Hepatomegaly

Hepatomegaly is the condition of having an enlarged liver.[4] It is a non-specific medical sign having many causes, which can broadly be broken down into infection, hepatic tumours, or metabolic disorder. Often, hepatomegaly will present as an abdominal mass. Depending on the cause, it may sometimes present along with jaundice.[1]

Hepatomegaly
Computerized tomography of hepatomegaly
SpecialtyHepatology 
SymptomsWeight loss, lethargy[1]
CausesLiver abscess (pyogenic abscess), Malaria[1]
Diagnostic methodAbdominal ultrasonography[2]
TreatmentPrednisone and azathioprine[3]

Signs and symptoms

The individual may experience many symptoms, including weight loss, poor appetite and lethargy (jaundice and bruising may also be present).[1]

Causes
Leptospirosis

Among the causes of hepatomegaly are the following:

Infective

Neoplastic

Biliary

Metabolic

Drugs (including alcohol)

Congenital

Others

Mechanism

The mechanism of hepatomegaly consists of vascular swelling, inflammation (due to the various causes that are infectious in origin) and deposition of (1) non-hepatic cells or (2) increased cell contents (such due to iron in hemochromatosis or hemosiderosis and fat in fatty liver disease).[14]

Diagnosis
Abdominal ultrasonography of the liver, as a sagittal plane through the midclavicular line, with some standard measurements.[2]
Right lobe of the liver at the midclavicular line at ages 0 to 7.[15]

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.[2] It is also possible to measure the cranio-caudal dimension, which is normally up to 15 cm in adults.[2] This can be measured together with the ventro-dorsal dimension (or depth), which is normally up to 13 cm.[2] 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.[2]

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, importantly liver-function series, which will 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 help to obtain accurate anatomical information, in individuals with hepatomegaly for the purpose of a complete diagnosis.[21]

Treatment
Prednisone

Treatment of hepatomegaly will vary depending on the cause of the liver enlargement and hence accurate diagnosis is the primary concern. In the case of auto-immune liver disease, prednisone and azathioprine may be used for treatment.[3]

In the case of lymphoma the treatment options include single-agent (or multi-agent) chemotherapy and regional radiotherapy, also surgery may be an option in specific situations. Meningococcal group C conjugate vaccine are also used in some cases.[22]

In primary biliary cirrhosis ursodeoxycholic acid helps the bloodstream remove bile which may increase survival in some affected individuals.[23]

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See also

References
  1. "Hepatomegaly. Read about Hepatomegaly (enlarged liver) | Patient". Patient. Retrieved 2016-02-27.
  2. Christoph F. Dietrich, Carla Serra, Maciej Jedrzejczyk (2010-07-28). "Ultrasound of the liver - EFSUMB – European Course Book" (PDF). European federation of societies for ultrasound in medicine and biology (EFSUMB). Archived from the original (PDF) on 2017-08-12. Retrieved 2017-12-21.CS1 maint: multiple names: authors list (link)
  3. "Cirrhosis: Practice Essentials, Overview, Epidemiology". 2018-10-31. Cite journal requires |journal= (help)
  4. "Hepatomegaly: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2016-02-27.
  5. Lang, Florian (2009-03-19). Encyclopedia of Molecular Mechanisms of Disease: With 213 Tables. Springer Science & Business Media. p. 824. ISBN 9783540671367.
  6. Prevention, CDC - Centers for Disease Control and. "CDC - Echinococcosis - Resources for Health Professionals". www.cdc.gov. Retrieved 2016-03-11.
  7. "Leptospirosis (Weil's Disease) | Doctor | Patient". Patient. Retrieved 2016-03-11.
  8. Banfalvi, Gaspar (2013-10-16). Homeostasis - Tumor - Metastasis. Springer Science & Business Media. p. 145. ISBN 9789400773356.
  9. "Cholesteryl Ester Storage Disease - NORD (National Organization for Rare Disorders)". NORD (National Organization for Rare Disorders). Retrieved 2016-03-11.
  10. "Hunter's Syndrome. MPS II information; symptoms | Patient". Patient. Retrieved 2016-03-11.
  11. "OMIM Entry - # 214100 - PEROXISOME BIOGENESIS DISORDER 1A (ZELLWEGER); PBD1A". www.omim.org. Archived from the original on 2015-02-14. Retrieved 2016-03-11.
  12. "CPT I deficiency". Genetics Home Reference. 2016-03-07. Retrieved 2016-03-11.
  13. "Sarcoidosis | Doctor | Patient". Patient. Retrieved 2016-03-11.
  14. Dennis, Mark; Bowen, William Talbot; Cho, Lucy (2012-01-01). Mechanisms of Clinical Signs. Elsevier Australia. p. 469. ISBN 9780729540759.
  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). Goldman-Cecil Medicine. Elsevier Health Sciences. p. 991. ISBN 9780323322850.
  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. PMC 3473688. PMID 20603412.
  20. Murray, Karen F.; Horslen, Simon (2013-12-11). Diseases of the Liver in Children: Evaluation and Management. Springer Science & Business Media. p. 199. ISBN 9781461490050.
  21. Mirvis, Stuart E.; Soto, Jorge A.; Shanmuganathan, Kathirkamanathan; Yu, Joseph; Kubal, Wayne S. (2014-08-19). Problem Solving in Emergency Radiology. Elsevier Health Sciences. p. 442. ISBN 9781455758395.
  22. "Non-Hodgkin's Lymphoma | Doctor | Patient". Patient. Retrieved 2016-03-11.
  23. "Primary biliary cirrhosis: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2016-03-12.

Further reading
Classification
External resources
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