Hepatomegaly Explained

Hepatomegaly
Symptoms:Weight loss, lethargy
Causes:Liver abscess (pyogenic abscess), Malaria
Diagnosis:Abdominal ultrasonography
Treatment:Prednisone and azathioprine

Hepatomegaly is enlargement of the liver.[1] It is a non-specific medical sign, having many causes, which can broadly be broken down into infection, hepatic tumours, and metabolic disorder. Often, hepatomegaly presents as an abdominal mass. Depending on the cause, it may sometimes present along with jaundice.[2]

Signs and symptoms

The patient may experience many symptoms, including weight loss, poor appetite, and lethargy; jaundice and bruising may also be present.[2]

Causes

Among the causes of hepatomegaly are the following:

Infective

Mechanism

The mechanism of hepatomegaly consists of vascular swelling, inflammation (infectious in origin), and deposition of (1) non-hepatic cells or (2) increased cell contents (such as that due to iron in hemochromatosis or hemosiderosis and fat in fatty liver disease).[3]

Diagnosis

Suspicion of hepatomegaly indicates a thorough medical history and physical examination, wherein the latter typically includes an increased liver span.

On abdominal ultrasonography, the liver can be measured by the maximum dimension on a sagittal plane view through the midclavicular line, which is normally up to 18 cm in adults. It is also possible to measure the cranio-caudal dimension, which is normally up to 15 cm in adults. This can be measured together with the ventro-dorsal dimension (or depth), which is normally up to 13 cm. Also, the caudate lobe is enlarged in many diseases. In the axial plane, the caudate lobe should normally have a cross-section of less than 0.55 of the rest of the liver.

Other ultrasound studies have suggested hepatomegaly as being defined as a longitudinal axis > 15.5 cm at the hepatic midline, or > 16.0 cm at the midclavicular line.[4] [5]

Workup

Blood tests should be done, especially liver-function tests, which give a good impression of the patient's broad metabolic picture.

A complete blood test can help distinguish intrinsic liver disease from extrahepatic bile-duct obstruction.[6] An ultrasound of the liver can reliably detect a dilated biliary-duct system,[7] it can also detect the characteristics of a cirrhotic liver.[8]

Computerized tomography (CT) can give accurate anatomical information for a complete diagnosis.[9]

Treatment

Treatment of hepatomegaly varies with the cause, so accurate diagnosis is the first concern. In auto-immune liver disease, prednisone and azathioprine may be used for treatment.[10]

In lymphoma the treatment options include single-agent (or multi-agent) chemotherapy and regional radiotherapy, and surgery is an option in specific situations. Meningococcal group C conjugate vaccine is used in some cases.[11]

In primary biliary cirrhosis, ursodeoxycholic acid helps the bloodstream remove bile, which may increase survival.[12]

See also

Further reading

External links

Notes and References

  1. Web site: Hepatomegaly: MedlinePlus Medical Encyclopedia. www.nlm.nih.gov. 2016-02-27. 2016-07-05. https://web.archive.org/web/20160705044650/https://www.nlm.nih.gov/medlineplus/ency/article/003275.htm. live.
  2. Web site: Hepatomegaly. Read about Hepatomegaly (enlarged liver) Patient. Patient. en-GB. 2016-02-27. 2022-02-01. https://web.archive.org/web/20220201171419/https://patient.info/doctor/hepatomegaly. live.
  3. Book: Mechanisms of Clinical Signs. Dennis. Mark. Bowen. William Talbot. Cho. Lucy. 2012-01-01. Elsevier Australia. 469. 9780729540759. en. 2020-10-25. 2023-01-12. https://web.archive.org/web/20230112194904/https://books.google.com/books?id=FIV-NYPRCzEC&q=Hepatomegaly%2520mechanism&pg=PA469. live.
  4. Gosink . BB . Leymaster . CE . Ultrasonic determination of hepatomegaly. . Journal of Clinical Ultrasound . January 1981 . 9 . 1 . 37–44 . 6792230. 10.1002/jcu.1870090110 . 22827636 .
  5. Kratzer . W . Fritz . V . Mason . RA . Haenle . MM . Kaechele . V . Roemerstein Study . Group. . Factors affecting liver size: a sonographic survey of 2080 subjects. . Journal of Ultrasound in Medicine . November 2003 . 22 . 11 . 1155–61 . 10.7863/jum.2003.22.11.1155 . 14620885. 29904060 . free .
  6. Book: Goldman-Cecil Medicine. Goldman. Lee. Schafer. Andrew I.. 2015-04-21. Elsevier Health Sciences. 991. 9780323322850. en.
  7. Meacock. L M. Sellars. M E. Sidhu. P S. 2010-07-01. Evaluation of gallbladder and biliary duct disease using microbubble contrast-enhanced ultrasound. The British Journal of Radiology. 83. 991. 615–627. 10.1259/bjr/60619911. 0007-1285. 3473688. 20603412.
  8. Book: Diseases of the Liver in Children: Evaluation and Management. Murray. Karen F.. Horslen. Simon. 2013-12-11. Springer Science & Business Media. 199. 9781461490050. en.
  9. Book: Problem Solving in Emergency Radiology. Mirvis. Stuart E.. Soto. Jorge A.. Shanmuganathan. Kathirkamanathan. Yu. Joseph. Kubal. Wayne S.. 2014-08-19. Elsevier Health Sciences. 442. 9781455758395. en.
  10. Web site: Cirrhosis: Practice Essentials, Overview, Etiology . Medscape . 16 May 2024 . 22 July 2021.
  11. Web site: Non-Hodgkin's Lymphoma Doctor Patient. Patient. en-GB. 2016-03-11. 2018-02-08. https://web.archive.org/web/20180208123453/https://patient.info/doctor/non-hodgkins-lymphoma-pro. live.
  12. Web site: Primary biliary cirrhosis: MedlinePlus Medical Encyclopedia. www.nlm.nih.gov. 2016-03-12. 2016-07-05. https://web.archive.org/web/20160705053938/https://www.nlm.nih.gov/medlineplus/ency/article/000282.htm. live.

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Hepatomegaly".

Except where otherwise indicated, Everything.Explained.Today is © Copyright 2009-2024, A B Cryer, All Rights Reserved. Cookie policy.