The liver, a large soccer ball-shaped organ in the right upper abdomen, is key to healthy body functions. The liver cleans and filters the blood and removes harmful chemicals produced by the body that enter the bloodstream. In addition, the liver produces bile, which helps break down fat from food and stores sugar (glucose) to provide additional energy for the body. An enlarged liver, or hepatomegaly, is not really a disease, but a symptom of certain medical conditions such as alcoholism, viral infections (hepatitis), metabolic disorders, cancer, gallstones, and some heart diseases. To determine if your liver is enlarged, you must know the signs and symptoms, seek a professional diagnosis, and be aware of the risk factors.
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Part 1 of 3: Recognizing the Signs and Symptoms
Step 1. Recognize the symptoms of jaundice
This pain is characterized by yellowing of the skin, mucus, and the whites of the eyes – caused by excess production of bilirubin. Bilirubin is an orange-yellow pigment found in bile, in the bloodstream in your body. Since a healthy liver usually gets rid of excess bilirubin, this means its presence indicates a liver problem.
The symptoms of jaundice usually appear when the liver is severely compromised. Make sure you seek medical attention immediately if you experience this
Step 2. Look for pain or swelling in the abdomen
If you're not pregnant, a swollen belly usually indicates an accumulation of fat, fluid, or feces, or the presence of an enlarged tumor, cyst, fibroid, or other organ, such as the liver or spleen. In some cases, you may even look as if you're eight months pregnant – even though you're not. Many causes of abdominal swelling indicate a medical condition that should be checked by a doctor.
- When it is fluid accumulation, this is called ascites and is a common symptom of an enlarged liver.
- This swelling of the stomach will often decrease your appetite because you feel too "full" to eat. This symptom is called “early satiety”. You may also completely lose your appetite due to a swollen stomach.
- You may also experience calf swelling.
- Abdominal pain can also be a sign of an enlarged liver, especially if you have other symptoms.
Step 3. Recognize the common symptoms that could indicate an enlarged liver
Fever, loss of appetite, nausea, vomiting, and weight loss are non-specific symptoms of an enlarged liver, but may indicate liver disease and enlargement if these signs are severe, prolonged, or occur suddenly.
- Lack of appetite or reluctance to eat can also accompany abdominal swelling – as mentioned above. Or, this condition can also show symptoms of gallbladder disease (people with gallbladder pain usually don't want to eat because it will cause pain). Sometimes, cancer and hepatitis can also cause an aversion to eating.
- Doctors usually assume significant weight loss is more than 10% of body weight. If you're not trying to lose weight but are experiencing it, call your doctor.
- Fever is a symptom of inflammation in the body. Since an enlarged liver can be caused by an infection such as hepatitis, it's important to recognize and treat a fever as soon as it occurs.
- Stools that are pale, light gray or even white in color, can also indicate liver problems.
Step 4. Find out if you tire easily
When you experience it, you will quickly feel tired after just a little activity. This can happen when the nutrients in the liver are damaged, and the body burns muscle tissue as nutrients for alternative energy sources.
Fatigue can indicate the presence of liver problems, and swelling can be another symptom that follows. Viral hepatitis and cancer can also cause fatigue
Step 5. Watch for itching that gets worse
When your liver is compromised, you may develop pruritus (itchy skin). Pruritus can be localized or generalized. This condition can occur when the bile ducts in the liver are blocked. As a result, bile salts that have been released into the bloodstream collect on the skin and cause itching.
Although treatment of itching requires you to investigate and treat the triggering condition, you can also relieve this feeling by using medications, including Atarax (take one tablet at a dose of 25 mg every six hours as needed) and Benadryl (25 mg every six hours). hours as needed). If your itching is severe or unbearable, use a sedative, such as Ativan (10 mg tablet) to help you fall asleep even if you feel uncomfortable
Step 6. Look for the symptoms of a spider angioma
This condition, or sometimes referred to as spider nevi, are enlarged blood vessels that spread from a central red dot and look like a spider's web. Enlarged veins usually occur on the face, neck, hands, and upper half of the chest and are a sign of liver disease/hepatitis.
- Cases of spider nevi that only occur at one point are usually nothing to worry about. However, if you experience other health conditions or symptoms, such as fatigue, weakness, swelling or signs of jaundice, see your doctor as you may have liver problems. In addition, if spider nevi occur in several places, also see a doctor because this indicates that something is wrong with your liver.
- Spider angiomas vary in size, up to 5 mm in diameter.
- If you press hard enough with your finger, the red color in this state will disappear for a few seconds and turn white because the blood will be blocked.
Part 2 of 3: Request a Professional Diagnosis
Step 1. Make an appointment with your health care provider
At the beginning of the appointment, the doctor will ask for a medical track record. Be honest and tell him everything that happened.
- Be aware that some of the questions your doctor will ask will be quite personal and involve substance use, alcohol consumption, and sexual partners. However, the answers you give are very important to your diagnosis. Tell what is clearly.
- Also tell your doctor about all medications or supplements you are taking, including vitamins and herbal medicines.
Step 2. Request a physical examination
A clinical physical examination is the first step in diagnosing an enlarged liver. Your doctor will start by checking for signs of jaundice and spider angiomas if you haven't reported any of these symptoms. He or she may then examine your liver by feeling your abdomen.
An enlarged liver may feel awkward, flabby, or firm, and may or may not be bulging, depending on the cause. This type of test can determine the size and texture of the level to check the degree of enlargement of the liver. The doctor will use two methods of physical examination: percussion test and palpation
Step 3. Use percussion to check the condition of the liver
Percussion is a method of checking the size of the liver and making sure it doesn't cross the boundaries of the proper costal margin (ribs), which is its protective barrier. This method works by exploring the internal organs of the body through the analysis of the sound produced. The doctor will perform this examination by tapping the surface of the body and listening to the sound. If he hears a low sound that lasts more than 2.5 cm below the ribs, your liver may be enlarged. Be aware that if you have abdominal distention, this test will not be accurate and you may need to have an abdominal ultrasound.
- If your doctor is right-handed, he or she will place his left hand on your chest and press his middle finger against the chest wall. With the middle finger of his right hand, he will tap the halfway point on the middle finger of his left hand. This movement should start from the wrist (as when playing the piano).
- Starting from below the chest, percussion will produce a tympanic drum sound. This is because your lungs are in that location and fill with air.
- The doctor will move down slowly in a straight line over the liver to look for when the drum tympanic sound changes to a "thump" sound. This sound indicates that the doctor has finished examining the liver. He will continue to look for and pay attention to the sound as he approaches the area at the end of the costal margin (ribs) to see if he hears the same sound, and, if so, how far away. The doctor will stop when this sound changes to various bowel sounds (eg gas and indigestion).
- He will calculate the distance (in centimeters) from the liver to the costal margin. This is usually a sign of disease, as our ribs are meant to protect important internal organs, such as the liver and spleen. If your lungs are hyperinflated when normally healthy, your doctor may be able to feel the edges of your liver.
Step 4. Try the palpation method to determine the shape and consistency of the liver
Your doctor will also use palpation to determine if your liver is enlarged. Palpation, like the percussion method, uses touch and hand pressure.
- If your doctor is right-handed, he or she will place his left hand on your right side. Inhale deeply and exhale slowly as he tries to “catch” the lever between his hands. He will use the tips of his fingers to feel the liver at the edge and underside of the rib cage. The doctor will study important details such as shape, consistency, surface texture, softness, and sharpness of the boundaries.
- The doctor will feel for rough, unusual, or bulging surface texture of the liver and determine whether your liver is hard or not. He will also ask if you feel rejected when he presses.
Step 5. Take a blood test
Your doctor may want to take a sample of your blood to check the function and health of your liver. Blood tests are usually used to determine the presence of a viral infection such as hepatitis.
A blood sample will also show the level of enzymes in the liver, which can provide important information about their health and function. Other blood tests may also be needed, including a blood cell count test, a hepatitis virus test, and a blood clotting test. The latter two tests are especially useful for checking liver function because it is responsible for producing a protein that helps blood clot
Step 6. Take the picture test
Imaging tests such as ultrasound, computed tomography (CT) and magnetic resonance imaging MRI are usually recommended to confirm the diagnosis and examine the anatomy of the liver and surrounding tissues. These tests can provide specific information for your doctor to make an accurate analysis of the condition of your liver.
- Abdominal Ultrasound – In this test, you will lie down. Then, an instrument will be held and moved over the abdomen. This device emits high-frequency sound waves that bounce off the body's organs and are received by the computer. This message is then translated as an image of the internal organs of the stomach. Your doctor will tell you what to prepare for the test, but generally you shouldn't eat or drink before the test.
- Abdominal CT scan - A CT scan involves using x-rays to create cross-sectional images around the abdominal region. You will have to lie on a narrow table that is inserted into the CT machine and remain still while the x-ray is run and around your body. The results are translated into images in the computer. Your doctor will tell you how to prepare for this test. Because CT tests sometimes involve a special dye being injected into your body (either by injection or by mouth), you may not be able to drink or eat beforehand.
- MRI abdominal scan – This test involves magnets and radio waves to produce pictures of the inside of the abdomen instead of radiation (x-rays). You have to lie down on a narrow table that will be inserted into a large, tunnel-like scanner. To clarify the appearance of organs on a scan, this test may use a dye. If you need it, the doctor will tell you in advance. As with other tests, you may be asked not to eat or drink beforehand.
Step 7. Follow the Endoscopic-Retrograde Cholangiopancreatography (ERCP) examination
This test is done with an instrument that looks for problems in the bile duct, which is the tube that transfers bile from the liver to the gallbladder and small intestine.
- In this test, an IV injection is placed in your arm and you will be given something to relax you. Then, the doctor will insert the endoscope through the mouth into the esophagus and stomach until it reaches the small intestine (the closest part of the stomach). He or she will insert a catheter through the endoscope into the bile duct that connects the pancreas and gallbladder. Then, the doctor will inject dye into this canal, so that he can see all the problems more clearly. The final step is usually an x-ray examination.
- This test is usually run after imaging tests, including ultrasound, CT, or MRI scans.
- Just like the other tests that have been mentioned, the doctor will tell you the procedure and what to expect. You must give permission for the ECRP check and not eat or drink in the previous four hours.
- ERCP can be a good option because doctors can also use it to facilitate treatment. For example, if there are stones or other obstructions in the bile duct, the doctor may remove them while performing an ERCP examination.
Step 8. Try considering a liver biopsy
As a general rule, an enlarged liver and any disease or condition can be diagnosed successfully through a history, physical examination, blood tests, and imaging tests. However, a biopsy may also be recommended in certain situations, especially if the diagnosis is unclear or you have possible cancer.
The biopsy procedure involves using a long, thin needle inserted into the liver to collect a sample of its tissue. This is usually done by a liver specialist (gastroenterologist or hepatologist). Due to the invasive nature of the test, you will be given local or general anaesthesia. The results of the sample are then sent to a laboratory for further examination, especially to determine whether there are cancer cells
Step 9. Follow a magnetic resonance elastography (MRE) examination
This new imaging technique combines MRI with sound waves to construct a visual map (elastograph). This map will be useful for checking the level of tension in the body's tissues, in this case your liver. Hardening of the liver is a symptom of chronic disease and can be detected by the MRE method. This test is non-invasive and can be an alternative to biopsy.
MRE is a new but rapidly developing technology. This technology is only offered at a few health centers but its popularity is on the rise. Talk to your doctor to see if this option is right for you
Part 3 of 3: Beware of the Risk Factors
Step 1. Determine the risk for hepatitis
Hepatitis A, B, and C cause inflammation and can result in an enlarged liver – which is also characterized by soft, tender edges. If you have any attack of hepatitis, you are at a higher risk of developing an enlarged liver.
Liver damage is caused by immune cells and blood flooding the liver to fight hepatitis infection
Step 2. Consider whether you have right-sided heart failure
Heart failure like this can lead to an enlarged liver, also with the edges turning soft and tender.
This occurs because blood collects in the liver, which is caused by the inefficient pumping of the heart. Because the heart is not doing its job, blood returns to the liver
Step 3. Learn about the risk of cirrhosis
Cirrhosis is a chronic disease that increases the density of the liver, as a result of fibrosis (excess production of scar tissue). Cirrhosis usually occurs as a result of poor lifestyle choices and affects the liver negatively, such as alcohol abuse.
Cirrhosis can cause enlargement or shrinkage of the liver, although it is more commonly associated with enlargement
Step 4. Consider any metabolic or genetic conditions you have
People with certain gene or metabolic conditions, such as Wilson's disease and Gaucher's disease are at higher risk of developing an enlarged liver.
Step 5. Understand the risk of cancer
People with cancer may experience an enlarged liver due to its spread (metastasis) to the liver. If you are diagnosed with cancer, especially cancer of organs near the liver, you are at a higher risk of developing an enlarged liver.
Step 6. Be careful of excess alcohol use
Chronic alcohol consumption (more than a few drinks a week) can damage the liver and hinder its regeneration. These two effects can then lead to irreversible structural and functional damage.
- When the liver loses its function due to alcohol consumption, it can enlarge and swell due to its reduced capacity to absorb fluids. You may also experience fat build-up in your liver if you drink too much alcohol.
- In the US, The National Institute on Alcohol Abuse and Alcoholism defines a "moderate" drinking style of no more than 1 alcoholic drink a day for women, and no more than 2 alcoholic drinks a day for men.
Step 7. Consider your medication consumption
Many over-the-counter medications can damage the liver if used for a prolonged period of time or in excess of recommended doses. The drugs most harmful to the liver include oral contraceptives, anabolic steroids, diclofenac, amiodarone, and statins.
- If you are on long-term medication, check yourself regularly and follow your doctor's advice obediently.
- Acetaminophen (Tylenol), especially when taken in excess, is a common cause of liver failure and enlargement. The risk is higher when acetaminophen is mixed with alcohol.
- Be aware that some herbal supplements, such as black cohosh, ma huang, and mistletoe, can also increase the chance of liver damage.
Step 8. Watch your intake of fatty foods
Regular consumption of fatty foods, including french fries, hamburgers, or other nutritious foods, can result in the accumulation of fat in the liver. This condition is called fatty liver. Fat accumulations will form, which will eventually destroy liver cells.
- A damaged liver will be disturbed and can swell because its ability to process blood and toxins is reduced, in addition to the accumulation of fat.
- Be aware that being overweight or obese increases your risk of liver disease. To find out, calculate your Body Mass Index (BMI), which is an indicator of the level of fat in your body. BMI is calculated by dividing a person's weight in kilograms (kg) by his height in meters squared. A BMI of 25-29.9 means that a person is overweight, while a BMI of more than 30 means that the subject is obese.
