Your liver, the large football-shaped organ in your upper right abdomen, is key to the healthy functioning of your body. The liver cleans and purifies your blood and gets rid of harmful chemicals made by your body that enter the bloodstream. In addition, the liver makes bile, which helps you break down fat from food, and also stores sugar (glucose), which can give you a needed energy boost. An enlarged liver, also known as hepatomegaly, is not a disease itself, but is a symptom of an underlying medical condition such as alcoholism, viral infection (hepatitis), metabolic disorder, cancer, gallstones, and certain heart problems. To determine whether your liver is enlarged, you must recognize the signs and symptoms, get a professional diagnosis, and be aware of the risk factors.
Recognizing the Signs and Symptoms
1. Be aware of jaundice symptoms. Jaundice is a yellow pigmentation of the skin, mucus, and whites of the eyes caused by excess bilirubin, a yellowish-orange pigment found in liver bile, in your blood stream. Because a healthy liver usually eliminates excess bilirubin, its presence indicates a liver problem.
2. Look for abdominal swelling (distention) or pain. Abdominal swelling, if you are not pregnant, usually indicates an accumulation of fat, fluid, or feces, or the presence of a tumor, cyst, fibroids, or other enlargement of an organ such as the liver or spleen.
3. Recognize general symptoms that could indicate an enlarged liver. Fever, loss of appetite, nausea, vomiting, and weight loss are symptoms that are not specific to liver enlargement, but can be a sign of liver disease and enlargement if they are severe, prolonged, or unexpected.
4. Look for fatigue. When you experience fatigue, you feel tired after exerting only a little effort. This can occur when the liver’s reserve of nutrients is damaged, and the body depletes its muscles of their nutrients as an alternative energy source.
5. Notice increased itching. When the liver is impaired, you may experience pruritus (itchy skin) that may be either localized or generalized. This condition happens when the liver biliary ducts are obstructed. As a result, bile salts that have been excreted into your bloodstream deposit themselves in your skin and causing an itching sensation.
6. Recognize spider angiomas. Spider angiomas (or spider nevi) are dilated blood vessels that spread out from a central red dot and look like spider webs. These veins often form on the face, neck, hands, and upper half of the chest and are a classic sign of liver disease and hepatitis.
Getting a Professional Diagnosis
1. Make an appointment with your primary health care provider. At the beginning of the appointment, your doctor will want to do a complete medical history with you. It's important to be forthcoming and honest with your provider.
2. Get a physical examination. A clinical physical examination is the first step to diagnosing an enlarged liver. Your physician will begin by examining your skin for jaundice and spider angiomas if you have not already reported these as symptoms. He may then examine your liver by feeling your stomach with his hand.
3. Use percussion to assess the state of your liver. Percussion is a method to assess the size of the liver and to make sure that the liver does not exceed the boundaries of the right costal margin (the rib cage), which is the liver's protective barrier.
4. Try palpation to determine liver shape and consistency. Your doctor will also use palpation to determine whether your liver is enlarged. Palpation, like percussion, uses the touch and pressure provided by your hands.
5. Get blood tests. Your doctor will likely want to have a sample of your blood drawn in order to assess your liver’s function and health. Blood tests are usually used to identify the possible presence of a viral infection such as hepatitis.
6. Get imaging testing. Imaging tests such as ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) scans are often recommended to confirm the diagnosis and assess the anatomy of the liver and its surrounding tissues. These tests can provide specific information to your doctor who can then make an informed assessment of your liver's condition.
7. Undergo an Endoscopic-Retrograde Cholangiopancreatography (ERCP). This is a scope that looks for problems in the bile ducts, the tubes that carry bile from the liver to your gallbladder and small intestine.
8. Look into getting a liver biopsy. As a general rule, an enlarged liver and any liver diseases or conditions can be diagnosed successfully through a medical history, physical examination, blood tests, and, finally, imaging tests. A biopsy, however, can be recommended in certain situations, particularly if the diagnosis is unclear or if cancer is suspected.
9. Get a magnetic resonance elastography (MRE).