaly
In some cases, benign or malignant liver tumors are the cause of hepatomegaly. In addition, malignant tumors in other parts of the body (such as colorectal, gastric or breast cancer) can form daughter ulcers in the liver (liver metastases) and thus lead to liver enlargement.
When should you see a doctor for hepatomegaly?
If you feel pressure and / or pain in the upper abdomen with by further symptoms, you should consult a doctor for clarification. Possibly there is a hepatomegaly behind it.
What does the doctor do for hepatomegaly?
First, the physician reports the history of the patient (anamnesis): He asks you in detail about your complaints, possible pre-existing diseases (such as hepatitis, tumors) and possible basic diseases (fat metabolism, diabetes, bile stones etc.).
For the clarification of a hepatomegaly, there are important details about your your alcohol and drug use, (foreign) trips in the past and a possible weight loss. Following the conversation, various studies follow.
Physical examination for hepatomegaly
The physician palpates the abdomen to estimate the size of the liver and to obtain possible indications of the cause of hepatomegaly. The liver feels soft and smooth in hepatitis and a congestive liver, and may hurt when under pressure. On the other hand, a hard, irregular to bony liver indicates, for example, liver cirrhosis or liver cancer as a possible cause of hepatomegaly.
In addition, the physician examines the skin for signs of jaundice or the iron storage disease hemochromatosis (possibly dark skin pigmentation). Indications of the cause of a hepatomegaly also provide other physical signs. For example, swollen legs and jammed cervical veins speak for a right heart failure.
If the physical examination has confirmed a hepatomegaly, a blood analysis is carried out. If the hepatomegaly is accompanied by an enlargement of the spleen (hepatosplenomegaly), the doctor may arrange additional blood tests (test for the detection of antibodies against red blood cells).
An ultrasound examination of the abdominal cavity (Abdominal ultrasound) is also part of the routine for the diagnosis of hepatomegaly. The physician examines liver, spleen, bile ducts, and the portal system (venous vascular system, which directs the blood from the stomach, intestine, and spleen through the portal vein first to the liver and then to the lower vena cava).
An X-ray image of the chest can provide further evidence of the cause of hepatomegaly. An enlarged heart and a pleural effusion may be the result of a heart attack. Also (malignant) swollen lymph nodes (lymphomas) can be seen on the radiograph.
If the doctor suspects certain diseases as a cause of hepatomegaly, further diagnoses are necessary. For example, in the case of suspicion of a certain form of tuberculosis or of sarcoidosis as the cause of enlargement of the liver, the removal of a tissue sample from the liver may be necessary.
How the doctor treats a hepatomegaly?
Since the enlargement of the liver is a companion for various diseases, it is necessary to treat them. For example, in the most common cause of hepatomegaly, the fatty liver, the underlying disease has to be treated or habits has to be changed. This is the only way to remove the hepatomegaly.