Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 23, 2016

There are multiple diseases and conditions that can affect the liver including hepatitis, cirrhosis, and hepatomegaly which is also referred to as an enlarged liver.


Definition & Facts

Hepatomegaly describes the abnormal enlargement and swelling of the liver. It is associated with many diseases and conditions such as metabolic disorders, hepatic tumors (liver cancer), infections, and hepatitis A, hepatitis B, or hepatitis C. Obesity and diabetes mellitus may also cause hepatomegaly.

Symptoms & Complaints

Since hepatomegaly is associated with several liver diseases, the initial procedure that is performed by doctors is to ask the patient for his or her symptoms in order to draw an association between symptoms and a specific liver disease. Symptoms can include:

These symptoms do not necessarily indicate hepatomegaly. In fact, some patients with slightly enlarged livers may not experience any of them. However, stomach pain or a feeling of fullness in the stomach (abdominal distension) could indicate that the liver might be swelling severely.

As each disease that causes the enlargement of liver may cause a variety of symptoms, hepatomegaly may likewise coincide with a wide variety of symptoms. Stomach pain is a common complaint but back pain can also be a sign. Ultimately, symptoms depend on the disease and the condition of the patient.


A variety of conditions can cause the liver to become enlarged. Various types of cancer including leukemia can cause hepatomegaly. Alcohol abuse such as that which results from alcohol use disorder may impair and enlarge the liver. Since alcohol is a toxin that is processed in the liver, too much of it is damaging and can cause alcoholic hepatitis and cirrhosis - both of which can lead to hepatomegaly.

Aside from alcohol and cancer, there are still many more diseases that can cause hepatomegaly. Cardiovascular disease (diseases of the heart and blood vessels) may involve blockages of the veins that prevent toxins which are processed in the liver from exiting the liver. This is referred to as hepatic vein thrombosis. Other diseases that may cause hepatomegaly are genetic disorders and viral infections.

Types of viruses that cause hepatitis include the hepatitis A virus, hepatitis B virus, and hepatitis C virus. These types of viruses can be transmitted via intravenous drugs (especially hepatitis C) and unprotected sex (sexually transmitted disease) depending on the type of hepatitis.

Diagnosis & Tests

Hepatomegaly or the enlargement of liver may not be noticed for a long time until it becomes severe. Because of this, it is important to have a periodic check-up (doctor's visit) in order to enable early diagnosis. Many physical examinations will involve routine blood tests. Initially, doctors may use their fingertips to press on the upper part of belly below the ribs in order to roughly measure whether the liver is obviously large or not (a diagnostic method called palpation).

For a more accurate measurement, doctors may ask the patients to have an abdominal ultrasound. Tests that are more accurate include CT scans and MRIs. These provide a more detailed image of the affected area.

Blood tests are usually necessary to diagnose hepatomegaly. They include liver function tests. Through blood tests, elevated liver enzyme levels may be detected, and the types of viruses that may cause liver enlargement can be found if the source of the hepatomegaly is an infection.

There are also cases where a liver biopsy is requested. It is a procedure in which a sample of liver tissue (biopsy) is collected for laboratory test. Nevertheless, there is an alternative for biopsy such as magnetic resonance elastography. This diagnostic test uses an elastogram to measure the stiffness of the liver. Instead of getting a sample of liver tissue, this type of test uses S-waves or shear waves that are noninvasive.

Treatment & Therapy

Hepatomegaly is treated depending on what the direct causes are. If hepatitis is the disease that causes it, treatment will focus on treating the underlying hepatitis. Antiviral drugs that treat hepatitis include adefovir dipivoxil, entecavir, interferon, lamivudine, peginterferon, telbivudine, or tenofovir.

Azathioprine and prednisone can be prescribed by doctors if the cause of enlargement is cirrhosis. Metformin and pioglitazone are two drugs used to treat non-alcoholic fatty liver disease. If the patient has lymphoma, the treatment could be radiotherapy or chemotherapy. In severe cases, surgery such as liver transplantation could be an option.

Prevention & Prophylaxis

Prevention is always better than cure. For hepatomegaly, this is also applicable. Although many use vitamin supplements to prevent disease, doctors warn patients to use them with caution as some vitamins and minerals may have toxicity to the liver in large dosage and sometimes cause trouble instead of preventing it.

Nonetheless, maintaining a healthy weight is key. Eating healthy food can help prevent non-alcoholic fatty liver disease and diabetes. Moreover, alcohol should be consumed in moderation and if alcoholism is suspected, should be diagnosed and treated. Smokers should quit smoking and all should be careful about avoiding secondhand smoke.

Vaccines that prevent certain types of viral infections that cause hepatitis and thus hepatomegaly should be taken. There is currently a hepatitis A vaccine, hepatitis B vaccine, and hepatitis C vaccine.