Hepatomegaly

Definition
Hepatomegaly is an objectively demonstrable enlargement of the liver against the standard found in abdominal examinations.

The Size of the Liver
The liver is, after skin, the largest organ of the human body. Its size is very individual.

The average values are: The doctor usually considers: The normal-sized liver should not exceed the right rib arch by more than 2 cm during inhalation. The upper edge should not exceed the 4. intercostal space in the medioclavicular line during percussion. It's appropriate to investigate changes in the finding lying down and standing, to get the right interpretation of the palpation checkup. CAVE!
 * width – 21–22,5 cm
 * height – 15–17,5 cm
 * depth – 10–12,5 cm
 * physical examination
 * palpaption – the lower edge of the liver
 * percussion – the upper edge by a strong tap in the right medioclavicular line, the lower edge by a weak tap
 * imaging methods
 * sonography – size standard: sagitally in the right medioclavicular line: < 13.0–15.0 cm, margins: < 30°(left lateral margin), < 45°(caudal margin of the right lobe)
 * X-RAY
 * CT
 * scintigraphy

Hepatomegaly can be mimicked by the liver: Hepatomegaly is sometimes not palpable by people with gibbous abdomen:
 * naturally long in shape (especially the right lobe),
 * low-lying liver (previously used term “hepatoptosis“ is already obsolete)
 * palpable due to the physical constitution of the patient
 * with cavernous stomach (during current or chronic starvation)
 * meteorism
 * abdominal obesity
 * pregnancy
 * ileal conditions
 * abdominal tumors
 * free abdominal fluids etc.

Clinical Symptoms
Hepatomegaly may be sometimes asymptomatic. Liver pain during palpation is determined by the degree of tension of the liver capsule.

Causes

 * acute or chronic hepatitis of various etiologies
 * non-specific reaction to extrahepatal disease
 * toxic and drug-induced liver damage
 * liver tumors
 * gastrointestinal neuroendocrine tumors (NE tumors)
 * compensated liver cirhosis (latent, subclinical)
 * liver steatosis
 * developed liver cysts
 * liver vein diseases
 * heart failure
 * blood diseases (eg ALL, CLL)
 * hemochromatosis
 * amyloidosis
 * metabolic diseases – glycogenosis (von Gierke, Pompe disease,...), disorders of sugar metabolism (galactosemia), disorders of lipid metabolism (Gaucher, Niemann-Pick disease)

Treatment
We treat the primordial cause of hepatomegaly.