Hepatomegaly: what is it? See symptoms, causes and prevention

Hepatomegaly can be related to several conditions, indicating a change in the correct functioning of the liver.

The condition can cause intense symptoms and even be noticed through discomfort and palpation in the abdomen, however, sometimes, there are no symptoms.

So it is important to know the condition!

What is Hepatomegaly?

Hepatomegaly is a condition characterized by an enlarged liver. In general, it indicates that there is an alteration or disease affecting the organ. But not all hepatology, that is, liver disease, makes it bigger or swollen.

Sometimes, when the increase is significant, the person may experience pain and discomfort in the abdominal region, but often the picture of hepatomegaly is asymptomatic.

The liver is the second largest organ in the body, second only to the skin. It usually weighs between 3 and 3.5 kg and, even if the organ does not change in size, problems can occur. It is important to be aware of it, as it has several functions in the body.

Hepatomegaly can still be a symptom of a more serious problem, such as:

  • Nausea and vomiting (with or without blood);
  • Tiredness;
  • Swelling of the feet and legs;
  • Lack of air;
  • Weight loss;
  • Abdominal pain (usually in the upper quadrant on the right side of the abdomen);
  • Yellowing of the skin and eyes (jaundice).

Causes of Hepatomegaly

The enlargement of the liver can arise from several causes, such as:

Obstruction of the outflow of the liver

  • Budd-Chiari syndrome: obstruction of the outflow of the liver out of the liver, which causes a rapid increase in intrahepatic venous pressure. Pain may occur in the area due to the increase in the size of the liver. There is no hepatojugular reflux. When the problem becomes chronic, it is common for the size of the organ to decrease due to liver necrosis.
  • Venocclusive diseases: symptoms similar to Budd-Chiari syndrome occur. In addition, there is also toxic damage to the endothelium of the terminal venules and perivenular hepatocytes, with obliteration of the terminal hepatic venules. Disease that is associated with pyrrolidizine alkaloids, 6-thioguanine, dacarbazine, mitomycin, curmustine, cyclophosphamide and others.

Venous congestion (blood accumulation)

  • Heart failure in the right chambers: endomyocardial fibrosis, cor pulmonale and constrictive pericarditis.
  • Biventricular cardiac insufficiencies or with predominance of the left chambers: hepatomegaly only happens if there is associated tricuspid insufficiency.
  • Congestive heart failure: hepatomegaly can vary between moderate and massive, with a blunt, painful and firm border. There is hepatojugular reflux and ascites. Hepatocyte necrosis starts from the centrobular vein. The liver is “nutmeg”.

Choledochal obstruction / biliary tract

  • Primary biliary cirrhosis (intrahepatic obstruction): causes destruction of the bile ducts. In these cases, hepatomegaly is mild to moderate in 25% of cases. The liver has a firm consistency and an uneven surface.
  • Extrahepatic obstruction: dilation of the intrahepatic bile ducts causes hepatomegaly. The liver has a regular surface and a blunt and firm border. In laparoscopy, the color is green. In this group of diseases, jaundice is an important element.

Accumulation of inflammatory cells (inflammatory diversion)

Infectious causes

  • Malaria: the liver is firm, and can cause pain during palpation and may regress if treated correctly.
  • Leptospirosis: intense cholestasis causes hepatomegaly.
  • Hepatic abscesses: pyogenic and amoebic abscesses are the most common. Hepatomegaly becomes painful.
  • Yersinia infection: hepatomegaly is associated with the septicemic form of the disease, with the appearance of multifocal abscesses.
  • Infections with hepatic granulomas: mild to moderate hepatomegaly. Its main causes are: brucellosis, syphilis, tuberculosis, disseminated fungal infections and visceral larva migrans.
  • Viral hepatitis:
  1. Acute viral hepatitis: mild to moderate hepatomegaly and painful on palpation.
  2. Chronic viral hepatitis (usually B and C): hepatomegaly depending on the predominant histological picture.
  3. Hepatitis E virus, Epstein-Barr, yellow fever virus, CMV and herpes virus: hepatomegaly and mild-moderate liver disease.
  • Other infections: kala azar, Salmonella and paracoccidioidomycosis.

Non-infectious causes

  • Sarcoidosis.
  • Autoimmune hepatitis Mild-moderate hepatomegaly that causes pain in 4 out of 10 cases. Associated splenomegaly in 5 out of 10 cases.

Accumulation of substances in the liver / hepatocytes

  • Hemochromatosis: moderate to massive hepatomegaly, with homogenous enlargement of the entire organ. The liver has a firm, rust-colored consistency.
  • Steatosis: occurs when the liver accumulates fat (lipids) above 5% of the hepatic weight. The liver does not hurt when touched. Liver steatosis occurs in obesity, diabetes, malnutrition, jejunoileal bypass surgery, alcoholism, chronic viral hepatitis, ulcerative colitis and Wilson’s disease.
  • Metabolic diseases: Gaucher disease, high-1-trypsin deficiency.
  • Extramedullary hematopoiesis (myeloid metaplasia) : large associated splenomegaly.
  • Amyloidosis: massive hepatomegaly. Liver is waxy or pale in color.

Action of toxic substances

  • Alcohol.
  • Drug hepatitis.

Neoplasias

  • Lymphomas / leukemias.
  • Metastatic tumors.
  • Hepatocellular carcinoma (hepatoma): the tumor can be unique, preferentially affecting the right lobe or nodular pattern, in which several small tumors spread through the liver. The organ has a hardened consistency, nodular surface and is painful on palpation.

Other causes

  • Acromegaly: mild-moderate hepatomegaly, accompanying other viceromegalies.
  • Congenital hepatic fibrosis.
  • Liver cirrhosis: liver may be normal, increased or decreased
  • Histiocytosis: may present with generalized lymphadenomegaly, splenomegaly and hepatomegaly.
  • Polycystic liver.

Classification

The classification of hepatomegaly can be done in three ways. There is mild, moderate or massive. The size is what sets them apart.

  • Light: measures between 13 and 16 cm.
  • Moderate: measures between 16 and 19 cm.
  • Massive: measures more than 19 cm.

Risk factors

There are specific risk factors for hepatomegaly. Know the main ones:

  • Hepatite A, B e C;
  • Excessive use of alcoholic beverages;
  • Use large doses of medications, supplements and vitamins;
  • Bad eating habits;
  • Overweight;
  • Infections, such as malaria and yellow fever.

Symptoms of Hepatomegaly

Hepatomegaly does not usually bring on symptoms at first, as the liver does not send signals to the brain about the problem. If there is an increase in the volume of the liver, it may become sensitive to palpation. When symptoms appear, they will be characterized by abdominal discomfort and pain.

In addition, vomiting, nausea, swelling and fatigue can arise in hepatomegaly. It is also important to pay attention to the color of urine and feces

Diagnosis

The specialist doctors responsible for caring for hepatomegaly are: gastroenterologist and general practitioner. To determine the diagnosis, the doctor can do a palpation test to find out if the size of the liver is altered and the main characteristics of the liver.

Blood tests, imaging and biopsy are some of the tests requested. There are also tests that can be carried out so that the diagnosis of hepatomegaly is given accurately, they are: liver ultrasound, abdominal radiography, abdominal computed tomography.

Blood test:

A blood sample can be taken to determine the level of liver enzymes. In addition to discovering the level of enzymes, viruses can be identified.

Imaging exams:

Tomography and ultrasound are indicated so that the doctor can examine the liver.

Biopsy:

Biopsy is done to collect a sample of liver tissue for laboratory analysis. The biopsy is done with a needle inserted through the skin and the liver, which can reveal an enlarged liver.

Hepatomegaly Treatment

The treatment of hepatomegaly varies according to the diagnosis and its causes. This means that the forms of treatment are very individual and depend, necessarily, on the medical diagnosis.

For example, it may be necessary to use medications, dietary changes, reduced alcohol intake and other guidelines.

Complications

Complications are not common, but, if they do occur, liver failure, liver decompensation, jaundice and bleeding may arise.

How is Hepatomegaly prevented?

To prevent hepatomegaly, some measures can be taken, such as:

  • Do not overdo the consumption of alcohol;
  • Maintain a healthy diet;
  • Stop smoking;
  • Limit contact with chemicals (use gloves, mask and long sleeves);
  • Maintain a healthy weight;
  • Take care with supplements;
  • Follow the doctor’s instructions.

So that other people besides you can find out about this condition that usually affects adults, share it with your friends, colleagues and family so that they also have knowledge about hepatomegaly!

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