Hepatomegaly
Definition[edit | edit source]
Hepatomegaly is an objectively demonstrable enlargement of the liver against the standard found in abdominal examinations.
The Size of the Liver[edit | edit source]
The liver is, after skin, the largest organ of the human body. Its size is very individual.
The average values are:
- width – 21–22,5 cm
- height – 15–17,5 cm
- depth – 10–12,5 cm
The doctor usually considers:
- physical examination
- palpation – the lower edge of the liver
- percussion – the upper edge by a strong tap in the right midclavicular line, the lower edge by a weak tap
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 midclavicular 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.
- 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
CAVE!
Hepatomegaly can be mimicked by the liver:
- naturally long in shape (especially the right lobe),
- low-lying liver (the previously used term “hepatoptosis“ is already obsolete)
- palpable due to the physical constitution of the patient
- with cavernous stomach (during current or chronic starvation)
Hepatomegaly is sometimes not palpable by people with gibbous abdomen:
- meteorism
- abdominal obesity
- pregnancy
- ileal conditions
- abdominal tumors
- free abdominal fluids etc.
Clinical Symptoms[edit | edit source]
Hepatomegaly may be sometimes asymptomatic. Liver pain during palpation is determined by the degree of tension of the liver capsule.
Causes[edit | edit source]
- acute or chronic hepatitis of various etiologies
- non-specific reaction to extrahepatic disease
- toxic and drug-induced liver damage
- liver tumors
- gastrointestinal neuroendocrine tumors (NE tumors)
- compensated liver cirrhosis (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[edit | edit source]
We treat the primordial cause of hepatomegaly.
References[edit | edit source]
Literature[edit | edit source]
- MAŘATKA, Zdeněk. Klinická gastroenterologie. 1. edition. Avicenum, 1988.
- 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, y. 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. The burden of liver disease in Europe: A review of available epidemiological data. J Hepatol [online]. 2013, y. 58, no. 3, p. 593-608, Available from <https://www.ncbi.nlm.nih.gov/pubmed/23419824>. ISSN 0168-8278 (print), 1600-0641.
