Hepatomegaly
Medical condition
Hepatomegaly | |
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Computerized tomography of affected person with hepatomegaly | |
Specialty | Hepatology |
Symptoms | Weight loss, lethargy [1] |
Causes | Liver abscess (pyogenic abscess), Malaria [1] |
Diagnostic method | Abdominal ultrasonography [2] |
Treatment | Prednisone and azathioprine [3] |
Hepatomegaly is enlargement of the liver . [4] It is a non-specific medical sign , having many causes, which can broadly be broken down into infection , hepatic tumours , and metabolic disorder . Often, hepatomegaly presents as an abdominal mass . Depending on the cause, it may sometimes present along with jaundice . [1]
Signs and symptoms
The patient may experience many symptoms, including weight loss, poor appetite , and lethargy ; jaundice and bruising may also be present. [1]
Causes
Among the causes of hepatomegaly are the following:
Infective
- Glandular fever (Infectious mononucleosis) [1]
- Hepatitis (A, B, C) [4]
- Liver abscess (pyogenic abscess) [1]
- Malaria [1]
- Amoeba infections [5]
- Hydatid cyst [6]
- Leptospirosis [7]
- Actinomycosis [8]
Neoplastic
Biliary
Metabolic
Drugs (including alcohol)
- Alcohol use disorder [4]
- Drug-induced hepatitis [1]
Congenital
Others
- Hunter syndrome (Spleen affected) [10]
- Zellweger's syndrome [11]
- Carnitine palmitoyltransferase I deficiency [12]
- Granulomatous: Sarcoidosis [13]
Mechanism
The mechanism of hepatomegaly consists of vascular swelling, inflammation ( infectious in origin), and deposition of (1) non-hepatic cells or (2) increased cell contents (such as that due to iron in hemochromatosis or hemosiderosis and fat in fatty liver disease). [14]
Diagnosis
Suspicion of hepatomegaly indicates a thorough medical history and physical examination , wherein the latter typically includes an increased liver span . [ citation needed ]
On abdominal ultrasonography , the liver can be measured by the maximum dimension on a sagittal plane view through the midclavicular line , which is normally up to 18 cm in adults. [2] It is also possible to measure the cranio-caudal dimension , which is normally up to 15 cm in adults. [2] This can be measured together with the ventro-dorsal dimension (or depth ), which is normally up to 13 cm. [2] Also, the caudate lobe is enlarged in many diseases. In the axial plane , the caudate lobe should normally have a cross-section of less than 0.55 of the rest of the liver. [2]
Other ultrasound studies have suggested hepatomegaly as being defined as a longitudinal axis > 15.5 cm at the hepatic midline, or > 16.0 cm at the midclavicular line . [16] [17]
Workup
Blood tests should be done, especially liver-function tests , which give a good impression of the patient's broad metabolic picture. [ medical citation needed ]
A complete blood test can help distinguish intrinsic liver disease from extrahepatic bile-duct obstruction . [18] An ultrasound of the liver can reliably detect a dilated biliary-duct system, [19] it can also detect the characteristics of a cirrhotic liver . [20]
Computerized tomography (CT) can give accurate anatomical information for a complete diagnosis. [21]
Treatment
Treatment of hepatomegaly varies with the cause, so accurate diagnosis is the first concern. In auto-immune liver disease, prednisone and azathioprine may be used for treatment. [3]
In lymphoma the treatment options include single-agent (or multi-agent) chemotherapy and regional radiotherapy, and surgery is an option in specific situations. Meningococcal group C conjugate vaccine is used in some cases. [22]
In primary biliary cirrhosis, ursodeoxycholic acid helps the bloodstream remove bile, which may increase survival. [23]
See also
References
- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 "Hepatomegaly. Read about Hepatomegaly (enlarged liver) | Patient" . Patient . Retrieved 2016-02-27 .
-
1
2
3
4
5
6
Christoph F. Dietrich, Carla Serra, Maciej Jedrzejczyk (2010-07-28).
"Ultrasound of the liver - EFSUMB – European Course Book"
(PDF)
.
European federation of societies for ultrasound in medicine and biology (EFSUMB)
. Archived from
the original
(PDF)
on 2017-08-12
. Retrieved
2017-12-21
.
{{ cite web }}
: CS1 maint: multiple names: authors list ( link ) -
1
2
"Cirrhosis: Practice Essentials, Overview, Epidemiology"
. 2018-10-31.
{{ cite journal }}
: Cite journal requires| journal=
( help ) - 1 2 3 4 5 6 7 8 9 "Hepatomegaly: MedlinePlus Medical Encyclopedia" . www.nlm.nih.gov . Retrieved 2016-02-27 .
- ↑ Lang, Florian (2009-03-19). Encyclopedia of Molecular Mechanisms of Disease: With 213 Tables . Springer Science & Business Media. p. 824. ISBN 9783540671367 .
- ↑ Prevention, CDC - Centers for Disease Control and. "CDC - Echinococcosis - Resources for Health Professionals" . www.cdc.gov . Retrieved 2016-03-11 .
- ↑ "Leptospirosis (Weil's Disease) | Doctor | Patient" . Patient . Retrieved 2016-03-11 .
- ↑ Banfalvi, Gaspar (2013-10-16). Homeostasis - Tumor - Metastasis . Springer Science & Business Media. p. 145. ISBN 9789400773356 .
- ↑ "Cholesteryl Ester Storage Disease - NORD (National Organization for Rare Disorders)" . NORD (National Organization for Rare Disorders) . Retrieved 2016-03-11 .
- ↑ "Hunter's Syndrome. MPS II information; symptoms | Patient" . Patient . Retrieved 2016-03-11 .
- ↑ "OMIM Entry - # 214100 - PEROXISOME BIOGENESIS DISORDER 1A (ZELLWEGER); PBD1A" . www.omim.org . Archived from the original on 2015-02-14 . Retrieved 2016-03-11 .
- ↑ "CPT I deficiency" . Genetics Home Reference . 2016-03-07 . Retrieved 2016-03-11 .
- ↑ "Sarcoidosis | Doctor | Patient" . Patient . Retrieved 2016-03-11 .
- ↑ Dennis, Mark; Bowen, William Talbot; Cho, Lucy (2012-01-01). Mechanisms of Clinical Signs . Elsevier Australia. p. 469. ISBN 9780729540759 .
- ↑ Rocha, Silvia Maria Sucena da; Ferrer, Ana Paula Scoleze; Oliveira, Ilka Regina Souza de; Widman, Azzo; Chammas, Maria Cristina; Oliveira, Luiz Antonio Nunes de; Cerri, Giovanni Guido (2009). "Determinação do tamanho do fígado de crianças normais, entre 0 e 7 anos, por ultrassonografia". Radiologia Brasileira . 42 (1): 7–13. doi : 10.1590/S0100-39842009000100004 . ISSN 0100-3984 .
- ↑ Gosink, BB; Leymaster, CE (January 1981). "Ultrasonic determination of hepatomegaly". Journal of Clinical Ultrasound . 9 (1): 37–44. doi : 10.1002/jcu.1870090110 . PMID 6792230 . S2CID 22827636 .
- ↑ Kratzer, W; Fritz, V; Mason, RA; Haenle, MM; Kaechele, V; Roemerstein Study, Group. (November 2003). "Factors affecting liver size: a sonographic survey of 2080 subjects" . Journal of Ultrasound in Medicine . 22 (11): 1155–61. doi : 10.7863/jum.2003.22.11.1155 . PMID 14620885 . S2CID 29904060 .
- ↑ Goldman, Lee; Schafer, Andrew I. (2015-04-21). Goldman-Cecil Medicine . Elsevier Health Sciences. p. 991. ISBN 9780323322850 .
- ↑ Meacock, L M; Sellars, M E; Sidhu, P S (2010-07-01). "Evaluation of gallbladder and biliary duct disease using microbubble contrast-enhanced ultrasound" . The British Journal of Radiology . 83 (991): 615–627. doi : 10.1259/bjr/60619911 . ISSN 0007-1285 . PMC 3473688 . PMID 20603412 .
- ↑ Murray, Karen F.; Horslen, Simon (2013-12-11). Diseases of the Liver in Children: Evaluation and Management . Springer Science & Business Media. p. 199. ISBN 9781461490050 .
- ↑ Mirvis, Stuart E.; Soto, Jorge A.; Shanmuganathan, Kathirkamanathan; Yu, Joseph; Kubal, Wayne S. (2014-08-19). Problem Solving in Emergency Radiology . Elsevier Health Sciences. p. 442. ISBN 9781455758395 .
- ↑ "Non-Hodgkin's Lymphoma | Doctor | Patient" . Patient . Retrieved 2016-03-11 .
- ↑ "Primary biliary cirrhosis: MedlinePlus Medical Encyclopedia" . www.nlm.nih.gov . Retrieved 2016-03-12 .
Further reading
- Hoffmann, Georg F.; Zschocke, Johannes; Nyhan, William L. (2009-11-21). Inherited Metabolic Diseases: A Clinical Approach . Springer Science & Business Media. ISBN 9783540747239 .
- Kim, Sun Bean; Kim, Do Kyung; Byun, Sun Jeong; Park, Ji Hye; Choi, Jin Young; Park, Young Nyun; Kim, Do Young (2015-12-01). "Peliosis hepatis presenting with massive hepatomegaly in a patient with idiopathic thrombocytopenic purpura" . Clinical and Molecular Hepatology . 21 (4): 387–392. doi : 10.3350/cmh.2015.21.4.387 . ISSN 2287-2728 . PMC 4712167 . PMID 26770928 .
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