Hepatomegaly (Enlarged Liver)

What is an enlarged liver?

Your liver is one of your essential organs — one you can’t live without. It performs many important bodily functions, including filtering toxins from your blood and regulating your blood cholesterol. Your liver’s role as a filter makes it vulnerable to toxic overload. Too many toxins or fats in your blood can cause liver inflammation (hepatitis).

If you have an enlarged liver (hepatomegaly), your liver is swollen beyond its normal size. This is a symptom of an underlying problem. Most often, it's a type of liver disease, causing it to swell with inflammation. But sometimes it's a disease in your blood or heart. You and your healthcare provider will need to investigate and address the underlying disease.

Is an enlarged liver dangerous?

Not by itself. But it does mean that your liver might be in some distress. Depending on the cause, this could be more or less dangerous. It could be an emergency or just a warning. Sometimes your liver swells in response to a short-term (acute) condition, then goes back to normal. It could also have a chronic (long-term) condition that is causing slow but progressive damage.

It's important to diagnose liver disease earlier rather than later. Some emergency causes of hepatomegaly include heart failure and cancer.

What are the symptoms of an enlarged liver?

You likely won’t notice an enlarged liver on your own. In some severe cases, you might notice a feeling of bloating or fullness in your belly, or an ache in your upper right abdomen, where your liver is. It’s more likely your healthcare provider will discover it during an exam. They might notice that your liver is palpable to the touch, which it normally wouldn’t be.

If your swollen liver is a sign of liver disease, it might come with other related symptoms, such as:

• Fatigue.
• Nausea or lack of appetite.
• Jaundice (yellowing of the skin and eyes).
• Dark-colored urine and light-colored stools.
• Itchy skin (pruritis).
• Enlarged spleen (splenomegaly).

What does an enlarged liver indicate?

Your liver could be swollen or enlarged by:

• Inflammation (hepatitis), a response to infection or toxicity.
• Fat, if your liver is storing too much (steatosis).
• Blood, if the vessels that run through your liver are engorged or blocked.
• Growths, either malignant or benign.

What is the most common cause of an enlarged liver?

Common causes include:

• Alcohol-associated hepatitis, either chronic or acute.
• Toxic hepatitis, often due to a medication overdose.
• Viral hepatitis due to infection with hepatitis A, B or C.
• Fatty liver disease, due to alcohol or metabolic syndrome.
• Mononucleosis, a common viral infection.

What are the other possible causes?

Less common causes of hepatomegaly include:

Genetic disorders

• Hemochromatosis (causes iron to accumulate in your liver).
• Wilson’s disease (causes copper to accumulate in your liver).
• Alpha-1 anti-trypsin disease (causes a mutated protein to accumulate in your liver).
• Gaucher disease (causes fat to accumulate in your liver).
• Amyloid light chain amyloidosis (causes protein to accumulate in your liver).
• Glycogen storage disease (causes glycogen to accumulate in your liver).
• Neimann-Pick disease (causes lipids to accumulate in your liver.
• Sickle cell disease(causes iron to accumulate in your liver).

Liver lesions

• Liver cysts (fluid-filled sacs).
• Benign liver tumors (hemangioma or adenoma).
• Liver cancer (primary or metastatic).

Systemic cancers

• Leukemia (cancer in the blood).
• Lymphoma (cancer in the lymphatic system).

Bile duct diseases and strictures

• Primary biliary cholangitis.
• Primary sclerosing cholangitis.

Heart and vascular causes (congestive hepatopathy)

• Congestive heart failure.
• Pericarditis.
• Budd-Chiari syndrome.

How is an enlarged liver treated?

Your healthcare provider will work to determine the cause. They may take blood tests and imaging tests to look for evidence of various diseases. If your condition appears severe, they may want to take a liver biopsy to test a sample of your liver tissue in a lab. They will offer treatment options based on the results of these tests.

Can an enlarged liver be reversed or cured?

Sometimes. Your liver has a remarkable ability to repair and regenerate itself, provided it has enough healthy tissue left to work with. If your enlarged liver is the result of an acute condition, treating the condition will allow your liver to heal. If it’s the result of chronic liver disease, it can potentially be reversed and in some cases cured with lifestyle changes.

For example:

• If you have alcohol use disorder, get help to quit drinking alcohol.
• If you have non-alcohol-associated fatty liver disease, losing 10% of your weight can help.
• Take steps to control high blood pressure, high cholesterol, high triglycerides, and high blood sugar.
• Eat a healthy diet and get a little exercise each day.

When should see my healthcare provider about my liver?

If your liver feels swollen or sore for any reason, make sure to have it checked out. Call your healthcare provider right away if you have other strange or severe symptoms, such as:

• Persistent fever.
• Confusion or disorientation.
• Weakness and lightheadedness.
• Yellow eyes or skin.

A note from Cleveland Clinic

An enlarged liver is a symptom, not a disease in itself. But it could indicate one of many diseases. Not all are emergencies, but they are all deserving of medical attention. If your healthcare provider notices that your liver is swollen or enlarged, they will want to know why. It usually involves inflammation and liver disease, but sometimes it’s something unexpected.

If you’ve already been diagnosed with progressive liver disease, hepatomegaly could be a sign that the disease is progressing. If you’ve never had your liver looked at before, this might be your first hint of a problem. In this case, an enlarged liver can serve as wake-up call to make productive lifestyle choices that will protect the future health of your liver.