Internal Medicine

Swollen liver

introduction

A swelling of the liver is called in medical jargon Hepatomegaly designated. It is actually more correct to speak of an enlarged liver than a swelling of the liver.

Such an enlargement is usually not painful, so in most cases it is a chance diagnosis during a physical exam or an ultrasound scan of the abdomen.

Causes of a swollen liver

The causes of liver enlargement are numerous.
Fatty liver is usually associated with an enlargement of the organ. The development of fatty liver is promoted, among other things, by chronic alcohol consumption, unhealthy excessive food intake and poorly controlled diabetes mellitus.

The fatty liver itself rarely causes symptoms. In the course of the disease, the fatty liver can develop from inflammation to liver cirrhosis (transformation of the liver structure into connective and scar tissue without function). Cirrhosis of the liver can manifest itself, for example, through a water belly. If there is cirrhosis of the liver, the risk of developing liver cancer is significantly increased.

also read: Stages of cirrhosis of the liver

Another cause of liver enlargement is the accumulation of certain metabolic products. These can occur as part of a metabolic disorder or storage disease in which various substances are deposited in cells or organs. Examples include Gaucher's disease, amyloidosis or hemosiderosis.

Swelling of the liver can also be caused by a weak heart. If the right heart is too weak to pump the resulting blood volume, the blood backs up into the liver and an enlarged, so-called congestive liver occurs.

Learn more at: Congested liver

Infectious diseases such as hepatitis can also cause the liver to swell, especially in the acute phase. During its development, liver cirrhosis can also be accompanied by an enlarged liver at times, but in the final stages of liver cirrhosis, the liver is usually smaller and has a humped surface. If cysts or abscesses develop in the liver as a result of a bacterial infection, this can also lead to an enlarged liver.

Enlargement of the liver can also be indicative of cancer. With some types of blood cancer (white blood cancer) in particular, the liver becomes markedly enlarged. The reason for this can be explained as follows: In healthy people, blood cells are produced in the bone marrow. In leukemia (blood cancer), cell clones develop that always produce the same type of cell and thereby displace the other cells from the bone marrow. These then have to be produced in other organs; one speaks of extramedullary blood formation, i.e. blood formation outside the bone marrow.

The spleen and / or the liver are usually used as an alternative for the production of blood cells; the increased cell production causes the organ to swell.

Cancer in the liver (liver cancer, hepatocellular carcinoma) or the presence of liver metastases caused by the spread of other types of cancer can also lead to swelling of the organ.

Liver swollen from glandular fever

Pfeiffer's glandular fever is an infection with the Epstein-Barr virus. This is usually transmitted from one person to the next through saliva and leads to a sore throat and severe swelling of the lymph nodes in the neck. Other organs can also be affected by the swelling.

In the context of Pfeiffer's glandular fever often occurs a so-called Hepatosplenomegaly (hepar = liver, splen = spleen, megalie = enlargement). This creates a swelling of the liver and spleen. Occasionally, only the spleen is affected. Liver dysfunction and a rupture of the spleen (rupture of the spleen due to the severe swelling) can occur as a serious complication of Pfeiffer's glandular fever.

For more information, see: Glandular Pfeiffer fever

Swollen liver from alcohol?

Alcohol is toxic to the liver above a certain level. This measure is a little different for each person, but can be roughly generalized.
One speaks

from 40 grams of alcohol per day for men and
20 grams of alcohol per day in women

of a poisonous amount.

40 grams of alcohol is equivalent to about 400 ml of wine or about 800 ml of beer.

If this amount is exceeded chronically, i.e. repeatedly, there is a high probability that the liver will be damaged. First of all, fatty liver develops with chronic excessive alcohol consumption.This can be done using an abdominal ultrasound (see also: Ultrasound). The liver has a different structure and is often somewhat enlarged.

In the further course, inflammation of the fatty liver develops (fatty liver hepatitis), which can lead to cirrhosis of the liver over the course of several years. In the end stage of liver cirrhosis, the liver is usually no longer enlarged but rather smaller than a healthy liver and of a coarser structure.

Read more on the topic:

Consequences of alcohol consumption
Alcohol addiction
Influence of alcohol on various organs

Swollen liver in cancer

An enlarged liver can indicate the presence of cancer. Liver cancer and blood cancer are particularly important here.

In blood cancer, the spleen is often enlarged, but only the liver can be affected. With blood cancer, there are often accompanying symptoms such as tiredness, those affected suffer more often from infections and can suffer from bruises even with the smallest trauma. However, the symptoms are very different, depending on the type of blood cancer.

Please also read our topic: Liver cancer symptoms

Liver swollen from eating

Enlargement of the liver after eating does not occur. Liver swelling associated with food intake is, if anything, a chronic process. In the event of one-sided, unhealthy and excessive consumption of food, an enlarged and fatty liver can develop.

Also read: Fatty liver

Diagnosis of the swollen liver

An increase in the size of the liver may be seen on a physical exam, but this depends on the degree of enlargement. A slight enlargement can often not be felt. If the liver is greatly enlarged, the edge of the liver, which normally lies under the right costal arch, can be clearly shifted downwards. With a pronounced enlargement, the edge of the liver can extend into the pelvic region.

An ultrasound examination of the abdomen is usually easy to see if the liver is enlarged; the size of the liver can be roughly measured here. How well this works, however, depends on how well the person concerned can be heard. For very corpulent people, the ultrasound scan may not provide sufficient information. Further imaging diagnostics, for example with computed tomography (CT) or magnetic resonance imaging of the abdomen (MRT), can then be carried out; the liver is clearly visible in these examinations.

Read more on the topic:

Enlarged liver
Ultrasound of the abdomen

How can you feel the liver yourself?

The healthy, non-enlarged liver is usually not palpable with normal breathing. In order to still be able to feel a healthy liver, the doctor asks the patient to lie on his back and exhale deeply and then inhale deeply. The doctor now feels with his fingers just below the right costal arch. Here you can feel the edge of the liver from bottom to top while inhaling.

In many cases, an enlarged liver can be felt without taking a deep breath. Depending on how much it is enlarged, the lower edge of the liver can in extreme cases reach deep into the lower abdomen.

The above technique for palpating the liver can be used on yourself, but it is easier if someone else does it. It is not always possible to feel a healthy liver.

How do liver values change in a swollen liver?

A swelling of the liver itself does not necessarily cause changes in the liver values. However, the triggering disease often leads to both a swollen liver and a deterioration in the liver values, which are included in the blood count.

Typical liver values include the so-called transaminases:

ALT (alanine aminotransferase) and
AST (aspartate aminotransferase).

These values can be increased in many liver dysfunction, so that changes in these liver values are often accompanied by swelling of the liver. Other laboratory values that suggest liver damage are, for example, the coagulation and bile values.

Read on under: Liver values in the blood count - what are they and what do they mean?

Accompanying symptoms of a swollen liver

It is not uncommon for an enlarged liver to be accompanied by an enlarged spleen. One then speaks of one Hepatosplenomegaly. Depending on what causes the liver enlargement, the possible accompanying symptoms are very variable.

In the case of fatty liver disease, there are usually no symptoms at first. If an infection, for example hepatitis, is responsible for the increase in size of the liver, symptoms that resemble a flu-like infection can also occur. Long-term tiredness, exhaustion and reduced performance also occur.

If the liver swells as part of a weak heart, symptoms such as shortness of breath, water in the legs (lower leg edema) or reduced performance can also occur.

In the presence of cirrhosis of the liver, a clearly bulging, tense stomach can develop due to water retention in the abdomen.

If the liver has enlarged due to blood cancer

an increased susceptibility to infection,
rapid appearance of bruises,
profuse night sweats (see also: Night sweats),
Weight loss,
Reduced performance and many other accompanying symptoms occur.

Pain from a swollen liver

A swollen liver does not initially cause pain because there are no pain-conducting nerve fibers in the liver itself. As a result, the liver cannot transmit a pain signal to the brain.

Symptoms arise when the liver is so swollen that the surrounding structures are affected by the swelling. One possible cause of pain from a swollen liver is capsular distension pain. The liver is encased in a tissue capsule with nerve fibers that conduct pain. Overstretching this capsule by causing the liver to swell can cause pain.

If the size of the liver presses against other structures in the abdomen, against the diaphragm or against the ribs from within, this can also lead to pain. The pain is usually felt in the right upper abdomen, but cannot be precisely located at one point.

Swollen liver and back pain

A swollen liver can occasionally be associated with back pain. The reason for this is usually that the enlarged liver presses on structures that are located on the back of the abdominal cavity or in close proximity to the back of the chest and / or the spine.

Typically, the back pain is felt on the right in the lower costal arch or just below it.

Also read: Back pain - what can be the cause?

Swollen liver and enlarged lymph nodes

If there is an enlarged liver in combination with a swelling of the lymph nodes, this can be an indication of an infectious disease such as Pfeiffer's glandular fever. In addition, those affected often suffer from severe fatigue, and fever can also occur.

But even with cancers such as white blood cancer, lymph node swelling can occur together with an enlarged liver. A doctor should therefore clarify such a combination of symptoms over a longer period of time. They can take blood, perform a physical exam, and order further exams if necessary.

Swollen liver and spleen

Hepatosplenomegaly, i.e. enlarged liver and spleen, can also have numerous causes.
Especially in older children and adolescents, when infected with the Epstein-Barr virus, both organs swell. It is often associated with fatigue, exhaustion and possibly fever. It is a mononucleosis, also known as Pfeiffer's glandular fever. Specific therapy is usually not necessary.

Malaria can also cause swelling of the spleen and liver. A special blood test can be used to make a diagnosis. Flare-ups are typical for most forms of malaria.

The above-mentioned metabolic or storage diseases such as amyloidosis can lead to an enlarged liver and spleen.
If blood cancer is present, this often leads to an enlarged liver and spleen. The spleen, which cannot be felt in healthy people, can then be greatly enlarged. This can be felt or verified with an ultrasound device.

What to do if the liver is swollen

An enlarged liver is usually not noticed by the person concerned, as it rarely causes pain. If the person concerned does notice it, it is advisable to see a doctor, provided that no risk factors for the development of an enlarged liver are known. Which includes

chronic alcohol consumption,
unhealthy and excessive diet and
Diabetes.

But even if one of these risk factors is present, a significant liver enlargement should be clarified by means of further diagnostics. The doctor can take blood to rule out hepatitis or blood cancer as far as possible. An ultrasound scan of the enlarged liver should also be done. Here the presence of cysts or an abscess can be seen.

Depending on the cause of the enlargement of the liver, the treating doctor will take further measures. As a rule, a change in diet and alcohol withdrawal must take place. In addition, behavior that is gentle on the liver must be observed. This includes e.g. not to take drugs that are broken down by the liver. In addition, if you have an enlarged liver, you should make regular check-ups with your family doctor to check your blood values.

How long has the liver been swollen?

How long a liver enlargement lasts cannot be said in general because of the very different causes. Often the swelling only goes down once the triggering cause has been eliminated or treated.