Enlarged liver

introduction

The liver is the largest organ in the human body and normally weighs 1200-1500 grams. During the physical examination, the doctor can determine the size of the liver by tapping or by scratch auscultation (with a stethoscope and a finger).

From a size of more than 12 centimeters in the medioclavicular line, one speaks of an enlarged liver (hepatomegaly). Normally the liver can be palpated a maximum of 1-2 centimeters below the costal arch; if the liver is enlarged, the liver can also be felt several centimeters below the costal arch. A relatively precise size determination of the liver is also possible using ultrasound.

The reasons

Enlargement of the liver can have various causes. For example, the liver can be damaged relatively easily by substances that are absorbed via the gastrointestinal tract, because the liver is so well supplied with blood and the substances absorbed in the digestive tract arrive in high concentrations in the liver cells.
Alcohol reaches a high concentration in the liver and damages the liver cells, especially with regular alcohol consumption, the structure of the liver can be changed and the liver enlarged.

An incorrect diet that is too high in fat, high blood pressure and diabetes lead to the storage of fats in the liver, which then increases in size. The liver can also be attacked by various pathogens, the hepatitis viruses trigger inflammations of the liver in a relatively specific manner, but the liver can also be affected and therefore enlarged in the context of another infectious disease.

Diseases of the heart, e.g. Heart failure (heart failure) can cause the blood to congest in front of the heart. This backlog can reach into the liver and cause the liver to enlarge. A liver that is enlarged due to blood pressure is also called congested liver.

Blood congestion in the liver also occurs in the rare Budd-Chiari syndrome, in which the draining blood vessels in the liver are completely or partially closed by blood clots or pressure from a tumor.

Both benign and malignant tumors of the liver also lead to an enlarged liver. If the outflow of the bile acids produced in the liver is "blocked" by a gallstone in the large bile duct, for example, they back up into the liver and can cause the liver to enlarge.

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The alcohol as the cause

Chronic alcohol abuse is the most common cause of liver disease in Central Europe. The disease begins with an enlarged liver due to the fatty tissue of the liver cells. This is how fatty liver develops. In later stages of the disease, alcoholic fatty liver inflammation (ASH = alcoholic steatohepatitis) and cirrhosis of the liver are common.

Fatty liver and ASH can usually be reversed if alcohol is not used, but if the disease has reached the stage of cirrhosis, the liver is irreversibly damaged.

Find out more about the topics here:

• The fatty liver
• Cirrhosis of the liver

The drugs as the cause

Medicines can generally be processed in the body through two main mechanisms and then excreted.

One way of excretion is through the kidneys (these substances have to combine well with water, so they are called hydrophilic substances). The excretion of drugs via the liver takes place in the case of hydrophobic substances that combine better with fatty substances and therefore cannot be excreted in the urine. If the liver is stressed too much with such drugs, it can damage the organ and result in an enlarged liver.

The metabolism of many drugs also takes place in the liver, where an overload of substances can also lead to enlargement. Typical drugs that, if taken in too large doses, can lead to liver enlargement are paracetamol, many antibiotics, immunosuppressants (drugs that weaken the immune system), chemotherapy drugs, etc.

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Pfeiffer's glandular fever as the cause

Pfeiffer's glandular fever (also known as kissing disease) is a disease caused by the Epstein-Barr virus (EBV). The viruses can be transmitted through saliva. They mainly settle in the lymphatics, lymph nodes and lymphatic organs (spleen and liver). In most

In some cases, tonsillitis with severe sore throat also occurs. Swelling of the lymph nodes (especially the neck) is very common, and the liver and spleen are also swollen in up to 50% of cases.

Read more about the topic here: Pfeiffer's glandular fever.

Leukemia as the cause

Leukemias are diseases of the blood-forming system. This affects the formation of leukocytes, i.e. white blood cells. There is a strong increase in the number of leukocytes in the bone marrow, after which the cells enter the blood. A fundamental distinction is made between acute (suddenly occurring) and chronic (gradually occurring) leukemia.

Depending on which cells are exactly affected, the leukemia can also be divided into leukemic and myeloid leukemia. The infiltration of the white blood cells into various organs leads to organ enlargement. The spleen and liver are particularly affected, as are the lymph nodes.

Find out more about the topic here: The leukemia.

The diagnosis

A physical exam is sufficient to diagnose an enlarged liver. The doctor can determine the size of the liver with a stethoscope and a finger (scratch auscultation), by tapping (percussion) or by a palpation examination.

If the examination reveals an enlarged liver, the underlying disease that is responsible for the enlarged liver must be found. An examination of the liver values ​​in the blood as well as an ultrasound examination of the liver and the other abdominal organs are suitable for this. Further examinations are then possible depending on the abnormalities.

Find out all about the diseases of the liver.

The laboratory values

The doctor looks at the so-called transaminases, which are produced by liver cells and which are increased in many different liver diseases because they are released when the liver cells are damaged. These include:

• GPT / ALT
• GOT / AST
• Glutamate dehydrogenase (GLDH)
• Lactate dehydrogenase (LDH)

However, LDH is also found in muscle cells or red blood cells. Other laboratory values ​​are also called "cholestasis enzymes" because they are increased in cholestasis (biliary stasis). These include: alkaline phosphatase (AP), it can also be increased with bone changes or during pregnancy. Gamma-glutamyl transferase (GGT) is produced to an increased extent even with minor damage. In addition, the production capacity of the liver can be assessed on the basis of the laboratory values ​​for blood coagulation, the amount of protein in the blood and the cholinesterase level in the blood.

You can read more about this here: Elevated liver values.

The accompanying symptoms

Typical symptoms of an enlarged liver are a feeling of pressure or tension in the right upper abdomen, a decrease in or loss of appetite, and pressure pain in the area of ​​the liver caused by the strained organ capsule.

Other accompanying symptoms are:

• Jaundice: Jaundice is also called jaundice and is manifested by yellowing of the eyes and, in more severe cases, the skin. The cause is an increased bilirubin level in the blood. Bilirubin is produced when the red blood pigment is broken down and has to be processed further in the liver. If the liver is damaged, this process can be disrupted. If you have jaundice, brown urine and discolored, light-whitish stools are also common.
• Itching: In the case of a bile congestion, the bile acids cannot enter the digestive tract as usual. Instead, their concentration in the blood increases and they build up in the skin, causing itching.
• Ascites ("ascites"): Ascites is the technical term for free fluid in the abdominal cavity. Patients notice that the abdomen is gaining in size and they are gaining weight. Often they also suffer from flatulence or impaired breathing. The most common cause is decompensated cirrhosis of the liver.
• Liver skin signs: Many different signs on the (mucous) membrane and the nails can occur with liver disease. These include spider nevi, fingernails discolored whitish, the so-called lacquer tongue, thinning of the skin, red palms, balding or clear veins on the abdomen (caput medusae).
• Bleeding: If the function of the liver is severely impaired, blood clotting disorders and bleeding in the skin can occur.
• Edema: With impaired liver function, fewer proteins are produced, the result is a leakage of fluid from the blood vessels and the formation of water retention
• Feminization: Men with impaired liver function can develop breasts and stunt the testicles because the female sex hormones can no longer be sufficiently broken down.

The pain

With an enlarged liver, pain usually cannot be caused by damage to the liver cells themselves. This is due to the fact that the liver itself does not contain any nerve fibers that conduct pain. So pain can only arise when pain fibers from the environment are stimulated. This can be the case with an enlarged liver, for example in the surrounding organs.

Also, pain with an enlarged liver is often reported as a non-specific complaint in the right upper abdomen. If the liver is particularly enlarged, the liver capsule can also be stretched. This also contains nerve fibers that conduct pain and can thus transmit the signal of pain to the brain.

Find out more about the topic here: The liver pain, pain relievers for liver diseases

The therapy

Treatment and therapy for an enlarged liver depend on the cause.

• Enlarged liver due to alcohol: The therapy consists in the absolute renunciation of alcohol. Fatty liver and alcoholic fatty liver inflammation can be reversed, but cirrhosis cannot, because it causes irreversible damage to the liver.
• Enlarged liver due to poor diet: The treatment is a low-fat and balanced diet.
• Enlarged liver due to inflammation of the liver (hepatitis): Hepatitis types A, B, D and E heal in most cases and do not become chronic. Type C hepatitis can be treated with antiretroviral drugs. If the hepatitis is very severe and leads to liver failure, a liver transplant is the only possible therapy.
• Enlarged liver due to heart disease: If the liver is enlarged due to heart disease, heart medication is given to improve the pumping function of the heart. Typical drug groups are, for example, ACE inhibitors, AT1 antagonists, beta blockers, diuretics ("water tablets") or digitalis.
• Enlarged liver due to Budd-Chiari syndrome: If a blood clot is not completely blocked, it is treated with blood-thinning medication. In the case of complete closure, a so-called "TIPS", a transjugular intrahepatic portosystemic shunt, is applied, which directs the blood around the closed area.
• Enlarged liver due to tumors: Benign tumors either do not require treatment at all or the tumor can be removed by surgery. In the case of malignant tumors or metastases, surgery and / or chemotherapy are necessary.
• Enlarged liver due to biliary obstruction: A stone in the large bile duct can be removed by an endoscopic procedure (ERCP).

Read more on the topic: Diet for fatty liver

The consequences

The most common cause of an enlarged liver is fatty liver. Fatty liver does not initially impair liver function, but can subsequently lead to liver inflammation or liver cancer. In many other cases, decreased liver function is the result of the enlarged liver.

If the liver is enlarged due to alcohol, inflammation of the liver, tumors or biliary congestion, the function of the liver decreases and the liver values ​​in the blood rise. Further consequences are liver cirrhosis and liver cancer.

More information on the topic Cirrhosis of the liver you'll find here.

The fatty liver

Fatty liver is the most common liver damage in industrialized countries; around 70% of overweight patients and a BMI> 30 have fatty liver. Around 10 million people are affected in Germany.In addition to an incorrect, excessively fatty diet, regular alcohol consumption, diabetes, high blood pressure and high blood lipid levels are risk factors for developing fatty liver.

The use of some medications can also favor fatty liver disease (cortisone, tetracycline, methotrexate). The severity of fatty liver is classified based on a microscopic examination of a tissue sample. If> 5% of the liver cells are fatty, one speaks of fatty liver. If it is> 50%, it is called fatty liver. Usually the diagnosis of fatty liver is made through an ultrasound scan. The liver then appears brighter on the ultrasound than a healthy liver.

Fatty liver can result in fatty liver inflammation. If the fatty liver persists for a very long time, the connective tissue of the liver is remodeled, the liver fibrosis, which increases the risk of liver cirrhosis and liver cancer.

The therapy of fatty liver lies in a healthy lifestyle with sport and a balanced diet.

Read more on the topic: The fatty liver

Cirrhosis of the liver

Liver cirrhosis is the result of an increase in connective tissue between the liver cells. In addition, the liver cells are irreversibly damaged, they die and the normal organ structure of the liver is destroyed. Liver cirrhosis can be caused by any disease or process that damages the liver. By damaging the liver, connective tissue cells are stimulated to produce to repair the damage. However, these repair measures are uncoordinated, creating knots of connective tissue and destroying the liver.

Cirrhosis of the liver is the final stage of many liver diseases, regardless of whether it is fatty liver, biliary stasis or liver inflammation. The liver does not always have to be enlarged in cirrhosis; in the final stages, the liver shrinks. Liver cirrhosis significantly increases the risk of liver cancer.

You can find more information on this topic at: Cirrhosis of the liver.

Prognosis

The prognosis for fatty liver disease is good if the patient changes their lifestyle after diagnosis. If he does not do this, all the consequences described above can occur. The prognosis for hepatitis A or E is also good; in most cases they will heal on their own within a few weeks. The prognosis for hepatitis B is good at a young age, but worse with age.

The prognosis for hepatitis C is moderate; it often leads to chronic liver disease with liver cirrhosis. Autoimmune hepatitis leads to cirhosis of the liver in 40% of cases even under therapy.

In the cirrhosis stage, the prognosis depends on liver function. Has this already decreased a lot (Child C), the prognosis is poor.

Enlarged liver and spleen - what could be behind it?

The enlargement of the liver is called hepatomegaly, the enlargement of the spleen is called splenomegaly, together they give the medical term of hepatosplenomegaly. The enlargement of these two organs can have different causes. Heart diseases that cause blood congestion in the liver, which are so pronounced that the blood backs up into the spleen, are possible.

Liver diseases can also lead to an enlarged spleen: In cirrhosis of the liver or the Budd-Chiari syndrome, for example, there is increased pressure in the venous vessels of the liver, which causes the blood to back up in the spleen.

Lymphomas, tumors of the lymphatic tissue, as well as blood diseases (e.g. polycythemia vera) and storage diseases (e.g. amyloidosis), can lead to an enlarged liver and spleen. Various infectious diseases as well: The Ebstein-Barr virus, like the cytomegalovirus, is common in Germany.

Less common infections with the symptom of hepatosplenomegaly are malaria, brucellosis, schistosomiasis, and leishmaniasis. These diseases are usually "brought along" from a stay abroad.

Enlarged liver in children - what does it mean?

An enlarged liver in newborns can be an indication of hemolysis (breakdown of blood to an increased extent), which can be triggered, for example, by a blood group incompatibility of mother and child. The liver then increases the production of new blood cells and therefore increases in size.

Other causes in newborns are infection with the cytomegalovirus during pregnancy or preductal coarctation of the aorta, a congenital constriction in the main artery. In older children, for example, the liver is enlarged in the context of glycogen storage diseases or lysosomal storage diseases.

Other diseases are autoimmune or viral inflammation of the liver, congenital heart defects, leukemia or alpha-1-antitrypsin deficiency. More rarely, but also possible, is the enlargement of the liver due to obesity or a biliary blockage.

Storage diseases - what are they? Read on here.

Enlarged liver with cysts

Cysts are cavities within an organ that contain fluid. Small and few in number cysts are a common incidental finding during an ultrasound scan of the abdomen. These are usually only pathological if they become inflamed or if a nearby blood vessel bleeds into them. These "normal" cysts usually do not lead to a significant enlargement of the liver.

Inherited polycystic liver disease has many and large liver cysts that grow as it progresses. Liver cysts can also occur in polycystic kidney disease. The cysts associated with polycystic disease lead to an enlarged liver and impair the functioning of the liver.

Enlarged liver after pregnancy

Fatty liver with inflammation can occur during pregnancy for no other apparent reason; the frequency is about 1 in 10,000 pregnancies. The first pregnancy or multiple pregnancies are more often affected.

The acute starts with nausea and pain in the right upper abdomen between the 30th and 38th week of pregnancy. The pregnancy fat liver leads to kidney failure, failure of the blood clotting system and pancreatitis within 1-2 weeks. The pregnancy must be terminated immediately after diagnosis by a caesarean section.

How can I feel an enlarged liver myself?

It takes a little practice to feel an enlarged liver. It is best to feel the whole abdomen first to get a feel for how the abdominal wall feels when there is no enlarged liver behind it. Then you start in the lower right abdomen and press your hand into the abdomen (not superficially, but also not so deeply that it hurts), while inhaling you move your groping hand slightly in the direction of the costal arch.

Repeat this at a distance of about 5cm until you reach the costal arch. When the liver is enlarged you can feel it through this technique, it feels harder than the rest of the abdomen, behind which the intestines are hiding. If the liver could not be palpated, it is either not enlarged or experience in palpating the liver is insufficient.