Hepatomegaly of the liver: what is it, echoes, how to treat

Hepatomegaly is an enlargement of the liver, which is a sign of various diseases. Consider the main causes of hepatomegaly, types, methods of diagnosis and treatment..

The liver is an organ in which chemical reactions occur that neutralize toxic substances. Enlarged liver is called hepatomegaly and can occur with poisoning of various etiologies. Scientists do not attribute this pathology to independent diseases, but define it as hepatomegaly syndrome. Very often, this syndrome is accompanied by an enlarged spleen. 

[1], [2], [3]

Causes of the hepatomegaly

Hepatomegaly is a characteristic sign of liver damage, the nature and stage of which depends on the size of the organ. It occurs in diseases of the cardiovascular system, tumor processes or metabolic disorders. Increased swelling and inflammation occur in cirrhosis and hepatitis. 

Causes of hepatomegaly of the liver can be divided into several groups, each of which depends on the disease causing its increase. [4]

Consider the main causes of hepatomegaly: 

• Hepatitis A, B, C, toxic hepatitis.
• Infectious diseases: malaria, [5]
• Alcoholic intoxication of the liver. [6]
• Non-alcoholic and alcoholic fatty  liver.
• Cancer metastases to the liver from other organs and cysts filled with fluid.
• Gaucher disease, glycogenosis. [7]
• Fibrous changes in the liver.
• Obstruction of the bile ducts and obstruction of the hepatic veins.
• Pericarditis.
• Leykemyya.
• Malignant tumors of the lymphatic system.
• Benign liver tumors: adenoma, hemangioma.
• The accumulation of abnormal protein in the liver is amyloidosis.
• Metabolic disorders.
• Wilson's disease, that is, the deposition of copper in the liver.

Symptoms of the hepatomegaly

Symptoms of hepatomegaly depend on the disease that caused the liver enlargement and its clinical manifestations. If hepatomegaly is pronounced (the liver reaches a large size), then it can be detected with palpation and even along the outlines of the abdomen. On palpation, the patient feels pain.

Consider the symptoms characteristic of hepatomegaly:

• Sore feeling and feeling of heaviness in the right side, especially when changing positions.
• Skin rash, itching.
• Accumulation of fluid in the abdominal cavity, ascites.
• Yellowness of the skin (most often occurs with hepatitis).
• Violation of the stool (diarrhea or constipation) and an increase in the abdomen.
• Heartburn and bad breath.
• Nausea.
• The appearance of "liver stars" on the skin.

If hepatomegaly occurs on the background of hepatitis, then the patient has a uniform increase and compaction of the parenchyma. Because of this, the lower edge of the liver can be palpated under the costal arch. Attempts to probe the liver cause pain and discomfort. With exacerbation of hepatitis, the pain becomes permanent. Hepatitis causes yellowness of the skin and symptoms of intoxication (weakness, fever, headaches). 

A complication of hepatitis is cirrhosis, which is also accompanied by hepatomegaly. In this case, healthy hepatocytes are replaced by connective tissue. The patient has a tendency to bleed, an earthy skin tone and constant pain in the right hypochondrium.

There are extrahepatic diseases, the main symptom of which is an increase in the liver. These include metabolic disorders, both hereditary and acquired. Due to the violation of glycogen catabolism, it begins to accumulate in the liver, which leads to its slow increase. But in addition to the liver, the kidneys and spleen, which also increase in size, suffer.

Hepatomegaly due to the left or right lobe causes hemochromatosis, an exchange disease that provokes the malfunctioning of the enzyme systems responsible for the absorption and binding of iron-containing compounds. In this case, an increase in the organ develops by the type of cirrhosis. But changes occur not only in the liver, but also in the lungs. The patient suffers from a strong cough with bloody sputum.

To provoke an increase in the liver can diseases of the cardiovascular system. Due to insufficient contractility, chronic cardiovascular insufficiency develops, which leads to the development of chronic hypoxia. As a result, a stagnant liver develops. Prolonged hepatomegaly can cause necrosis of hepatocytes and their replacement by connective tissue.

Diffuse hepatomegaly occurs when the size of the liver in an adult exceeds 12–13 cm. Streptococcal, staphylococcal and other infections cause abscesses in the liver, which leads to diffuse hepatomegaly. The treatment in this case is carried out only by a surgical method, since the use of medication is not effective. If diffuse changes in the size and structure of an organ are caused by cirrhosis (alcohol intoxication or toxic substances, poisons), then hepatomegaly causes joint pain and an enlarged spleen.

The cause of diffuse changes in hepatomegaly may be in the long-term use of drugs or the abuse of fatty foods. Daily exposure to toxins on the body leads to impaired liver function, changes in the structure and size of the body. Light diffuse changes can even provoke a new diet, by the way, this is a common cause of hepatomegaly in women.

To diagnose a diffuse enlargement of the liver, an ultrasound is performed. When detecting a slight increase in the organ and uniform compaction of the parenchyma, the patient is checked for hepatitis. In more detail, the degree of impairment in liver function and severity of liver failure is judged by the results of a biochemical blood test. If there are changes in the contours of the organ, a lumpy and uneven structure, this may indicate cirrhosis.

The main treatment for hepatomegaly with diffuse changes is to follow a diet. A patient is given a diet that means giving up fatty, spicy, and sweet food, as well as alcohol and other bad habits. For cleansing the liver can use alternative medicine methods and, of course, medical drugs. But the most important thing is to promptly determine the cause of the pathology and begin immediate treatment and a complex effect on the symptoms of the disease.

[8]

Partial hepatomegaly

Partial hepatomegaly is not a uniform enlargement of the liver, that is, a change in the size of individual parts or parts of an organ. For example, hepatomegaly of the left or right lobe of the liver indicates partial enlargement of the organ. In rare cases, there is an uneven change in the lower edge of the liver. On palpation, this pathology is felt uneven and bumpy.

Partial hepatomegaly can be diagnosed by ultrasound. The disease has a characteristic echoprism: a violation of the homogeneity of the tissues of the organ. The presence of tumors, cysts or abscesses also indicate a partial change in the liver and the progression of the disease.

[9], [10]

Hepatomegaly and splenomegaly

These are two conditions that very often occur simultaneously and one of them can provoke the appearance of the second. Hepatomegaly is an enlargement of the liver, and splenomegaly is an enlargement of the spleen. There is hepatolienal syndrome, that is, a combination of pathologies and changes in the size of the spleen and liver.

Hepatomegaly and splenomegaly occur with such diseases of the body:

1. Chronic liver damage (focal, diffuse), as well as diseases that cause circulatory disorders in the systems of the hepatic and splenic veins.
2. Hemochromatosis, amyloidosis, Gaucher disease, hepato-cerebral dystrophy and other diseases.
3. Parasitic and infectious diseases: abdominal tuberculosis, malaria, alveococcosis, infectious mononucleosis and others.
4. Diseases of the lymphoid tissue and blood: leukemia, lymphogranulomatosis, hemolytic anemia.
5. Diseases of the cardiovascular system, accompanied by chronic circulatory failure: coronary heart disease, heart defects, pericarditis.

Involvement in the pathological process of the spleen is explained by the close functional connection of the organs. Hepatolienal syndrome is more common in pediatric patients than in adults. This is due to the anatomical and physiological characteristics of the growing organism. Hereditary diseases, infectious diseases and congenital anomalies can also provoke hepatomegaly and splenomegaly.

As a rule, the diagnosis is not difficult and is carried out by the method of percussion and palpation. The main difficulty lies in determining the cause, that is, the underlying disease that caused hepatomegaly and damage to the spleen.

[11], [12]

Hepatomegaly in the context of fatty hepatosis

It is an enlargement of the liver caused by the degeneration of organ cells into fat. Most often, this disease occurs when lipids accumulate in the liver cells (hepatocytes). Pathology develops due to the effects on the body of alcohol, fatty foods, drugs and other negative factors.

Left without treatment, fatty hepatosis is generated in fibrosis and cirrhosis of the liver. There are several stages of this disease:

• In the first stage, cell foci appear with a high concentration of simple fats. If there are several lesions, they can cause diffuse changes in the liver tissue.
• In the second stage, the number of fat cells increases, and connective tissue begins to grow between the cells.
• At the last stage, pronounced strips of connective tissue appear, which subsequently lead to fibrosis and marked hepatomegaly.

One of the causes of hepatomegaly on the background of fatty hepatosis is metabolic disorders and obesity. But there are other factors that can cause disease, consider them:

• Diseases causing lipid metabolism disorders: diabetes mellitus type II, obesity, hypertriglyceridemia, and others.
• Toxic effect on the liver. Due to the constant neutralization of toxic substances, the liver ceases to fully perform its functions, which leads to its inflammation and increase. There is such a thing as alcoholic fatty hepatosis caused by the systematic use of alcohol.
• Digestive disorders and related diseases. The liver takes an active part in the process of digestion, but if there is a violation of fat absorption or excretion of bile acids, then this leads to serious pathologies.
• Diseases of the endocrine system. Fatty hepatosis occurs when excessive production of adrenal hormones and a lack of thyroid hormone.
• Malnutrition causes a violation of lipids, which entails hepatomegaly and fatty hepatosis. Irregular meals, a limited amount of protein, regular fasting, frequent change of diet. All this leads to the depletion of the body and to the fact that the liver cells no longer perform their work.
• Prolonged use of drugs or probiotics, as well as radiation, causes liver disease.

The main symptom of hepatomegaly on the background of fatty hepatosis is nausea, vomiting, pain in the right hypochondrium. Dysbacteriosis appears in the patient, the skin condition worsens, visual acuity may drop. Pronounced symptoms of the disease occur in the last stage of fatty hepatosis.

[13], [14], [15], [16], [17]

Hepatomegaly in children

Hepatomegaly in children can occur at any age, both in newborns and in adolescents or children of school age. Disorders of nutrition, autoimmune processes in the body and other factors can cause pathologies of the liver and spleen. For example, in children 5-7 years old, an enlarged liver is age-related, so hepatomegaly is moderate. Such a physiological phenomenon does not require medical intervention and treatment. But if this occurs in older children, the reason may be in disorders of the body or diseases.[18]

The danger is not just an enlarged liver, but the accompanying symptoms. If the baby complains of pain under the ribs, rashes and changes in skin pigmentation, the appearance of spider veins on the stomach, nausea and vomiting, fatigue and loss of appetite, this indicates serious health problems. Any of the above symptoms in combination with an enlarged liver is a reason to immediately seek medical help. The doctor will order tests to confirm or rule out liver damage.[19]

Causes of hepatomegaly in children are diverse, but doctors identify 6 main factors that can lead to problems, consider them:

• Inflammatory diseases - congenital infections (herpes, cytomegalovirus, rubella), toxic and medicinal organ damage, closure of the lumen of the biliary tract, hepatitis A, B, C, parasitic diseases.
• Metabolic disorders - violation of the structure and metabolism of glycogen, protein metabolism disorders, Wilson's disease, lipid metabolism disorders, mucopolysaccharidoses, porphyria, and others.
• Liver damage (infiltrative) - hemolytic diseases of newborns, lymphoma, leukemia, hepatoma, metastases, blood formation in “atypical” organs, histiocytosis.
• Violation of the outflow of bile and blood - cirrhosis, stenosis, thrombosis, atresia, heart failure, Wilson's disease.
• The primary damage to the liver is multiksystosis, congenital liver fibrosis, biliary cirrhosis and others.
• Hyperplasia of Kupffer cells that absorb and process dead cells - granulomatous hepatitis, sepsis, hypervitaminosis.
• False hepatomegaly - develops due to pathologies of the respiratory system, for example, in emphysema. Enlarged organs push the liver out from under the ribs

For the examination, the child is subjected to percussion of the abdominal circumference and palpation. Particular attention is paid to the pronounced venous network in the abdomen, changes in the pigmentation of the skin and mucous membranes, symptoms of intoxication, pain and heaviness. If hepatomegaly is moderate, there are no objective symptoms.

For reliable confirmation of liver damage, conduct an ultrasound study. Such a diagnosis is fully justified in the absence of external manifestations of hepatomegaly. Ultrasound allows you to recognize different forms of the disease, to detect violations in the structure of the body. Based on the results of the examination, a suitable treatment is selected. But hepatomegaly itself is not treated, the main disease that caused this pathology is to be treated.

Hepatomegaly in the fetus indicates that the liver of the embryo is larger than normal. This pathology is easily diagnosed, as an increase in the body leads to an increase in the abdomen, which is impossible not to pay attention during the ultrasound of a pregnant woman. The primary task of the doctor is to determine the reasons that caused the pathology of the unborn child. It depends on this treatment tactics and prognosis.[20]

There are many causes of hepatomegaly in the fetus, consider them in more detail:

• Intrauterine infections - negative effects of toxoplasmosis, cytomegalovirus, varicella, rubella, Coxsackie virus, syphilis, and even rhesus conflict can lead to an enlarged liver. 
• Various liver formations.
• Metabolic disorders.
• Heart failure.
• Hemolysis.
• Syndrome Dacna, Beckwith - Wiedemann, Zellweger.

If hepatomegaly occurs on the background of intrauterine infection, this leads not only to an increase in the organ, but also to the appearance of small hyperechoic inclusions. As for the neoplastic lesions in the liver of the fetus, this can be hemangioma, hepatoblastoma, adenoma, mesenchymal hamartoma and others.

Quite often, an enlarged liver is accompanied by pathologies of the spleen. Typically, hepatomegaly is detected in the second half of pregnancy. But the most important thing in detecting these problems is to eliminate Down syndrome. The tactics of introducing pregnancy depends on the causes of the pathology, since isolated hepatomegaly in the fetus occurs very rarely.

Hepatomegaly in newborns

It is considered the norm if it has an unexpressed nature, less than 2 cm. The list of diseases is extensive, since hepatomegaly does not appear by itself, but signals the presence of diseases of an organ or organism. Hepatomegaly syndrome may be associated with eating disorders, autoimmune processes, or a state after vaccination.[21]

The main causes of pathology lie in inflammatory and dystrophic processes in the liver parenchyma. Hepatomegaly in newborns can be a physiological phenomenon. Consider the main causes of liver enlargement in infants:

• Infectious diseases - almost all viral infections in babies cause induration and enlargement of the liver.
• Diseases of the cardiovascular and respiratory systems - pathology can develop due to right ventricular failure. 
• Blockage of the biliary tract and cyst of the bile duct - this disease is very rare, but also causes an enlarged liver. The main symptoms are fever, and when trying to palpate the liver, the child begins to cry.
• Cholangitis - hepatomegaly appears due to inflammation of the bile ducts. The disease is accompanied by fever and pain in the right hypochondrium.
• Debre syndrome - pathology occurs in children who develop poorly. Due to the developmental delay in the liver, glycogen and fat accumulate, which can cause fatty hepatosis.
• Disorders of lipid metabolism - in this case, the newborn appears severe diarrhea, vomiting and skin xanthomas.
• Echinococcosis is a disease caused by the introduction of tapeworms into the liver of the larvae. Pathology causes a nodular enlargement of the organ. The main cause of echinococcosis is contact with animals, especially dogs.
• Voringer syndrome - hepatomegaly occurs in children with autonomic symptoms and abnormal body weight.
• Mauriac's syndrome is a complication of diabetes mellitus that causes fat accumulation in the baby's liver.
• Liver tumors - hepatoblastomas and isolated organ tumors are extremely rare, but they can metastasize and affect one or both lobes of the liver.
• Gyrke disease - a disease of glycogen accumulation. In addition to an increase in the liver, it causes convulsions, an increased content of lactic acid in the blood and the excretion of acetoacetic acid in the urine.

Despite such a variety of causes, and factors causing hepatomegaly in newborns, there are common symptoms that may indicate a disease, consider them:

• Yellowness of the skin - persistent jaundice appears in many liver diseases. Particular attention should be paid to the color of the child's feces. If your baby has a colorless stool, you should immediately seek medical attention.
• Vascular stars in the abdomen.
• Nausea, company, poor appetite.
• Drowsiness, fatigue.
• Swelling of the navel - this happens only in severe diseases of the liver and abdominal cavity. The abdomen of the child greatly increases due to the accumulation of fluid.

Particular attention is paid to HIV-infected newborns with hepatomegaly. In some cases, an enlarged liver is an early symptom of HIV infection. In such children, the spleen increases, infections of the upper respiratory tract, dermatitis, mumps, and lymph node enlargement appear. If the disease is in moderate course, then the baby may suffer from long-term oral candidiasis, hepatitis, diarrhea, fever, anemia, meningitis, or sepsis.

[22]

Hepatomegaly during pregnancy

It occurs quite often. Liver problems usually occur in the last trimester. Due to the increase in the uterus, the liver shifts upward to the right, the body becomes more voluminous and full-blooded. At the same time, the excursions of the diaphragm are reduced, which causes difficulties in removing bile. In addition, during pregnancy there are a number of changes that must be taken into account when examining an organ. For example, the appearance of spider veins on the skin, high content of fatty acids, triglycerides in serum or cholesterol. All this is due to the influence of estrogen and progesterone and an increase in circulating blood volume.[23]

All liver diseases that occur during pregnancy and cause hepatomegaly are divided into three groups:

• Organ lesions associated with pregnancy (occur only in pregnant women).
• Intrahepatic cholestasis of pregnant women is a disease that is diagnosed in 20% of women. The basis of the pathology is a hereditary predisposition to an abnormal cholestatic reaction to estrogens and progesterones produced during gestation.
• Liver damage due to toxicosis (with excessive vomiting). A similar phenomenon occurs in 2% of pregnant women and develops between 4 and 10 weeks of gestation, ending by the 20th week of pregnancy. Excessive vomiting leads to dehydration, protein catabolism, electrolyte disturbances and weight loss.

In addition to the reasons described above, hepatomegaly during pregnancy can occur due to vascular stasis, fatty hepatosis, diabetes, leukemia, inflammatory diseases, tumor neoplasms and cysts.

[24]

Forms

Hepatomegaly is included in the international classification of diseases 10 revision. That is, a single regulatory document used to account for the incidence, causes of death and the causes of the population seeking medical help.

Unexpressed hepatomegaly

Characterized by an increase in the liver of 1-2 cm. Such changes do not cause painful symptoms, so their presence can only be diagnosed using ultrasound. But the process of liver deformity sooner or later begins to manifest itself with characteristic clinical symptoms. Since without proper treatment, unexpressed hepatomegaly progresses.

Typical symptoms of unexpressed hepatomegaly are weakness, rapid fatigability, which occurs without physical or other exercise. In the abdominal cavity, there are unpleasant feelings of heaviness and discomfort, possible heartburn, bad breath, pruritus and dyspepsia. When the above symptoms appear, it is necessary to undergo a full examination, since palpation is ineffective. The patient is prescribed an ultrasound, the results of which can assess the condition and size of the liver. In addition to ultrasound, an abdominal computed tomography scan can be performed, which provides more complete and reliable information about the condition of the organ.

If a change in the liver is found, the patient is prescribed a diet and drug treatment. The first step to recovery is proper nutrition and the rejection of bad habits. If the pain in the right hypochondrium becomes stronger, then the doctor prescribes drugs to strengthen the membrane of the liver cells: Kars, Ursosan, Essentiale-forte and others.

Moderate hepatomegaly

It is diagnosed in patients with minor diffuse changes in the liver and the corresponding clinical symptoms. Doctors use this term to describe abnormalities in the structure and size of an organ that do not meet the norm.

A moderate increase in the liver occurs with prolonged alcohol abuse and unbalanced nutrition. As a rule, this diagnosis can be seen after an ultrasound examination or CT scan of the abdominal cavity. Without proper treatment and a healthy lifestyle, the pathology progresses and becomes pronounced.

Severe hepatomegaly

Indicates pathological, but still reversible changes in the size of the liver. As a rule, this is observed in hemoblastosis and leukemia, due to massive infiltration of the tissues of the organ with malignant cells. This provokes the emergence of foci of necrosis and the growth of connective tissue. In these cases, the liver reaches a huge size, occupying most of the abdominal cavity, thereby disrupting the work of other internal organs.

With severe hepatomegaly, doctors evaluate not only the size of the organ, but also the structure, contours and pattern of the tissue. A significant increase in certain areas, the appearance of stony consistency or tumor foci, indicates certain diseases. Rapid enlargement of the liver is possible with fatty infiltration and cardiovascular diseases.

[25], [26]

Diagnostics of the hepatomegaly

The doctor examines the patient, conducts palpation and liver percussion. Special attention is paid to the history of the disease. The patient should tell the doctor if there is pain in the abdomen, vomiting and nausea, an unusual color of the stool, yellowing of the skin, a feeling of excessive heaviness or a lump in the abdomen. For the purpose of further examination, the doctor will find out whether the patient is taking any medications, how much alcohol he consumes and about nutrition.

Symptoms characteristic of hepatomegaly give all reasons for conducting a detailed examination of the body. As a rule, patients are prescribed:

• Biochemical analysis of blood (serum bilirubin, thymol test, alkaline phosphatase, total protein and proteinogram, ALT and AST).
• Computed tomography and magnetic resonance imaging of the abdominal cavity.
• Ultrasound examination of the abdominal cavity.
• X-ray.
• Analysis of liver function, including tests for blood clotting.

In some cases, to clarify the processes in the liver, conduct a biopsy. This analysis is done using laparoscopy. All of the above diagnostic methods allow you to understand the situation and accurately determine the cause of hepatomegaly.

Ultrasound signs of hepatomegaly

Manifest on scans as focal lesions. An enlarged liver is characterized by the presence of zones with a reduced accumulation of radionuclides. During the examination, the doctor revealed topographic changes in the position, size of the organ, changes in the structure of the liver segments.

Ultrasound can detect any focal lesions of the liver. Diagnosis makes it possible to determine the degree of hepatomegaly, the condition of the spleen and other internal organs. More extensive information to study the causes of liver enlargement is obtained using echohepatography.[27]

Echoes of hepatomegaly

They play an important role in determining the diseases causing an increase in the liver.

• If the pathology is caused by heart failure, acute hepatitis or parasitic diseases, then the homogeneous echostructure of the organ is maintained.
• If a heterogeneous echostructure of the liver is detected, this may indicate fatty hepatosis, cirrhosis, and chronic hepatitis.
• In the event of foci of inflammation or necrosis in the tissues of the liver that caused disturbances in the echoic structure, it is possible to speak of the presence of tumor neoplasms, cysts or abscesses.

Echo signs of hepatomegaly allow you to accurately determine the degree of pathology: unexpressed, moderate and pronounced enlargement of the liver.

[28],

Differential diagnosis

Differential diagnosis of hepatomegaly is necessary in order to accurately determine the cause of liver damage and to separate it from other diseases with similar symptoms. Particular attention is paid to the size of the shares of the body. Thus, an increase in the edge of the right lobe without differential diagnosis can be mistaken for tumors of the colon, gall bladder or kidney. Another important stage of diagnosis is to distinguish hepatomegaly from hepatoptosis and hepatosis. To accurately determine the causes of an increase in the liver, palpation is performed in different positions and an ultrasound examination.[29]

• When diagnosing hepatomegaly with acute viral hepatitis, information about recent transfusions of blood or its components is important. Multiple injections, parenteral manipulations, as well as the patient’s belonging to a risk group or the presence of an epidemiological history of an adverse nature. In order to eliminate acute viral hepatitis, a study of markers of viruses B, C, D, G is conducted. This allows you to establish the phase of virus replication and to detect its presence.
• Hepatomegaly is one of the first symptoms of cirrhosis of the liver, so this disease is also important to differentiate. Cirrhosis causes portal hypertension, functional impairment and thickening of the liver.
• Portal hypertension is accompanied by circulatory disorders, which causes an increase in the organ. To recognize this disease, gastroscopy is carried out, which reveals the varicose veins of the stomach and esophagus, possibly a biopsy.
• An enlarged liver and pain in the right hypochondrium are also characteristic of obstruction of the hepatic veins, which leads to impaired outflow of blood from the organ (Budd-Chiari syndrome). The patient complains of fever, weakness and ascites. Doppler ultrasound with blood flow assessment is performed for diagnosis. The main symptom of this disease is hepatomegaly with complete liver dysfunction. Mandatory is a puncture biopsy.
• It is extremely important to recognize diseases of accumulation (amyloidosis, fatty hepatosis, hepatocerebral dystrophy, hemochromatosis), which at the initial stage give one single symptom - hepatomegaly. To identify fatty hepatosis using CT and ultrasound. In the diagnosis of hemochromatosis, special attention is paid to the results of blood tests. To confirm the diagnosis of hepatocerebral dystrophy, attention is paid to the presence of neurological symptoms and puncture biopsy data.
• When diagnosing diseases of the cardiovascular system that cause hepatomegaly, it is necessary to remember about the possible pericarditis in the area of the right ventricle. As a rule, in this case there were injuries in the heart area or tuberculosis. The first signs of the disease cause pain in the right hypochondrium, an increase in the left lobe of the liver, shortness of breath, and increased pressure. 

[30], [31]

Treatment of the hepatomegaly

Treatment of hepatomegaly completely depends on the results of diagnostics and on the etiological component of the pathology. Treatment should be aimed at eliminating the causes of liver damage and to combat the painful symptoms. It is obligatory to observe a special diet, a gentle exercise regime and prophylactic hepatoprotective therapy.

If hepatomegaly is caused by hepatitis, then antiviral and hepatoprotective therapy leads to full recovery and restoration of the normal size of the liver. Appointment of betaine, pentoxifylline, rosuvastatin, orlistat, ursodeoxycholic acid and atorvastatin with non-alcoholic steatohepatitis. [32], [33], [34], [35], [36]. Studies have shown that the intake of vitamin E and vitamin C reduces fibrosis in patients with non-alcoholic steatohepatitis [37]. In cirrhosis, which causes irreversible replacement of liver cells with connective tissue, complete recovery of the liver is not possible. Treatment is aimed at replenishing the deficiency of enzymes of the body and maintaining normal functioning. Treatment is reduced to palliative therapy, against which hepatomegaly slowly progresses and the patient's condition is steadily worsening.

If a patient has an enlarged liver on the background of compensated cirrhosis, then it is recommended to limit physical exertion, follow a diet with enough vitamins and protein, and also completely give up alcohol. Active viral cirrhosis B and C causes viral replication, therefore, treatment is carried out with medical drugs.[38], [39]  

When hepatomegaly is caused by liver failure with ascites and sodium chloride deficiency, diuretics are prescribed for treatment. If the underlying disease progresses, is accompanied by cirrhosis of the liver or a patient under 60 years old, organ transplantation is possible.[40], [41]

[42], [43]

Nutrition for hepatomegaly

Nutrition for hepatomegaly is one of the most important conditions for restoring the health of the liver. A healthy balanced diet has a beneficial effect on the liver and the body as a whole. Consider the basic rules of nutrition in hepatomegaly:

• You need to eat at least 6 times a day, that is, three main meals and three snacks. Food is recommended to take fractional, small portions.
• It is necessary to completely abandon the fat and fried. Meals are best steamed, boiled or baked. On the day it is allowed to consume no more than 70 g of fat, while animal fats are better to replace with vegetable.
• From the food you need to completely eliminate bakery products, sugar and any sweets.
• It is forbidden to eat fatty meat and fish, lard, smoked, spicy, canned or salted food.
• In the diet should be steamed and boiled vegetables, cereal, steamed or baked fish, poultry meat. It is recommended to eat more seasonal vegetables and fruits.

Diet for hepatomegaly

Diet for hepatomegaly is aimed at normalizing the functioning of the liver. Diet is a five meals every 3-4 hours with certain restrictions in the choice of products. These requirements are fully consistent with the diet of Pevzner №5. In addition to prescribed medications for the treatment of hepatomegaly, recovery can be accelerated with food. Failure to follow the rules of the diet can have very serious consequences for the body and provoke inflammation of the liver, which only aggravates hepatomegaly.

Permitted Products:

• Vegetable oils.
• Sea and river lean fish.
• Fresh vegetables and fruits, greens.
• Milk and dairy products.
• Honey, marshmallow, jam.
• Dried fruits.
• Cereals.
• Low-fat poultry.
• Vegetable, cereal and milk soups.
• Sauerkraut.

Meals for hepatomegaly obliges to have dinner no later than seven o'clock in the evening. It is strictly forbidden to overeat, between meals should be intervals of 2.5-3 hours, but no more.

Contraindications:

• Butter (more than 50 g per day) and margarine.
• Eggs (no more than 2 per week).
• Sausage and sausages.
• Pork, goose meat, lamb.
• Cheese with high fat content.
• Marinated and fried foods.
• Spicy seasonings, sauces, vinegar.
• Legumes and onions.
• Tomato juice.
• White refined sugar and any confectionery.
• Chocolate.
• Canned food.
• Bakery products.

Diet and hepatomegaly are two inseparable concepts. Since without proper nutrition it is impossible to fully restore the functions of the liver and the health of the body. After diagnosis, the doctor may add additional nutritional restrictions that are associated with the specific disease that caused an increase in the organ. The duration of the diet is also determined by the attending physician, but some recommendations will have to be followed throughout life.[44], [45]

[46]

Prevention

Prevention of hepatomegaly depends on the underlying disease that caused an increase in the liver. To prevent hepatomegaly, you must follow a healthy diet, give up bad habits (alcohol, smoking) and control weight. With extreme caution and only after medical authorization, you can take drugs, as they can also cause toxic damage to the liver.[47]

For preventive purposes, it is recommended to maintain an active lifestyle, play sports. A prerequisite for well-being is to have a healthy sleep and timely treatment for medical help.

[48]

Forecast

The prognosis of hepatomegaly depends on the nature of the occurrence of this pathology and the severity of violations. If the liver enlargement is due to viral and infectious lesions, then it is treatable. Antiviral therapy is particularly effective in the early stages, while the risk of transition to the expressed form is 5%. With liver pathologies caused by toxic damage, the prognosis worsens. An unfavorable prognosis has cirrhosis, uncontrolled fatty hepatosis, fulminant forms of hepatitis.

Any diseases that caused not only an increase in the organ, but also changes in the liver parenchyma are characterized by rapid progression and development of severe consequences. In 30% of cases death occurs from the complications of the underlying disease that caused hepatomegaly. These can be intraperitoneal bleeding, severe infectious diseases, impaired antitoxic function of the liver, and more.[49]

Hepatomegaly is a sign of liver and body problems. Regular medical examinations and ultrasound examinations reveal the enlarged liver in its early stages. Due to this, it is possible to start timely treatment of the underlying disease and return to normal the size of the body and its functional abilities.

[50], [51], [52], [53]