Hepatomegaly – Causes, Symptoms, Treatment, Prognosis

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Hepatomegaly means an enlarged liver. It is actually not a disease. It is in fact a sign of an underlying problem like a liver disease, congestive heart failure or cancer.

Home remedies

Below mentioned are some of the simple remedies for liver enlargement which may be tried after consulting with your doctor –

Aloe vera – pulp of the single leaf of the plant is taken and mixed with black salt and ginger. This should be taken every morning for 10 days.

Amla – 300 grams of powder of Indian gooseberry should be mixed with 100 grams of dried ginger powder. 1 teaspoonful of this should be taken with warm water twice in a day.
Read – Amla Benefits, Dose, How To Use, Side Effects, Home Remedies

Bitter gourd – juice of bitter gourd mixed with small amount of salt is helpful.

Chicory juice – obtained from its flowers, seeds and roots is highly beneficial.

Dandelion Root – tea prepared from this root is useful.

Haritaki – Terminalia chebula powder mixed with jaggery in equal proportions (roughly 1.5-2 grams each) should be taken at least twice daily with warm water for 1-1.5 months.

Herbal decoction – Make a decoction of 1 teaspoon each of fennel seeds, ginger and coriander, 5 numbers of black pepper, garlic cloves and leaves of holy basil in 1-1.5 cups of water for 5 minutes. Strain it, add 1 teaspoon of honey once the liquid gets warm and take it twice daily after meals.

Kantakari – Solanum xanthocarpum is highly beneficial in treating hepatosplenomegaly i.e. enlargement of both liver and spleen.

Lemon juice – is an effective remedy for hepatomegaly. It reduces liver inflammation owing to its richness of vitamin C and other antioxidants and diuretic properties. For better results, it should be taken early in the morning, on empty stomach.

Onion – is diuretic, has cleansing properties, detoxifies liver and reduces liver inflammation, hence beneficial in hepatomegaly.
Read – Onion Uses, Remedies, Research, Side Effects

Tamarind tea – should be taken 2-3 times a day. Tamarind is a naturally detoxifying agent and reduces liver inflammation.

Other remedies –

• Papaya – eating fruit or drinking its juice
• Spearmint juice with sugar
• Orange juice on empty stomach
• Daily intake of long brinjals
• Green Tea

Ayurveda concept

Read – Yakrutodara

Treatment

The treatment for enlarged liver involves treating the condition or disease that is causing it. Below mentioned are some of the recommended treatments –

• Medications and treatments for liver failure / infections
• Chemotherapy, surgery or radiation for liver cancer
• Liver transplant when there is liver damage

Lifestyle changes

• Quitting alcohol or any other drugs
• Eating healthy diet
• Doing regular exercise
• Losing weight if you are obese or overweight
  Read – Effective Obesity Treatment, Remedies And Ayurveda Tips

Prevention

• Following healthy lifestyle
• Maintaining a healthy weight
• Managing blood sugar levels
• Restriction or avoiding alcohol intake
• Quit smoking
• Taking supplements in consultation with doctor
• Following recommendations for safe handling if you are working with chemicals, insecticides or aerosolized cleaners

If the hepatomegaly is discovered earlier, there is a better outcome in the treatment. Recovery and reduction of symptoms also depends on the scale of underlying causes of hepatomegaly.

Causes of Hepatomegaly

1. Liver diseases

• Liver cirrhosis
• Hepatitis A, B and C
• Hepatitis caused by infectious mononucleosis
• Alcoholic fatty liver disease
• Nonalcoholic fatty liver disease
• Amyloidosis – abnormal protein accumulation in liver
• Wilson’s disease – genetic disorder, marked by copper accumulation in the liver
• Hemochromatosis – caused due to iron accumulation in the liver
• Gaucher’s disease – caused by fatty substances accumulating in the liver
• Liver cysts – fluid filled pockets in the liver
• Hemangioma and adenoma – presence of non-cancerous liver tumors in the liver
• Toxic hepatitis
• Obstruction of gallbladder or bile ducts
  Read – Liver Diseases: Causes, Symptoms, Treatment, Home Remedies

2. Cancers

• Secondary / metastatic liver carcinomas
• Leukemia
• Lymphoma
• Liver cancer
• Multiple myeloma
  Read – 10 Diet and Lifestyle Tips To Prevent Cancer

3. Problems of heart and blood vessels

• Budd-Chiari syndrome – caused by blockage of veins of liver
• Heart failure
• Pericarditis – inflammation of tissue surrounding the heart
• Congestive hepatomegaly – Congestive heart failure can cause blood to back up into the hepatic veins. These are the veins that help drain blood from the liver. When they back up, liver will become congested and grow larger. This is called as congestive hepatomegaly.
  Read – Ayurvedic Treatment For Heart Diseases – Hridroga Chikitsa

4. Congenital conditions

• Hemolytic anemia
• Polycystic liver disease
• Sickle cell disease
• Hereditary fructose intolerance 

5. Infection

• Glandular fever (infectious mononucleosis)
• Hepatitis
• Liver abscess / Pyogenic abscess
• Malaria
• Amoeba infections
• Hydatid cyst
• Leptospirosis
• Actinomycosis
  Read – Ayurvedic Home Remedy For Liver Diseases

6. Biliary conditions

• Primary biliary cirrhosis
• Primary sclerosing cholangitis

7. Metabolic disorders

• Cholesteryl ester storage disease
• Porphyria
• Niemann Pick disease
• Glycogen storage disease

(Haemochromatosis, Wilson’s disease, Non-alcoholic fatty liver disease – mentioned in liver diseases are also included here)
Read – Jaundice With Alcoholic Liver Disease – A Clinical Case Presentation

8. Drugs

• Alcohol abuse
• Drug induced hepatitis

9. Other conditions

• Granulomatous conditions – Sarcoidosis
• Zellweger’s syndrome
• Hunter’s syndrome
• Carnitine palmitoyltransferace I deficiency
  Read – Fatty Liver: Symptoms, Ayurvedic Treatment, Remedies, Tips

Symptoms

Most times an enlarged liver may not cause any symptoms.

When a liver disease causes enlargement of liver, it may present the below mentioned symptoms –

• Pain in the abdomen, and abdominal mass
• Increasing abdominal size
• Feeling of fullness or discomfort in your belly
• Fatigue and weakness
• Nausea and vomiting
• Jaundice
• Weight loss
• Poor appetite
• Muscle aches
• Itching
• Swelling of feet and legs
• Easy bruising
  Read – Kamala Roga Chikitsa: Liver Disorder Causes, Symptoms, Treatment

If the symptoms are too troublesome you need to see a doctor as soon as possible. Below mentioned symptoms require immediate medical attention –

• Severe abdominal pain
• Jaundice and fever
• Shortness of breath
• Black, tarry stools
• Bright red blood in stools
• Bloody or coffee ground vomit

These symptoms might indicate medical emergency.
Read – Dyspnoea – Difficulty in breathing: Causes, Pathophysiology, Diagnosis

Risk Factors

Having a liver disease is the greatest risk factor for hepatomegaly. You are likely to develop enlargement of liver if you have a liver disease. Below mentioned are the factors and conditions which tend to increase your risk of getting liver problems.

• Autoimmune disorders afflicting the liver
• Taking large amounts / doses of medicines, vitamins or supplements predisposes to hepatomegaly. Overdose of acetaminophem is the commonest cause for acute liver failure in US. Reading the labels and knowledge of what medicines or supplements causes liver enlargement will help.
• Infectious diseases – including viral, bacterial or parasitic diseases increases risk of liver damage
• Inflammatory bowel disease
• Hepatitis viruses
• Poor eating choices and habits – unhealthy foods and those rich in excess fat or sugar are risk factors for liver damage
• Being overweight
• Sickle cell disease
  Read – Autoimmune Hepatitis: Causes, Symptoms, Diagnosis, Treatment

Lifestyle factors

• Excessive use of alcohol
• Blood transfusions
• Tattooing
• Blood transfusions
• Unprotected sex
• Traveling to foreign countries associated with risks for malaria
• Taking herbs like ma huang, comfrey and mistletoe in excess

Diagnosis

Physical examination – Liver enlargement is usually diagnosed by your physician while feeling / examining your abdomen. Enlarged liver is felt during palpation and percussion of abdomen.

Other tests and procedures –

Blood tests – to determine liver enzyme levels and to identify the viruses causing enlargement of liver

Imaging tests – CT scan, USG or MRI

Magnetic resonance elastography – uses sound waves to create a visual map of the liver tissue stiffness. This map is called elastogram. This is now days considered as an alternative to liver biopsy and is noninvasive.

Liver biopsy – may be advised to find out the cause for liver enlargement.
Read – Autoimmune Hepatitis Ayurvedic Concept, Explanation, Treatment

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