Hepatomegaly

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]

## Contents

* 1 Signs and symptoms
* 2 Causes
* 2.1 Infective
* 2.2 Neoplastic
* 2.3 Biliary
* 2.4 Metabolic
* 2.5 Drugs (including alcohol)
* 2.6 Congenital
* 2.7 Others
* 3 Mechanism
* 4 Diagnosis
* 4.1 Workup
* 5 Treatment
* 6 See also
* 7 References
* 8 Further reading
* 9 External links

## 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

Leptospirosis

Among the causes of hepatomegaly are the following:

### Infective

* Glandular fever (Infectious mononucleosis)[2]
* Hepatitis (A, B, C)[1]
* Liver abscess (pyogenic abscess)[2]
* Malaria[2]
* Amoeba infections[3]
* Hydatid cyst[4]
* Leptospirosis[5]
* Actinomycosis[6]

### Neoplastic

* Metastatic tumours[1]
* Hepatocellular carcinoma[1]
* Myeloma[2]
* Leukemia[1]
* Lymphoma[2]

### Biliary

* Primary biliary cirrhosis.[2]
* Primary sclerosing cholangitis.[2]

### Metabolic

* Haemochromatosis[2]
* Cholesteryl ester storage disease[7]
* Porphyria[2]
* Wilson's disease[2]
* Niemann–Pick disease[1]
* Non-alcoholic fatty liver disease.[2]
* Glycogen storage disease (GSD)[1]
* Glycogenic hepatopathy (Mauriac syndrome)[8]

### Drugs (including alcohol)

* Alcohol use disorder[1]
* Drug-induced hepatitis[2]

### Congenital

* Hemolytic anemia[2]
* Polycystic liver disease[2]
* Sickle cell disease[2]
* Hereditary fructose intolerance[1]

### Others

* Hunter syndrome (spleen affected)[9]
* Zellweger's syndrome[10]
* Carnitine palmitoyltransferase I deficiency[11]
* Granulomatous: Sarcoidosis[12]

## 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).[13]

## Diagnosis

Abdominal ultrasonography of the liver, as a sagittal plane through the midclavicular line, with some standard measurements[14] Right lobe of the liver at the midclavicular line at ages 0 to 7[15]

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.[14] It is also possible to measure the cranio-caudal dimension, which is normally up to 15 cm in adults.[14] This can be measured together with the ventro-dorsal dimension (or depth), which is normally up to 13 cm.[14] 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.[14]

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.[16][17]

### 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.[18] An ultrasound of the liver can reliably detect a dilated biliary-duct system,[19] it can also detect the characteristics of a cirrhotic liver.[20]

Computerized tomography (CT) can give accurate anatomical information for a complete diagnosis.[21]

## Treatment

Prednisone

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.[22]

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.[23]

In primary biliary cirrhosis, ursodeoxycholic acid helps the bloodstream remove bile, which may increase survival.[24]

## See also

* Hepatosplenomegaly
* Liver function tests

## References

1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 "Hepatomegaly: MedlinePlus Medical Encyclopedia". https://www.medlineplus.gov/ency/article/003275.htm.
2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 "Hepatomegaly. Read about Hepatomegaly (enlarged liver) | Patient" (in en-GB). http://patient.info/doctor/hepatomegaly.
3. ↑ Lang, Florian (2009-03-19) (in en). Encyclopedia of Molecular Mechanisms of Disease: With 213 Tables. Springer Science & Business Media. p. 824. ISBN 9783540671367. https://books.google.com/books?id=DdBJ6jCf8KgC. Retrieved 2016-03-11.
4. ↑ Prevention, CDC - Centers for Disease Control and. "CDC - Echinococcosis - Resources for Health Professionals" (in en-us). https://www.cdc.gov/parasites/echinococcosis/health_professionals/.
5. ↑ "Leptospirosis (Weil's Disease) | Doctor | Patient" (in en-GB). http://patient.info/doctor/leptospirosis-weils-disease.
6. ↑ Banfalvi, Gaspar (2013-10-16) (in en). Homeostasis - Tumor - Metastasis. Springer Science & Business Media. p. 145. ISBN 9789400773356. https://books.google.com/books?id=O3nGBAAAQBAJ.
7. ↑ "Cholesteryl Ester Storage Disease - NORD (National Organization for Rare Disorders)" (in en-US). http://rarediseases.org/rare-diseases/cholesteryl-ester-storage-disease/.
8. ↑ Sherigar, JM; Castro, J; Yin, YM; Guss, D; Mohanty, SR (27 February 2018). "Glycogenic hepatopathy: A narrative review.". World Journal of Hepatology 10 (2): 172–185. doi:10.4254/wjh.v10.i2.172. PMID 29527255.
9. ↑ "Hunter's Syndrome. MPS II information; symptoms | Patient" (in en-GB). 20 August 2014. http://patient.info/doctor/hunters-syndrome.
10. ↑ "OMIM Entry - # 214100 - PEROXISOME BIOGENESIS DISORDER 1A (ZELLWEGER); PBD1A". http://www.omim.org/entry/214100.
11. ↑ "CPT I deficiency". 2016-03-07. https://medlineplus.gov/genetics/condition/carnitine-palmitoyltransferase-i-deficiency/.
12. ↑ "Sarcoidosis | Doctor | Patient" (in en-GB). http://patient.info/doctor/sarcoidosis-pro.
13. ↑ Dennis, Mark; Bowen, William Talbot; Cho, Lucy (2012-01-01) (in en). Mechanisms of Clinical Signs. Elsevier Australia. p. 469. ISBN 9780729540759. https://books.google.com/books?id=FIV-NYPRCzEC&q=Hepatomegaly%20mechanism&pg=PA469. Retrieved 2020-10-25.
14. ↑ 14.0 14.1 14.2 14.3 14.4 Christoph F. Dietrich, Carla Serra, Maciej Jedrzejczyk (2010-07-28). "Ultrasound of the liver - EFSUMB – European Course Book". http://www.kosmos-design.co.uk/efsumb-ecb/ecbse-ch02-ultrasoundliver.pdf.
15. ↑ Rocha, Silvia Maria Sucena da; Ferrer, Ana Paula Scoleze; Oliveira, Ilka Regina Souza de; Widman, Azzo; Chammas, Maria Cristina; Oliveira, Luiz Antonio Nunes de; Cerri, Giovanni Guido (2009). "Determinação do tamanho do fígado de crianças normais, entre 0 e 7 anos, por ultrassonografia". Radiologia Brasileira 42 (1): 7–13. doi:10.1590/S0100-39842009000100004. ISSN 0100-3984.
16. ↑ Gosink, BB; Leymaster, CE (January 1981). "Ultrasonic determination of hepatomegaly.". Journal of Clinical Ultrasound 9 (1): 37–44. doi:10.1002/jcu.1870090110. PMID 6792230.
17. ↑ Kratzer, W; Fritz, V; Mason, RA; Haenle, MM; Kaechele, V; Roemerstein Study, Group. (November 2003). "Factors affecting liver size: a sonographic survey of 2080 subjects.". Journal of Ultrasound in Medicine 22 (11): 1155–61. doi:10.7863/jum.2003.22.11.1155. PMID 14620885.
18. ↑ Goldman, Lee; Schafer, Andrew I. (2015-04-21) (in en). Goldman-Cecil Medicine. Elsevier Health Sciences. p. 991. ISBN 9780323322850. https://books.google.com/books?id=40Z9CAAAQBAJ.
19. ↑ 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. doi:10.1259/bjr/60619911. ISSN 0007-1285. PMID 20603412.
20. ↑ Murray, Karen F.; Horslen, Simon (2013-12-11) (in en). Diseases of the Liver in Children: Evaluation and Management. Springer Science & Business Media. p. 199. ISBN 9781461490050. https://books.google.com/books?id=HzC5BAAAQBAJ.
21. ↑ Mirvis, Stuart E.; Soto, Jorge A.; Shanmuganathan, Kathirkamanathan; Yu, Joseph; Kubal, Wayne S. (2014-08-19) (in en). Problem Solving in Emergency Radiology. Elsevier Health Sciences. p. 442. ISBN 9781455758395. https://books.google.com/books?id=E3tYBAAAQBAJ.
22. ↑ "Cirrhosis: Practice Essentials, Overview, Etiology". 22 July 2021. https://emedicine.medscape.com/article/185856-overview#a12.
23. ↑ "Non-Hodgkin's Lymphoma | Doctor | Patient" (in en-GB). http://patient.info/doctor/non-hodgkins-lymphoma-pro.
24. ↑ "Primary biliary cirrhosis: MedlinePlus Medical Encyclopedia". https://www.medlineplus.gov/ency/article/000282.htm.

## Further reading

* Hoffmann, Georg F.; Zschocke, Johannes; Nyhan, William L. (2009-11-21) (in en). Inherited Metabolic Diseases: A Clinical Approach. Springer Science & Business Media. ISBN 9783540747239. https://books.google.com/books?id=ILIs-P6sDekC&q=hepatomegaly&pg=PA105.
* Kim, Sun Bean; Kim, Do Kyung; Byun, Sun Jeong; Park, Ji Hye; Choi, Jin Young; Park, Young Nyun; Kim, Do Young (2015-12-01). "Peliosis hepatis presenting with massive hepatomegaly in a patient with idiopathic thrombocytopenic purpura". Clinical and Molecular Hepatology 21 (4): 387–392. doi:10.3350/cmh.2015.21.4.387. ISSN 2287-2728. PMID 26770928.

## External links

* Merck Manual: Hepatomegaly

Classification|

* ICD-10: R16..0
* ICD-9-CM: 789.1

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External resources|

* MedlinePlus: 003275

| Wikimedia Commons has media related to Hepatomegaly.

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