Enlarged Liver (Hepatomegaly): Causes, Symptoms & What to Expect

Hepatomegaly (liver >15.5 cm in midclavicular line or palpable >2 cm below costal margin) is a sign, not a disease. It reflects underlying pathology.

Major Etiologic Categories

Category	Examples
Infiltrative/Storage	Fatty liver (NAFLD/ALD), glycogen storage diseases, amyloidosis, sarcoidosis, hemochromatosis
Inflammatory	Viral hepatitis (A/B/C/E), autoimmune hepatitis, alcoholic hepatitis, drug-induced liver injury (DILI)
Congestive	Right heart failure, constrictive pericarditis, tricuspid regurgitation, Budd-Chiari syndrome
Neoplastic	HCC, metastases (colon, breast, lung, melanoma), lymphoma, hepatic adenoma
Infectious	Pyogenic abscess, amebic abscess, hydatid cyst, TB, malaria
Vascular	Portal vein thrombosis, hepatic artery aneurysm

Symptoms

Often asymptomatic early. With significant enlargement: RUQ fullness/discomfort, early satiety, nausea. Signs of liver dysfunction (jaundice, ascites, encephalopathy, coagulopathy) reflect the underlying disease, not size alone.

Evaluation

• LFTs (AST, ALT, ALP, GGT, bilirubin, albumin, INR).
• Viral serologies, autoimmune panel, iron studies, ceruloplasmin, α1-antitrypsin.
• Imaging: US (first-line), CT/MRI for characterization.
• Biopsy if etiology unclear after non-invasive workup.

Key Takeaway

Hepatomegaly is a clinical sign prompting investigation for metabolic, inflammatory, congestive, neoplastic, or infectious etiologies. Treatment targets the underlying cause.