A larger-than-normal liver may be a sign of a wide range of diseases. Although diseases of the liver itself often cause an enlarged liver, there are many other possible causes, including:
- Bacteria, viruses and parasites
- Certain heart conditions
- Several genetic diseases
- Some types of leukemia and lymphoma
The liver, a wedge-shaped organ on the right side of your upper abdomen, is the largest internal organ. An adult liver normally weighs between 2.6 and 3.3 pounds (1.2 to 1.5 kg) and measures an average of 5.9 inches (15 cm) in width.
It's very unusual to have an enlarged liver without other signs and symptoms that point to an underlying disease.
In itself, an enlarged liver typically has no symptoms.
Signs and symptoms of conditions that commonly cause liver enlargement include:
- Pain in the upper right belly
- Muscle aches (myalgia)
- Poor appetite and weight loss
- Yellowing of the skin and the whites of the eyes (jaundice)
When to see a doctor
Make an appointment with your doctor if you have any symptoms that worry you.
Among the most common causes of liver enlargement are:
- Alcoholic liver disease, which includes alcoholic fatty liver disease, alcoholic hepatitis and cirrhosis
- Nonalcoholic fatty liver disease, a lifestyle-related metabolic disease
- Viral hepatitis (hepatitis A, B, C, D or E )
- Liver cancer, or cancer that has spread to the liver from a different organ
Many less-common liver diseases may also cause liver enlargement, as do some diseases that primarily affect other organs but involve the liver indirectly. A partial list includes:
- Some types of leukemia
- Some types of lymphoma
- Multiple myeloma
- Wilson's disease
- Glycogen storage diseases
- Gaucher's disease
Heart and blood vessel problems
- Blockage of the veins that drain the liver (Budd-Chiari syndrome)
- Congestive heart failure
- Narrowing (stenosis) of the heart’s tricuspid or mitral valves
- Liver abscess, caused by parasites (amebiasis) or bacteria
- Other parasitic infections (schistosomiasis, fascioliasis)
- Relapsing fever, which humans catch from body lice or ticks
Damage from toxins
- Drug-induced liver injury from such medications as acetaminophen (Tylenol, others) and amoxicillin-clavulanate (Augmentin, Amoclans)
- Toxic hepatitis from exposure to poisons, such as the industrial chemicals carbon tetrachloride and chloroform
Complex liver and systemic diseases
- Autoimmune hepatitis
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
Factors that may increase your risk of liver problems include:
- Excessive alcohol use. Drinking large amounts of alcohol can be damaging to your liver.
- Large doses of medicines, vitamins or supplements. Taking larger than recommended doses of vitamins, supplements, or over-the-counter or prescription medicines may increase your risk of liver damage.
- Medicinal herbs. Certain herbs, including comfrey, ma huang and mistletoe, can increase your risk of liver damage.
Preparing for your appointment
If you have any signs or symptoms that worry you, visit your primary care doctor. If your doctor suspects that you have a condition involving your liver, you may need additional tests and referral to a liver specialist (hepatologist).
Because appointments can be brief, and there's a lot of ground to cover, it's a good idea to be prepared.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements that you're taking.
- Take a family member or friend along. Sometimes it can be difficult to remember all of the information provided during an appointment. Someone who accompanies you may recall something that you missed or forgot.
It's also helpful to write down questions you may want to ask your doctor. Possible questions:
- How are my symptoms related to my enlarged liver?
- Is the cause of my enlarged liver more likely to be a primary liver disease or the result of a disease originating in another organ?
- What kinds of tests do I need?
- Is my condition temporary or long lasting?
- What treatments are available?
- Could liver enlargement be related to other medical conditions I have, or to medications I take for those conditions?
- Should I see a specialist?
- Will I need follow-up visits?
What to expect from your doctor
Your doctor is likely to ask questions about your past and current use of alcohol and drugs, as well as your sexual history. For a correct diagnosis, it’s important that you answer these questions honestly. Be sure to report recent illnesses and overseas travel as well. Other questions may focus on your eating and exercise habits.
Tests and diagnosis
An enlarged liver may go unnoticed for a long time. Frequently, liver enlargement isn't discovered until you see a doctor for more-obvious signs and symptoms of the condition responsible for your enlarged liver.
As part of the physical examination for possible liver disease, doctors use their fingertips to press on the right side of your belly just below your rib cage and feel (palpate) the lower edge of your liver, noting its size, texture, and tenderness. Depending on the underlying cause, an enlarged liver may feel soft, firm or irregular. Well-defined lumps may be present as well.
This exam provides only a very rough estimate of liver size, though. For a precise measurement, you'll need imaging, typically starting with an abdominal ultrasound. If there's a need for more-detailed images, you may also have a computerized tomography (CT) scan or magnetic resonance imaging (MRI).
Once your doctor determines that you have an enlarged liver, further tests help determine the cause. These tests include:
- Blood tests. A blood sample is tested to determine liver enzyme levels. This can give clues about the health of your liver. Blood tests can also identify viruses that can cause enlarged liver, such as the hepatitis viruses.
- Magnetic resonance elastography uses shear waves to create a visual map (elastogram) of the stiffness of liver tissue. This test is noninvasive and can be an alternative to a liver biopsy.
- Removing a sample of liver tissue for testing (liver biopsy). Your doctor may recommend a biopsy to collect a sample of liver tissue for laboratory testing. A liver biopsy is often done using a long, thin needle that's inserted through your skin and into your liver. The needle draws out a core of tissue that is then sent to a laboratory for testing. Your doctor may use ultrasound to help guide the biopsy.
Treatments and drugs
Treatment for an enlarged liver varies, depending on condition that's causing it. Some of the most common causes, including alcoholic hepatitis and nonalcoholic fatty liver disease, improve dramatically with alcohol abstinence, a healthy diet, regular exercise and weight loss.
To reduce your risk of liver disease, you can:
- Choose a healthy diet. Choose a diet full of fruits, vegetables and whole grains.
- Drink alcohol in moderation, if at all. Check with your doctor to find out what's the right amount of alcohol for you, if any.
- Follow directions when taking medications, vitamins or supplements. Limit yourself to the recommended doses when taking vitamins, supplements, and over-the-counter or prescription medications.
- Limit contact with chemicals. Use aerosol cleaners, insecticides and other toxic chemicals only in well-ventilated areas. In addition, wear gloves, long sleeves and a mask.
- Maintain a healthy weight. If your weight is healthy, work to maintain it. If you need to lose weight, cut back on the number of calories you eat each day and increase the amount of daily exercise. Ask your doctor about healthy ways to lose weight.
- Use supplements with caution. Talk with your doctor about the risks and benefits of dietary supplements and herbal remedies before you take them. Many of these products can be harmful to your liver, particularly those containing combinations of ingredients and marketed for body-building or weight loss. Specific herbs to avoid include germander, chaparral, senna, mistletoe, comfrey, ma huang, valerian root, kava, celandine and green tea extracts.