Mixing
Hepatomegaly
| Hepatomegaly | |
|---|---|
 | |
| Computerized tomography of hepatomegaly | |
| Specialty | Internal medicine  |
| Causes | Liver abscess (pyogenic abscess), Malaria[1] |
| Diagnostic method | Abdominal ultrasonography[2] |
| Treatment | Prednisone and azathioprine[3] |
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]
Contents
1 Symptoms/signs
2 Causes
2.1 Infective
2.2 Neoplastic
2.3 Biliary
2.4 Metabolic
2.5 Drugs (and alcohol)
2.6 Congenital
2.7 Others
3 Mechanism
4 Diagnosis
4.1 Workup
5 Treatment
6 See also
7 References
8 Further reading
9 External links
Symptoms/signs
Symptoms having to do with hepatomegaly can include several, among them the individual may experience some 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
Glandular fever (Infectious mononucleosis)[1]
Hepatitis (A, B or C)[4]
Liver abscess (pyogenic abscess)[1]
Malaria[1]
Amoeba infections[5]
Hydatid cyst[6]
Leptospirosis[7]
Actinomycosis[8]
Neoplastic
- Metastatic tumours[4]
Hepatocellular carcinoma[4]
Myeloma[1]
Leukemia[4]
Lymphoma[1]
Biliary
Primary biliary cirrhosis.[1]
Primary sclerosing cholangitis.[1]
Metabolic
Haemochromatosis[1]
Cholesteryl ester storage disease[9]
Porphyria[1]
Wilson's disease[1]
Niemann Pick disease[4]
Non-alcoholic fatty liver disease.[1]
Glycogen storage disease (GSD)[4]
Drugs (and alcohol)
Alcohol abuse[4]
- Drug-induced hepatitis[1]
Congenital
Hemolytic anemia[1]
Polycystic Liver Disease[1]
Sickle cell disease[1]
Hereditary fructose intolerance[4]
Others
Hunter syndrome (Spleen affected)[10]
Zellweger's syndrome[11]
Carnitine palmitoyltransferase I deficiency[12]
- Granulomatous: Sarcoidosis[13]
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.[citation needed]
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]
On CT scan, hepatomegaly has been defined as a longitudinal axis > 15.5 cm at the hepatic midline, or > 16.0 cm at the midclavicular line[16]
Workup
Blood tests should be done, importantly liver-function series, which will give a good impression of the patient's broad metabolic picture.[medical citation needed]
A complete blood test can help distinguish intrinsic liver disease from extrahepatic bile-duct obstruction.[17] An ultrasound of the liver can reliably detect a dilated biliary-duct system,[18]
it can also detect the characteristics of a cirrhotic liver,.[19]
Computerized tomography (CT) can help to obtain accurate anatomical information, in individuals with hepatomegaly for the purpose of a complete diagnosis.[20]
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.[21]
In primary biliary cirrhosis ursodeoxycholic acid helps the bloodstream remove bile which may increase survival in some affected individuals.[22]
See also
- Hepatosplenomegaly
- Liver function tests
References
^ abcdefghijklmnopqr "Hepatomegaly. Read about Hepatomegaly (enlarged liver) | Patient". Patient. Retrieved 2016-02-27..mw-parser-output cite.citation{font-style:inherit}.mw-parser-output .citation q{quotes:"""""""'""'"}.mw-parser-output .citation .cs1-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/thumb/6/65/Lock-green.svg/9px-Lock-green.svg.png")no-repeat;background-position:right .1em center}.mw-parser-output .citation .cs1-lock-limited a,.mw-parser-output .citation .cs1-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/thumb/d/d6/Lock-gray-alt-2.svg/9px-Lock-gray-alt-2.svg.png")no-repeat;background-position:right .1em center}.mw-parser-output .citation .cs1-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/thumb/a/aa/Lock-red-alt-2.svg/9px-Lock-red-alt-2.svg.png")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration{color:#555}.mw-parser-output .cs1-subscription span,.mw-parser-output .cs1-registration span{border-bottom:1px dotted;cursor:help}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/thumb/4/4c/Wikisource-logo.svg/12px-Wikisource-logo.svg.png")no-repeat;background-position:right .1em center}.mw-parser-output code.cs1-code{color:inherit;background:inherit;border:inherit;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;font-size:100%}.mw-parser-output .cs1-visible-error{font-size:100%}.mw-parser-output .cs1-maint{display:none;color:#33aa33;margin-left:0.3em}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration,.mw-parser-output .cs1-format{font-size:95%}.mw-parser-output .cs1-kern-left,.mw-parser-output .cs1-kern-wl-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right,.mw-parser-output .cs1-kern-wl-right{padding-right:0.2em}
^ abcdef 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).CS1 maint: Multiple names: authors list (link)
^ ab "Cirrhosis: Practice Essentials, Overview, Epidemiology". 2018-10-31.
^ abcdefghi "Hepatomegaly: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2016-02-27.
^ Lang, Florian (2009-03-19). Encyclopedia of Molecular Mechanisms of Disease: With 213 Tables. Springer Science & Business Media. p. 824. ISBN 9783540671367.
^ Prevention, CDC - Centers for Disease Control and. "CDC - Echinococcosis - Resources for Health Professionals". www.cdc.gov. Retrieved 2016-03-11.
^ "Leptospirosis (Weil's Disease) | Doctor | Patient". Patient. Retrieved 2016-03-11.
^ Banfalvi, Gaspar (2013-10-16). Homeostasis - Tumor - Metastasis. Springer Science & Business Media. p. 145. ISBN 9789400773356.
^ "Cholesteryl Ester Storage Disease - NORD (National Organization for Rare Disorders)". NORD (National Organization for Rare Disorders). Retrieved 2016-03-11.
^ "Hunter's Syndrome. MPS II information; symptoms | Patient". Patient. Retrieved 2016-03-11.
^ "OMIM Entry - # 214100 - PEROXISOME BIOGENESIS DISORDER 1A (ZELLWEGER); PBD1A". www.omim.org. Retrieved 2016-03-11.
[permanent dead link]
^ "CPT I deficiency". Genetics Home Reference. 2016-03-07. Retrieved 2016-03-11.
^ "Sarcoidosis | Doctor | Patient". Patient. Retrieved 2016-03-11.
^ Dennis, Mark; Bowen, William Talbot; Cho, Lucy (2012-01-01). Mechanisms of Clinical Signs. Elsevier Australia. p. 469. ISBN 9780729540759.
^ 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.
^ Vermelho, Marli Batista Fernandes; Correia, Ademir Silva; Michailowsky, Tânia Cibele de Almeida; Suzart, Elizete Kazumi Kuniyoshi; Ibanês, Aline Santos; Almeida, Lanamar Aparecida; Khoury, Zarifa; Barba, Mário Flores (2015). "Abdominal alterations in disseminated paracoccidioidomycosis: computed tomography findings". Radiologia Brasileira. 48 (2): 81–85. doi:10.1590/0100-3984.2013.0025. ISSN 0100-3984. PMC 4433296. PMID 25987748.
^ Goldman, Lee; Schafer, Andrew I. (2015-04-21). Goldman-Cecil Medicine. Elsevier Health Sciences. p. 991. ISBN 9780323322850.
^ 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.
^ 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.
^ 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.
^ "Non-Hodgkin's Lymphoma | Doctor | Patient". Patient. Retrieved 2016-03-11.
^ "Primary biliary cirrhosis: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2016-03-12.
Further reading
Hoffmann, Georg F.; Zschocke, Johannes; Nyhan, William L. (2009-11-21). Inherited Metabolic Diseases: A Clinical Approach. Springer Science & Business Media. ISBN 9783540747239.
Kim, Sun Bean; Kim, Do Kyung; Byun, Sun Jeong; Park, Ji Hye; Choi, Jin Young; Park, Young Nyun; Kim, Do Young (2015-12-01). "Peliosis hepatis presenting with massive hepatomegaly in a patient with idiopathic thrombocytopenic purpura". Clinical and Molecular Hepatology. 21 (4): 387–392. doi:10.3350/cmh.2015.21.4.387. ISSN 2287-2728. PMC 4712167. PMID 26770928.
External links
| Classification | D
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| External resources |
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Merck Manual: Hepatomegaly
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