What is mild hepatomegaly
The term hepatomegaly means nothing other than liver enlargement. As a wedge-shaped, bilobed organ, the liver is mostly located in the right upper abdomen directly below the diaphragm. It is the central metabolic organ and, at around 1.5 kilograms, the largest gland in the body.
If the liver is abnormally enlarged, it is usually a fatty liver. Other diseases are rarely the cause of hepatomegaly. In many cases, in addition to the liver enlargement, there is also an enlargement of the spleen. Doctors then speak of hepatosplenomegaly.
Hepatomegaly: causes and possible diseases
Hepatomegaly can occur as a side effect of various diseases. The most common reason for an enlarged liver is fatty liver. But other liver diseases and diseases of other organs can also cause hepatomegaly:
Metabolic or toxic liver diseases
The liver reacts to a wide variety of harmful influences with obesity, for example to chronic alcohol consumption, overeating (obesity), viral or metabolic diseases (such as diabetes mellitus or increased blood lipid levels) as well as certain drugs and chemicals. However, doctors only speak of fatty liver when fat is stored in more than half of all liver cells. If fewer cells are fatty, this is called fatty liver. The heavy fat storage leads to an enlarged liver.
Other metabolic or toxic substance-related liver diseases that can lead to hepatomegaly are storage diseases (such as the iron storage disease hemochromatosis) and certain forms of the metabolic disease porphyria. Liver involvement with subsequent hepatomegaly can also occur in the context of other metabolic and hormonal diseases.
Inflammatory liver disease
Inflammatory liver disease is another possible cause of hepatomegaly. The inflammation can be caused by viruses, an incorrect reaction of the immune system (autoimmune disease), alcohol or toxins. Examples of inflammatory liver diseases that can be associated with hepatomegaly are acute or chronic inflammation of the liver (hepatitis), liver cirrhosis and liver granulomas. Granulomas are inflammation-related, nodular tissue growth. They arise, for example, in the context of tuberculosis, AIDS or sarcoid.
Diseases with biliary obstruction
Diseases associated with an impaired drainage of the bile (cholestatic diseases) can also result in hepatomegaly.
The bile is formed in the liver and released into the small intestine to support fat digestion (with the gall bladder as a temporary store). If the bile builds up, the liver can become enlarged. The cause of the congestion can be inside or outside the liver. Examples of cholestatic diseases with possible hepatomegaly are biliary obstruction (e.g. due to gallstones), primary biliary cirrhosis and biliary obstruction due to drugs or during pregnancy.
Blood vessel disorders
Sometimes hepatomegaly results from a blood vessel (vascular) disease. An example of this is right heart failure (right heart failure): Here the right ventricle is no longer able to pump the venous blood coming from the body further into the pulmonary circulation. As a result, the venous blood backs up, which, in addition to jammed neck veins, can also lead to congested liver with enlarged liver. Even with a defective heart valve between the right atrium and right ventricle (tricuspid valve defect) as well as with a "armored heart" (constrictive pericarditis), the venous blood can back up into the liver.
Other vascular diseases that can lead to hepatomegaly are, for example, an (incomplete) occlusion of the large hepatic veins (Budd-Chiari syndrome), a clot-related occlusion of the inferior vena cava (inferior vena cava thrombosis) and an occlusion or a A bulging (aneurysm) of the hepatic artery.
Infections with various pathogens are also possible causes of hepatomegaly. For example, inflammation of the bile ducts (cholangitis), liver abscesses and parasitic liver diseases (such as echinococcosis or schistosomiasis) can cause liver enlargement. In addition, hepatomegaly can also turn out to be a reactive liver change in infectious diseases.
Cyst liver and liver cysts
Liver cysts are smooth, fluid-filled cavities in the liver, the size of which can range from a few millimeters to over ten centimeters. They can occur individually or in groups. If the liver is riddled with cysts, it is called cyst liver. With very large cysts and liver cysts, the liver can become enlarged.
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 colon, stomach or breast cancer) can form daughter ulcers in the liver (liver metastases) and thus lead to liver enlargement.
Diseases with this symptom
Find out here about the diseases that can cause the symptom:
Hepatomegaly: When Should You See a Doctor?
If you feel pressure and / or pain in the upper abdomen - possibly accompanied by other complaints - you should consult a doctor for clarification. It may be due to hepatomegaly.
Hepatomegaly: what does the doctor do?
First, the doctor collects the medical history (anamnesis): He asks you in detail about your symptoms, possible previous illnesses (such as hepatitis, tumors) and possible underlying diseases (lipid metabolism disorder, diabetes, gallstones, etc.). Information about your alcohol and medication consumption, (foreign) travel in the past and any weight loss are also important for clarifying hepatomegaly. Various examinations follow after the conversation.
The doctor feels the abdomen (palpation) to estimate the size of the liver and obtain possible clues as to the cause of the hepatomegaly. With hepatitis and congested liver, the liver feels soft and smooth and may be painful when pressure is applied. In contrast, a hard, irregular to bumpy liver indicates, for example, cirrhosis or liver cancer as a possible cause of hepatomegaly.
The doctor also examines the size of the spleen by palpation. Because hepatomegaly (enlarged liver) sometimes goes hand in hand with splenomegaly (enlarged spleen) - together then called hepatosplenomegaly.
The doctor also examines the skin for signs of jaundice (jaundice) or the iron storage disease hemochromatosis (possibly dark skin pigmentation). So-called liver skin signs are also revealing, i.e. characteristic skin changes in chronic liver diseases (such as liver cirrhosis). These include, for example, spider nevi (visible expansion of skin arteries, reminiscent of spider legs) and reddened palms (palma erythema).
Other physical signs also indicate the cause of hepatomegaly. For example, swollen legs (leg edema) and congested neck veins suggest a right heart failure.
If the physical exam confirms hepatomegaly, a blood analysis is done. For example, the differential blood count, the rate of sedimentation of blood cells (ESR), various liver enzymes, iron and cholesterol levels and blood clotting (Quick value / INR) are determined.
If the hepatomegaly is accompanied by an enlarged spleen (hepatosplenomegaly), the doctor may order additional blood tests (such as the Coombs test to detect antibodies against red blood cells).
An ultrasound examination of the abdominal cavity (abdominal ultrasound) is also part of the routine when clarifying hepatomegaly. The doctor examines the liver, spleen, biliary tract and the portal vein system (venous vascular system which directs the blood from the stomach, intestines and spleen via the portal vein first to the liver and then on to the inferior vena cava).
A chest x-ray can provide additional clues as to the cause of the hepatomegaly. An enlarged heart and a pleural effusion can be the result of a right heart failure. Even (malignantly) swollen lymph nodes (lymphomas) can be seen on the X-ray.
If the doctor suspects certain diseases as the reason for the hepatomegaly, further diagnostic steps may be necessary. For example, if a certain form of tuberculosis (miliary tuberculosis) or sarcoidosis is suspected as a trigger for liver enlargement, it may be necessary to take a tissue sample from the liver (liver puncture).
This is how the doctor treats hepatomegaly
Since the liver enlargement is a side effect of various diseases, it is important to treat it. For example, in the case of the most common cause of hepatomegaly, fatty liver, the underlying disease has to be treated or lifestyle changes have to be made. This is the only way to ultimately eliminate hepatomegaly.
These examinations help to find out the causes of the symptoms:
Hepetomeglie: You can do that yourself
In most cases, hepatomegaly is caused by fatty liver. At some point this can turn into dangerous, irreversible cirrhrosis. But there are several things you can do to keep your liver healthy. A healthy lifestyle is crucial, because too much alcohol, too much and too fatty food, obesity and lack of exercise put a strain on the organ.
Appropriate vaccinations also protect against hepatitis. You should also have your liver values checked regularly so that you can take action in good time if your liver is suffering. Then it doesn't even come to one Hepatomegaly.
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