Hepatomegaly

Signs and symptoms

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

Causes

Among the causes of hepatomegaly are the following:

Infective

• Glandular fever (Infectious mononucleosis)
• Hepatitis (A, B, C)
• Liver abscess (pyogenic abscess)
• Malaria
• Amoeba infections
• Hydatid cyst
• Leptospirosis
• Actinomycosis

Neoplastic

• Metastatic tumours
• Hepatocellular carcinoma
• Myeloma
• Leukemia
• Lymphoma

Biliary

• Primary biliary cirrhosis.
• Primary sclerosing cholangitis.

Metabolic

• Haemochromatosis
• Cholesteryl ester storage disease
• Porphyria
• Wilson's disease
• Niemann–Pick disease
• Non-alcoholic fatty liver disease.
• Glycogen storage disease (GSD)
• Glycogenic hepatopathy (Mauriac syndrome)

Drugs (including alcohol)

• Alcohol use disorder
• Drug-induced hepatitis

Congenital

• Hemolytic anemia
• Polycystic liver disease
• Sickle cell disease
• Hereditary fructose intolerance

Others

• Hunter syndrome (spleen affected)
• Zellweger's syndrome
• Carnitine palmitoyltransferase I deficiency
• Granulomatous: Sarcoidosis

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).

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.

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. An ultrasound of the liver can reliably detect a dilated biliary-duct system, it can also detect the characteristics of a cirrhotic liver.

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

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.

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.

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

References

References

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