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HEPATOMEGALY

Overview - Refers to the enlargement of the liver - Indicates potentially reversible primary or secondary liver disease - Maybe confirmed by palpation, percussion, or radiologic tests Assessment History - Ask about alcohol use - Determine exposure to hepatitis - Obtain a drug history - Ask about the location and description of any associated abdominal pain. Physical assessment - Inspect the skin and sclerae for jaundice, dilated vein, scars from previous surgery, and spider angiomas - Inspect the contour of the abdomen and measure abdominal girth - Percuss the liver - During deep inspiration, palpate the liver's edge - Take vital signs - Assess nutritional status - Evaluate level of consciousness - Watch for personality changes, irritability, agitation, memory loss, inability to concentrate, poor mentation, and coma - in a severely ill patient Medical causes Cirrhosis - In late cirrhosis,liver becomes enlarged, modular, and hard - Other late findings affect all body system and include jaundice and abdominal distention Diabetes mellitus - Hepatomegaly, and right upper quadrant tenderness along with polydipsia, polyphagia, and polyuria may occur in overweight patients with poorly controlled diabetes Heart failure

- Hepatomegaly occurs along with jugular vein distention, cyanosis, nocturia, dependent edema of the legs and sacrum, steady weight gain, confusion, and possibly nausea, vomiting, abdominal discomfort, and anorexia - Massive right sided failure may cause anasarca, oliguria,, severe weakness, and anxiety - If left sided failure precedes right sided failure, findings include dyspnea, orthopnea, paroxysmal nocturnal dyspnea, tachypnea, arrhythmias, tachycardia, and fatigue

Hepatitis - Hepatomegaly occurs in the icteric phase and continues during the recovery phase - Early findings include nausea, vomiting, fatigue, malaise, photophobia, sore throat, cough, and headache - Other findings of the icteric phase include liver tenderness, slight weight loss, dark urine, clay colored stools, jaundice, pruritus, right upper quadrant pain, and splenomegaly Leukemia and lymphomas - Moderate to massive Hepatomegaly, splenomegaly, and abdominal discomfort are common - General findings include malaise, low grade fever,fatigue, weakness, tachycardia, weight loss, bleeding disorders, and anorexia Liver cancer - Primary rumors cause irregular, nodular, firm hepatomegaly, with pain or tenderness in the right upper quadrant and a friction rub or bruit over the liver - Other findings include weight loss, anorexia, cachexia, nausea, vomiting, peripheral edema, ascites, jaundice, and a palpable right upper quadrant mass - Metastatic liver rumors cause hepatomegaly, but accompanying signs and symptoms reflect the primary cancer Mononucleosis ( infectious ) - Hepatomegaly may occur - Prodromal symptoms include headache, malaise, and fatigue - After 3-5 days findings include sore throat, cervical lymphadenopathy, temperature fluctuations, stomatitis, palatal petehiae, periorbital edema, splenomegaly, exudative tonsillitis, pharyngitis, and a maculopapular rash Obesity - Hepatomegaly may occur along with respiratory difficulties, cardiovascular disease, diabetes, renal disease, gallbladder disease, and psychological difficulties Pancreatic cancer

- Hepatomegaly accompanies anorexia, weight loss, abdominal or back pain, and jaundice - Other findings include nausea, vomiting, fever, fatigue, weakness, pruritus, and skin lesions

Diagnosis A suspicion of hepatomegaly indicates a thorough medical history and physical examination, wherein the latter typically includes an increased liver span. Blood tests should be done, importantly liver-function series, which will give a good impression of the patient's broad metabolic picture. An ultrasound of the liver can reliably detect a dilated biliary-duct system, which helps distinguish parenchymal liver disease from extrahepatic bile-duct obstruction. Ultrasound can also detect the characteristic texture of a cirrhotic liver, and can guide fineneedle aspiration of cysts, abscesses and tumours. Computed tomography (CT) can help obtain more accurate anatomical information, and is unaffected by obesity or the presence of bowel gases.

TREATMENT AND PREVENTION OF HEPATOMEGALY Homeopathic Treatment of Enlarged Liver Homeopathic remedies improve the functioning of the liver and prevent further damage to the liver. Homeopathic medicines neutralize toxins and acts as a liver-friendly anti-oxidant, vitamin and mineral supplement. Some of the remedies are: Bryonia Mercurius Podophyllum Conventional / Allopathic Treatment of Enlarged Liver In allopathic medicine, effective drug treatment of liver disease is very limited, and is often restricted to treating the symptoms and preventing the complications. Surgical Treatment of Enlarged Liver In some cases, surgical reversal of intestinal bypass for obesity is required. Dietary & Herbal Treatment of Enlarged Liver Eat fruits and vegetables Avoid refined carbohydrates Avoid junk food Avoid sugar-sweetened drinks Drink raw fruit and vegetable juices Prevention of hepatomegaly relies on reducing risk factors that may contribute to this condition. Stop smoking, reducing alcohol consumption, practicing safe sex, avoiding exposure to hazardous chemicals, avoiding injuries to the liver, controlling diabetes, identifying congenital conditions, protecting oneself against contagious viruses such as hepatitis and infectious mononucleosis are risk factors that depend on patients. Eliminating these risk factors may prevent conditions of the liver such as hepatomegaly.

For the most part, an enlarged liver is a symptom of another resulting condition. Preventing a swollen liver is not 100 percent effective. If preventative measures are taken, then the risk of developing is significantly reduced. However, no individual is immune to liver conditions and at any time an unexpected conditions and diseases may occur without any warning signs.

REMEDIOS TRINIDAD ROMUALDES MEDICAL FOUNDATION COLLEGE of MEDICINE

Written Output HEPATOMEGALY Medicine 1

Prepared by: Acosta, Carl Francis Amac, Osee Bryce Balonga, Aileen May Barreda, Maria Prescilla Capungcol, Marc Steven Chavez, Glenn De la Cruz, Katherine Dico, Rubielyn Evangelista, Anthony Firmo, Art Rainier Gorres, Sheryl Jaro, Julie Ann Labajosa, Paul Vincent Lominoque, Andreu Leo

Mendoza, Angela Nebrija, Avelino Odita, Rhica Cyrae Prada, Ma. Lourdes Santos, Rosa Labatos, Mae Joy Vilches, Philip Michael