The liver, the large oval-shaped organ found on the right side of the upper abdominal cavity, is indispensable for ensuring the proper functioning of the organism. Its purpose is to cleanse and purify the blood by eliminating harmful substances that enter the bloodstream. The liver also produces bile which helps to separate fat from food and allows you to store sugars (glucose), which provide the necessary energy supply. Enlargement of the liver, also known as hepatomegaly, in itself is not a disease but a symptom of a health problem, such as alcoholism, viral infections (hepatitis), metabolic diseases, cancer, gallstones, and some heart problems. To understand if your liver is enlarged, you need to recognize the signs and symptoms, get a professional diagnosis, and know what the risk factors are.
Steps
Part 1 of 3: Recognizing Signs and Symptoms
Step 1. Pay attention to the symptoms of jaundice
We talk about jaundice when the skin turns yellow, including the mucous membranes and the sclera, due to an excess of particular substances in the bloodstream. Since these substances are usually eliminated by the liver, their presence indicates some liver problem.
Jaundice usually occurs when the liver is severely damaged, so you should see a doctor if it occurs
Step 2. Check your abdomen for swelling or distention
If your abdomen is swollen but you are not pregnant, then it indicates a buildup of fat, fluid, or stool. Pay attention if your abdomen resembles that of a woman in the eighth month of pregnancy, because in this case there is certainly foreign material and you suffer from a condition that requires immediate medical attention.
- If liquid material has accumulated, then it is referred to as ascites, a typical symptom of hepatomegaly.
- This abdominal swelling often leads to lack of appetite, because you always feel too "full", a symptom that is called "early satiety"; sometimes you may even have no appetite at all due to such swelling.
- You may also suffer from swollen legs.
- Abdominal pain can also be a sign of an enlarged liver, especially if it occurs alongside other symptoms.
Step 3. Recognize the general symptoms that may indicate an enlarged liver
Fever, decreased appetite, nausea, and weight loss are not specific signs of hepatomegaly but, if they are particularly severe, unexpected and continuous, they can indicate a liver problem or an enlarged liver.
- As previously described, lack of appetite or refusal to eat is accompanied by abdominal distension. They can also be a symptom of a gallbladder problem, because people who suffer from it report worsening pain after a meal, which leads them to avoid food. Lack of appetite can also be related to cancer and hepatitis.
- Doctors consider weight loss serious when it accounts for more than 10% of body weight. If you are not on a weight loss diet but are losing weight, you should discuss this with your doctor.
- Keep in mind that fever is also a sign of inflammation in the body. Since hepatomegaly can develop following an infection such as hepatitis, it is important to recognize and manage fever when it occurs.
- The presence of unusually light, light gray, or even white stools can be a sign of liver problems.
Step 4. Notice if you feel exhausted
In this case you feel tired even after a slight effort because the reserves of nutrients managed by the liver are insufficient and the body seeks alternative resources by taking them from the muscles.
All this points to liver damage and swelling is the direct consequence. Know that viral hepatitis and cancer also cause fatigue
Step 5. Notice if itching increases
When the liver is diseased, you may experience severe itching of the skin, both localized and widespread. This symptom occurs when the bile ducts are blocked and, as a result, the bile salts that have been expelled into the bloodstream are deposited in the skin causing an itchy sensation.
To get rid of the itching, you first need to identify the underlying cause and treat it, but some relief can be found with medications such as Atarax (you can take one 25 mg tablet every 6 hours if needed) and Benadryl. (one 25 mg dose orally every 6 hours if needed). If the itching is severe or otherwise unbearable, take a sedative, such as Lorazepam (one 10 mg tablet) or Valium (one 10 mg tablet), to help you sleep and overcome the discomfort
Step 6. Recognize stellar (spider) angioma
This manifestation is generated by dilated blood vessels that branch off from the same red dot creating a spider web-shaped structure. Stellar angioma often appears on the face, neck, hands, and upper half of the chest and is a classic sign of a liver problem or hepatitis.
- If you have a single stellar angioma, know that it is not a sign of disease and should not cause concern. However, if it appears in conjunction with other symptoms or health problems, such as lethargy, fatigue, swelling, or signs of jaundice, you should see your doctor, as this could indicate a liver problem. Also, you need to see your doctor if you have multiple spider angiomas joining in clusters, as they are a clear sign of liver damage.
- Spider angiomas can reach the size of 5 mm in diameter.
- If you apply moderate pressure with your fingers, the red color disappears for a few seconds and the skin turns white (pale) as the blood drains.
Part 2 of 3: Getting a Medical Diagnosis
Step 1. Make an appointment with your family doctor
In the first phase of the visit, the doctor will want to know your complete medical history. In this circumstance it is important that you are cooperative and honest.
- Be aware that your doctor will ask you quite personal questions about the substances you use, the alcohol you consume, and your sexual partners. Remember that your answers are critical to getting a correct diagnosis, so you need to be honest and tell the truth.
- Tell your doctor if you are taking any other medications or supplements, including vitamins and herbal remedies.
Step 2. Undergo a physical exam
A physical medical examination is the first step in diagnosing hepatomegaly. Your doctor will start by examining your skin for signs of jaundice and spider angiomas if you haven't already reported them. He will then check the liver with an abdominal palpation.
An enlarged liver appears irregularly shaped, soft or firm to the touch, with or without lumps, depending on the underlying cause that caused the swelling. This type of test allows you to understand the size and consistency of the liver, in order to determine how much it has become enlarged. The doctor will be able to use two methods for this physical examination: by percussion or by palpation
Step 3. Undergo the Percussion Percussion test to determine the state of health of the liver
This method helps determine the size of the liver and make sure it does not go beyond the edge of the right rib (rib cage), which is in fact a protective barrier for this organ. Percussion allows to analyze the internal organs through the sounds they produce when they are struck through the skin. If you hear a dull sound that extends more than 2.5 cm below the lower part of the rib cage, it means that the liver is enlarged. Be aware that if you also have abdominal distension, this test cannot detect the problem and you will likely need to have an abdominal ultrasound.
- The doctor, if he is right-handed, places his left hand on your chest, pressing his middle finger firmly against the chest wall; with the middle finger of the right hand he hits the same finger of the left hand with a snap of the wrist (a bit like playing the piano).
- Starting from the lower chest area, the percussion should emit a sound similar to the drum's eardrum. This is because the lung is in that area and is filled with air.
- The doctor will slowly move the hand down, in a straight line, over the liver, where the "tympanic" sound should become more dull, similar to a "thud". This means that the doctor is now right above the liver, where he will continue beating and will pay close attention when he is at the end point of the rib margin (the rib cage), to check if the sound is always similar to a "thud" and how deep it is. The doctor will stop when the "thud" becomes a mixture of intestinal noises (gas and gurgling).
- During the exam he will also check how many centimeters the liver has gone beyond the costal margin. This sign is always pathological, since the rib cage has the purpose of protecting the precious internal organs such as the liver and spleen.
Step 4. Undergo a palpation test to determine the shape and texture of the liver
This is another method to tell if the organ is enlarged and, like that of percussion, it uses touch and pressure with the hands.
- If the doctor is right-handed, he will put his left hand on your right side of the abdomen. He will ask you to take a deep breath and slowly exhale as he tries to "grab" the liver in your hands. He will use his fingertips to feel the profile of the liver below the rib cage and to analyze important aspects, such as the shape, texture, surface structure, any tenderness and regularity of the outer edges.
- The doctor will also check the texture of the surface to see if it is rough, uneven, if it has lumps, or if it is firm or hard. It will ask you if you feel any pain while applying pressure.
Step 5. Take a blood test
This is another way to check liver function and to analyze health in general. It usually aims to detect the presence of a viral infection such as hepatitis.
The blood test allows you to check the level of liver enzymes and provide important information about the health and functions of the liver. There are other blood tests that may be useful for this, such as complete blood cell counts, hepatitis virus screening, and blood clotting tests. The latter tests are particularly suitable for checking the functions of the liver, since it is this organ that creates the proteins that clot the blood
Step 6. Undergo an imaging test
These types of tests, such as ultrasound, computed tomography (CT), and magnetic resonance imaging, are often recommended both to confirm the diagnosis and to observe the anatomy of the liver and surrounding tissues. These are tests that provide important information, so as to clearly establish the state of health of the liver.
- Abdominal ultrasound. During this exam you will be asked to lie down while a probe handled manually by the technician is run over the abdomen. This probe emits high-frequency sound waves that bounce off internal organs and are sent to a computer to be transformed into tissue images. Your doctor will tell you how to prepare for the exam, but in most cases, you probably won't need to eat or drink before the test.
- Computed tomography. In the CT scan you are subjected to X-rays that create cross-sectional images over the abdominal region. In this case you are made to lie down on a narrow table that slides inside the equipment and you must remain still while the X-rays are directed on and around the body. Again, the images are sent to a computer. Your doctor will give you instructions to properly prepare for the exam: since a special dye, called contrast fluid (which can be intravenously or orally) is introduced into the body, you will not be able to eat or drink before the test.
- Abdominal magnetic resonance. This exam uses the energy of magnets and radio waves to create images of the internal abdominal region, rather than radiation (X-rays). You will be asked to lie down on a narrow table that fits into a large tunnel-shaped scanner. To make the organs more visible, a counterstain is sometimes injected, which your doctor will tell you about anyway and you can discuss together. As in the other cases, you will be asked not to eat or drink before the exam.
Step 7. Undergo endoscopic retrograde cholangio-pancreatography (ERCP)
It is an endoscopic exam that analyzes the bile ducts, the tubes that carry bile from the liver to the gallbladder and small intestine. This test is intended to check for possible malfunctions.
- During this examination, an intravenous catheter with a relaxant is inserted into the arm. Then, an endoscope will be inserted through the mouth, esophagus and stomach to the small intestine (the part closest to the stomach). A catheter is passed through the endoscope to the bile ducts that connect to the pancreas and gallbladder. At this point a coloring substance is injected which allows to better analyze any problems. At the same time, an x-ray of the area is taken.
- This is a test that is performed after the other diagnostic imaging systems, such as those just described.
- As with the other tests already mentioned, also in this case the doctor will describe the procedure and tell you what to expect. You will need to provide informed consent to perform the test and you will not have to eat or drink for the previous four hours.
- This is an important test, as the doctor can decide the type of treatment based on the outcome; for example, if he finds that the obstruction of the bile ducts is caused by stones, he can remove them during the same ERCP.
Step 8. Consider getting a liver biopsy
Hepatomegaly and other liver diseases can usually be diagnosed through medical history, physical exam, blood test, and finally imaging tests. However, in certain situations, a biopsy may be recommended, especially if the diagnosis is unclear and there is a suspicion of a possible tumor.
The procedure involves inserting a long, thin needle into the liver to take a tissue sample. The surgery is usually performed by a specialized doctor (a gastroenterologist or a hepatologist). Since this is a rather invasive test, you will be given local or general anesthesia. The sample will then be sent to a laboratory to be analyzed, especially looking for any cancerous cells
Step 9. Undergo an elastographic MRI scan
This is a fairly recent diagnostic imaging technique, which combines magnetic resonance with sound waves to create a visual map (elastography) and assess the stiffness of the body's tissues, in this case the liver. If the liver is hardened, it means that chronic liver disease is present and MRI can detect it. This test is non-invasive and can be an alternative to biopsy.
Elastographic MRI is an innovative procedure, but it is developing rapidly. Currently it is present only in a few health facilities, which however are gradually increasing in number. Talk to your doctor to see if this is a feasible option for your specific case
Part 3 of 3: Knowing the Risk Factors
Step 1. Hepatitis can lead to liver enlargement
Hepatitis A, B, and C all cause inflammation of the liver that swells and has smooth, painful edges to the touch.
Liver inflammation is caused by the blood and immune cells flowing into the organ in an attempt to fight off the viral infection
Step 2. Right-sided heart failure can increase the risk of hepatomegaly with smooth, painful edges
In this case, blood accumulates in the liver due to the heart's inability to pump it properly. This heart failure causes blood to stagnate in the liver
Step 3. Cirrhosis is another risk factor for hepatomegaly
It is a chronic disorder that causes an increase in the density of the liver, leading to fibrosis (excessive production of scar tissue). Cirrhosis is usually a consequence of a bad lifestyle that causes a negative effect on the liver. In particular, alcohol abuse is the direct cause of cirrhosis.
Cirrhosis can indifferently cause an enlargement or a narrowing of the liver, although more often than not it causes an enlargement
Step 4. Consider possible genetic or metabolic diseases
People with genetic disorders such as Wilson's syndrome or Gaucher disease may be at high risk of suffering from an enlarged liver.
Step 5. Understand the risk of cancer
People with cancer may have an enlarged liver due to the presence of liver metastases. If you have been diagnosed with cancer, especially in an organ near the liver, you are at high risk of suffering from an enlarged liver as well.
Step 6. Beware of excessive alcohol consumption
Chronic or excessive consumption of alcoholic beverages can cause liver damage and impair its ability to regenerate. Functional and structural damage can be irreversible.
- When the liver loses its function due to alcohol abuse, it tends to enlarge and swell because it is unable to excrete fluids.
- The National Institute on Alcohol Abuse and Alcoholism defines "moderate" to drink no more than 1 drink per day for women, no more than 2 drinks per day for men.
Step 7. Taking medications can also increase the risk of liver enlargement
Many over-the-counter medicines can cause liver damage if taken for prolonged periods or in doses higher than recommended. Among the most harmful drugs for the liver are oral contraceptives, anabolic steroids, diclofenac, amiodarone, statins and many others.
- If you have to take medications for a long time, you should have regular check-ups and strictly follow the directions given by your doctor.
- Paracetamol is one of the main drugs responsible for liver damage and can cause hepatomegaly, especially if taken together with alcohol.
- Keep in mind that some herbal supplements, such as black cohosh, ephedra, and mistletoe, can also increase the risk of liver damage.
Step 8. Pay attention to nutrition
If you regularly eat fatty foods, such as french fries, hamburgers or other junk foods such as those from fast food, it is inevitable that fat will accumulate in the liver; in this way, lipid deposits are formed which lead to the destruction of liver cells.
- The damaged liver is compromised and can swell due to the inability to process blood and toxins.
- Be aware that if you are overweight or obese you run a higher risk of liver dysfunction. If you fall into these categories of people you should calculate your body mass index (BMI), a measure of body fat. This calculation is determined by the body weight expressed in kilograms divided by the square of the height expressed in meters. If the result is a BMI of 25-29, 9 means that you are overweight, while with a BMI greater than 30 the subject is considered obese.
