Hepatomegaly

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Definition

Hepatomegaly is an objectively demonstrable enlargement of the liver against the norm detected during abdominal examination.

Liver Size

Hepatomegaly on CT

The Liver is the largest organ in the human body after the skin. But their size is individual. Average values:

• width - 21-22.5 cm
• height - 15-17.5 cm
• depth - 10-12.5 cm

It is usually assessed:

• physical examination
  1. by palpation – the lower edge of the liver
  2. by tapping – the upper edge by a strong tap in the right medioclavicular line, the lower edge by a weak tap

A normal liver should not exceed the right costal arch by more than 2 cm in inspiration. On palpation, the upper border is in the 4th intercostal space in the medioclavicular line. For the interpretation of the palpation finding, it is appropriate to investigate changes in the finding lying down and standing up, as needed.

• display methods
  1. sonography – size standard: sagittally in the right medioclavicular line: < 13.0–15.0 cm, margins: < 30° (left lateral margin), < 45° (caudal margin of the right lobe)
  2. X-ray
  3. CT
  4. scintigraphy

CAVE!

Liver can mimic hepatomegaly:

• congenitally long due to its shape (especially the right lobe),
• low deposit (the term "hepatoptosis" used in the past is already obsolete)
• palpable due to the physical constitution of the examined person
• with a sunken abdomen (with current or chronic starvation)

Hepatomegaly sometimes cannot be palpated with a distended abdomen:

• meteorism
• abdominal obesity
• pregnancy
• ileotic conditions
• abdominal tumors
• free liquid, etc.

Clinical symptoms

Hepatomegaly may be asymptomatic. Painfulness of the liver during palpation is determined by the degree of tension of the liver capsule.

Causes

• hepatitis acute and chronic various etiologies
• non-specific reaction to extrahepatic disease
• toxic and medicinal damage to the liver
• liver tumors
• gastrointestinal neuroendocrine tumors (NE tumors)
• compensated liver cirrhosis (latent, subclinical)
• steatosis of the liver
• developed liver cysts
• diseases of the hepatic veins
• Heart Failure
• blood diseases (eg ALL, CLL)
• hemochromatosis
• amyloidosis
• metabolic diseases – glycogenoses (von Gierke, Pompe disease,...), disorders of sugar metabolism (galactosemia), disorders of lipid metabolism (Gaucher's disease, Niemann- Pick's disease)

Therapy

We treat the primary cause of hepatomegaly.

Links

References

• WIEGAND, Johannes – BERG, Thomas. The etiology, diagnosis and prevention of liver cirrhosis: part 1 of a series on liver cirrhosis. Dtsch Arztebl Int [online]. 2013, vol. 110, no. 6, p. 85-91, Available from <https://www.ncbi.nlm.nih.gov/pubmed/23451000>. ISSN 1866-0452. 

• BLACHIER, Martin – LELEU, Henri – PECK-RADOSAVLJEVIC, Markus. , et al. The burden of liver disease in Europe: A review of available epidemiological data. J Hepatol [online]. 2013, vol. 58, no. 3, p. 593-608, Available from <https://www.ncbi.nlm.nih.gov/pubmed/23419824>. ISSN 0168-8278 (print), 1600-0641.