What Is Hepatomegaly?

Hepatomegaly is an enlarged liver, which may be caused by a variety of different conditions.

The liver is a large, wedge-shaped organ in the right upper abdomen. In adults, the liver measures about 14 centimeters (5.5 inches) from top to bottom, with some variability depending on sex or body size.

This article discusses the signs and symptoms of hepatomegaly. It also covers causes, diagnosis, and treatment options.

What Are the Signs and Symptoms of Hepatomegaly?

Individuals with an enlarged liver may not have any symptoms. Occasionally, individuals may experience pressure or tenderness in their right upper abdomen.

Hepatomegaly itself is usually a symptom of some other underlying condition. For example, if an individual has liver disease, they may also experience:

• Jaundice, or yellowing of the eyes or skin
• Poor appetite
• Dark urine and light-colored stools

In addition to an enlarged liver, individuals with acute viral hepatitis, or an infection that causes liver damage, may also experience:

• Nausea
• Vomiting
• Fever
• Abdominal pain
• Fatigue
• Malaise, or generally feeling unwell
• Muscle and joint pain

Hepatomegaly Causes

A wide range of diseases can cause hepatomegaly. These include:

• Viral hepatitis
• Autoimmune disease, or when your immune system attacks its own tissues
• Steatosis, or fatty liver disease
• Genetic diseases
• Drinking excessive amounts of alcohol
• Cancerous or non-cancerous liver tumors
• Storage disorders of the liver

How Is Hepatomegaly Diagnosed?

Hepatomegaly is often found during a routine physical examination. Your healthcare provider will:

• Take a medical history
• Perform a physical examination in search of risk factors for liver disease
• Look for signs and symptoms that may reveal the cause of hepatomegaly

Non-Invasive Tests

Imaging tests may be used to confirm liver enlargement and offer information about the size and structure of the liver.

If imaging tests are ordered, the first may be an abdominal ultrasound, which uses sound waves to create images of your organs. During the test, a sonographer will place a device on your skin surface and record the resulting images. Abdominal ultrasounds are painless, fast, and inexpensive.

If necessary, your healthcare provider may order additional, more complex imaging tests including:

• An abdominal computed tomography (CT) scan
• Magnetic resonance imaging (MRI)

Invasive Tests

More invasive testing is sometimes necessary depending on the results of the non-invasive tests. More invasive tests may include:

• Blood tests, which can be used to determine whether there is ongoing liver inflammation
• A biopsy of the liver, or a procedure in which a small amount of tissue is removed for examination under a microscope 
• Paracentesis, a procedure that removes fluid from the body for analysis and may be prescribed if fluid in your abdomen is found
  

Hepatomegaly Treatment

Remember that hepatomegaly is usually a symptom of an underlying condition that is usually benign. Your treatment plan will ultimately be determined by what is causing your liver enlargement.

Viral Hepatitis

Viral hepatitis is the inflammation of the liver, which can be caused by viruses. Your healthcare provider’s specific treatment recommendations will depend on your medical history.

• If you are diagnosed with chronic hepatitis B virus, your healthcare provider may recommend antiviral treatment if an initial evaluation reveals that you have severe active disease.
• Most individuals with chronic hepatitis C will be considered for therapy. Antiviral agents for hepatitis B and C are available.

Hepatomegaly With Steatosis

Steatosis occurs when liver cells accumulate fat in response to injury. Non-alcoholic fatty liver disease (NAFLD) refers to an accumulation of fat in the liver not caused by alcohol, viral infection, medications, or genetic disease. A related term is non-alcoholic steatohepatitis (NASH), which refers to steatosis associated with inflammation. 

Just like individuals with other types of liver disease, those with NAFLD can progress to advanced liver disease and cirrhosis. Obesity, type 2 diabetes, and hyperlipidemia place you at higher risk for NAFLD. Treatment often centers on lifestyle modification such as:

• Diet
• Exercise
• Weight loss
• Medications if you have a more severe disease

Drinking Too Much Alcohol

Drinking excessive amounts of alcohol can cause a range of liver conditions, including alcoholic hepatitis, alcoholic fatty liver disease, or cirrhosis.

It is critical to recognize the signs and symptoms of alcohol use disorder early because individuals often do not develop symptoms until they have life-threatening liver disease. 

Treatment for alcohol use disorder may take many different forms, including:

• Counseling
• Residential treatment
• Support groups
• Medications, as an adjunct to other types of therapy

Liver Tumors

Both benign and malignant liver tumors may cause enlargement of the liver. The most common types of benign liver tumors include cysts, hemangiomas, adenomas, or focal nodular hyperplasia. 

Benign Liver Tumors

Usually, no treatment is necessary for benign liver tumors, unless they are causing severe symptoms such as abdominal pain or bleeding. 

Rarely, liver adenomas can degenerate into a cancerous tumor, and your healthcare provider may recommend periodic imaging to make sure no changes have occurred in your liver.

Malignant Liver Tumors

Malignant liver tumors can be divided into primary or secondary liver tumors. Primary liver tumors are tumors that arise directly from the liver tissue. The most common examples are hepatocellular carcinoma or cholangiocarcinoma.

The treatment for primary liver tumors may include:

• Chemotherapy
• Radiation
• Surgery
• Curative liver transplantation

A secondary liver tumor is a tumor from some other part of the body that has involved the liver. Tumors may grow directly into the liver (known as direct invasion) or may spread to the liver via the bloodstream (known as metastasis). Almost any tumor can spread to the liver, and treatment is variable.

Storage Disorders of the Liver

This refers to a group of diseases where the liver stores too much carbohydrate, minerals, or other biological molecules. Often, the cause is genetic and may be exacerbated by diet or other factors in your environment. 

There are numerous liver storage diseases—examples include hemochromatosis (in which the liver stores too much iron), Wilson’s disease (too much copper), or glycogenosis (glycogen, a molecule related to sugar). 

If left untreated, these diseases can cause life-threatening liver failure. Treatment is variable and can include dietary changes or medications which capture the offending molecules.

A Word From Verywell

It may be frightening to learn that your liver is enlarged. However, most of the causes of liver enlargement are benign and treatable. Your medical history and symptoms will guide the appropriate workup. 

Open communication with your healthcare workers will ensure that you understand the diagnostic and treatment plan and will help mitigate any anxiety you might have.