Enlarged Liver

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Introduction

What is enlarged liver?

Enlarged liver, called hepatomegaly, is an increase in size of the liver, whatever the cause. In some cases, both the liver and spleen become enlarged together, and the resulting condition is called hepatosplenomegaly. The liver is an organ in the digestive system that assists the digestive process and carries out many other essential functions. These functions include producing bile to help break down food into energy; creating essential substances, such as hormones; cleaning toxins from the blood, including those from medication, alcohol and drugs; and controlling fat storage and cholesterol production and release.

Enlarged liver, on its own, is not a symptom that you will notice. You cannot normally feel that your liver is enlarged. Instead, it is sometimes discovered by your physician during a physical exam. Normally, the edge of the liver emerges just to the lower edge of your right rib cage; it is thin and firm and cannot be felt except, in some people, during a deep inhalation. Even if you take a deep breath, an enlarged liver may or may not be palpable to a medical practitioner.

An enlarged liver is usually caused by liver disorders related to excessive alcohol use, congestive heart failure, glycogen storage disease, viral hepatitis, liver cancer, and steatosis (fat in the liver). It can also be caused by a large variety of other disorders, such as mononucleosis or tumor metastases from other primary cancers in the body.

An enlarged liver is not normally a symptom that you can feel. However, it is frequently accompanied by other, more obvious symptoms that may indicate a serious liver condition. Seek immediate medical care (call 911) if you experience any of the following symptoms related to liver disease or its complications, including confusion, hallucinations, extreme fatigue, fainting, fever (especially if combined with a swollen abdomen), or vomiting blood.

Seek prompt medical care if you experience any of the following symptoms, including yellowing of the skin and whites of the eyes (jaundice); abdominal pain; nausea, vomiting or diarrhea; constant weakness or dizziness; difficulty thinking and understanding; and low-grade fever. Also seek prompt medical care if you are being treated for a liver disease but your symptoms persist, recur, or cause you concern.

Symptoms

What other symptoms might occur with enlarged liver?

Enlarged liver may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Symptoms that frequently affect the digestive tract may also involve other body systems.

Gastrointestinal symptoms that may occur along with enlarged liver

Enlarged liver may accompany other symptoms affecting the gastrointestinal system including:

Other symptoms that may occur along with enlarged liver

Enlarged liver may accompany symptoms related to other body systems including:

  • Discolored urine

  • Fatigue

  • Fever or chills

  • Headache

  • Itchy skin

  • Joint pain

  • Loss of body hair

  • Malaise or lethargy

  • Menstrual irregularities

  • Redness on the palms of the hands

  • Spider angiomas (red skin lesion consisting of small blood vessels that spread out in a pattern that resembles a spider web)

  • Yellowing of the skin and whites of the eyes (jaundice)

Serious symptoms that might indicate a life-threatening condition

In some cases, enlarged liver may be a symptom of a life-threatening condition that should be evaluated immediately in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Abdominal pain

  • Abdominal swelling, distention or bloating

  • Agitation

  • Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions

  • Difficulty walking

  • Rapid heart rate (tachycardia)

  • Severe fatigue

  • Vomiting blood or black material (resembling coffee grounds)

Causes

What causes enlarged liver?

Enlarged liver is usually caused by liver disorders related to excessive alcohol use, congestive heart failure, glycogen storage disease, viral hepatitis, liver cancer, cirrhosis, and steatosis (fat in the liver). It can also be caused by a large variety of disorders affecting other body systems, such as infectious mononucleosis or tumor metastases from other primary cancers in the body.

Gastrointestinal causes of enlarged liver

Enlarged liver may be caused by liver disorders and other gastrointestinal (or related) disorders including:

  • Alcohol abuse

  • Glycogen storage disease (inherited disorder that causes liver enlargement)

  • Hemochromatosis (buildup of excess iron in body tissues, particularly the liver)

  • Sclerosing cholangitis (inflammation and destruction of the bile ducts)

  • Steatosis (fatty liver)

  • Viral hepatitis

Other causes of enlarged liver

Enlarged liver can also be caused by disorders affecting a variety of other body systems including:

Serious or life-threatening causes of enlarged liver

In some cases, enlarged liver may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include:

  • Adverse drug reactions such as acetaminophen toxicity

  • Blood infections

  • Hepatocellular carcinoma (liver cancer)

  • Injury to the liver or bile-draining tubes

  • Leukemia (cancer of the blood or bone marrow)

  • Liver metastases (spread of cancer to the liver from other parts of the body)

  • Lymphomas (cancers of the lymph system)

  • Reye’s syndrome (rare, serious illness that occurs following a viral infection)

Questions for diagnosing the cause of enlarged liver

To diagnose your condition, your doctor or licensed health care practitioner will ask you several questions related to your enlarged liver including:

  • Have you noticed a feeling of fullness or lump in your abdomen?

  • Have you experienced any abdominal pain?

  • Have you had any vomiting or vomiting of blood?

  • Have you had any unusually colored stools?

  • Have you had a fever or chills?

  • How much alcohol do you drink? Have you noticed any increased pain after drinking alcohol?

  • Have you seen changes in your skin? A change in color? New blood vessels? Any itching?

  • What medications do you take?

  • Have you had any other symptoms?

What are the potential complications of enlarged liver?

Because enlarged liver can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including:

  • Cirrhosis (scarring of the liver that causes severe dysfunction)

  • Hepatic encephalopathy (brain disorder caused by liver disease)

  • Hepatocellular carcinoma (Liver cancer)

  • Liver failure

  • Portal hypertension (increased blood pressure in the veins around the liver, stomach and esophagus)

  • Spread of cancer

  • Spread of infection

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Dec 22
  1. Hepatomegaly. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/003275.htm.
  2. Hepatitis. American Gastroenterological Association. http://www.gastro.org/patient-center/digestive-conditions/hepatitis.
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