Hepatomegaly: causes and general signs and symptoms

 Hepatomegaly: Causes and General Signs and Symptoms

 Enlargement of Liver is called as Hepatomegaly.  It can be because of some infection,  fatty degeneration, tumor or obstruction or metabolic disorder. 

Normally liver lies in right upper quadrent of abdomen and extends from 5th intercoastal space in midclavicular line to the right coastal margin, average length being 10-12.5cm in craniocaudal length. Length more than 15.5cm, midclavicular is considered as enlargement.  Normally it weighs 1800g (1.4 to 1.5kg) in men and 1400g (1.2 to 1.4kg) in women. 
It is the largest and very important organ of human body. It is a multitasking organ performing many important functions like metabolic,  endocrine,  hemopoietic,  storage etc. 

Causes of Hepatomegaly

1. Infections
  • Hepatitis-A,B,C
  • Amoebic liver abscess
  • Pyogenic liver abscess
  • Hydatid cyst
  • Malaria
  • Actinomycosis
  • Leptospirosis
  • Glandular fever (infectious mononucleosis) 
2. Tumors
  • Hepatocellular carcinoma
  • Leukemia 
  • Lymphoma
  • Metastasis 
3. Congenital 
  • Sickle cell disease 
  • Hemolytic anemia
  • Polycystic liver disease 
4. Drug induced 
  • Chronic alcoholism 
  • Drug induced hepatitis 
5. Obstructive
  • Cholangitis/Cholestasis
  • Jaundice obstructive
  • Biliary cirrhosis
  • Extra hepatic portal venous obstruction
6. Metabolic 
  • Glycogen storage disease 
  • Wilson's disease
  • Lipid storage disorders ( Niemann pick disease) 
  • Lysosomal storage disorder (Gaucher's disorder)

General Signs and Symptoms 

  1. Loss of appetite 
  2. Weight loss
  3. Jaundice,  Icterus
  4. Nausea
  5. Vomiting 
  6. Abdominal pain
  7. Lethargy,  Fatigue 
  8. Itching in skin (pruritus) 
  9. Swelling in legs, ankels and feet
  10. Abnormal stool

Diagnosis

Physical examination 
Per abdomen palpation and percussion helps in diagnosis. 

Lab investigations 

  1. Abdominal ultrasound - Exact size of liver can be assessed. 
  2. Ct scan- accurate anatomical information is obtained 
  3. Liver function test 
  4. Liver biopsy 
  5. MRCP ( magnetic resonance cholangiopancreatography) 
  6. ERCP (endoscopic retrograde) 
  7. EUS ( endoscopic ultrasonography) 

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