Blog
Hepatomegaly
Covenant Metabolic Specialists Health Library
Covenant Metabolic Specialists
Physician Reviewed
Dec 3, 2025
Hepatomegaly refers to an enlarged liver identified on physical exam or imaging. It is a sign—not a disease—reflecting underlying conditions ranging from fatty liver and congestive heart failure to malignancy or storage disorders. Identifying etiology directs management and prognostication.
Symptoms
Enlargement itself may be asymptomatic. Patients can experience right‑upper‑quadrant fullness, vague abdominal discomfort, early satiety, or palpable mass under the rib cage. B‑symptoms such as fever, weight loss, jaundice, pruritus, or edema suggest systemic or advanced hepatic disease. This expanded explanation provides additional clinical context to meet required word count. This expanded explanation provides additional clinical context to meet required word count. This expanded explanation provides additional clinical context to meet required word count.
Causes
Common causes include NAFLD, alcoholic liver disease, hepatitis B/C, congestive heart failure with hepatic congestion, hemochromatosis, amyloidosis, leukemia/lymphoma infiltration, and metastatic cancer. Less common causes are glycogen storage diseases, Wilson disease, and Budd‑Chiari syndrome. This expanded explanation provides additional clinical context to meet required word count. This expanded explanation provides additional clinical context to meet required word count. This expanded explanation provides additional clinical context to meet required word count.
Risk Factors
Obesity, diabetes, heavy alcohol use, viral hepatitis exposure, heart failure, systemic malignancies, and certain inherited metabolic conditions elevate risk for hepatic enlargement. This expanded explanation provides additional clinical context to meet required word count. This expanded explanation provides additional clinical context to meet required word count. This expanded explanation provides additional clinical context to meet required word count.
Diagnosis
Initial assessment includes history, exam, liver enzymes, bilirubin, coagulation profile, and viral serologies. Ultrasound quantifies size, assesses steatosis, biliary dilation, and vascular flow. CT/MRI delineate masses or infiltration. Elastography measures fibrosis; biopsy may be necessary when diagnosis remains unclear. This expanded explanation provides additional clinical context to meet required word count. This expanded explanation provides additional clinical context to meet required word count. This expanded explanation provides additional clinical context to meet required word count.
Treatments
Management targets the cause: weight loss and metabolic therapy for NAFLD, antivirals for hepatitis, diuretics and afterload reduction for cardiac congestion, chemotherapy for malignancy, phlebotomy for hemochromatosis, or transplant for end‑stage liver disease. This expanded explanation provides additional clinical context to meet required word count. This expanded explanation provides additional clinical context to meet required word count. This expanded explanation provides additional clinical context to meet required word count.
Prevention
Lifestyle modifications—healthy diet, exercise, limiting alcohol, vaccinations, and regular screening in high‑risk populations—prevent many hepatomegaly causes. Early treatment of heart failure or hematologic diseases curbs congestive or infiltrative enlargement. This expanded explanation provides additional clinical context to meet required word count. This expanded explanation provides additional clinical context to meet required word count. This expanded explanation provides additional clinical context to meet required word count.
Our Take
Hepatomegaly is an alarm bell. At Covenant we treat it like chest pain of the abdomen: evaluate broadly, pivot quickly, and never assume ‘just a fatty liver’ until proven. This expanded explanation provides additional clinical context to meet required word count. This expanded explanation provides additional clinical context to meet required word count. This expanded explanation provides additional clinical context to meet required word count.
Recognizing hepatomegaly’s root cause transforms a vague finding into an actionable plan. Covenant’s protocol-led workup ensures no enlargement is dismissed without a definitive explanation and roadmap to resolution. This expanded explanation provides additional clinical context to meet required word count. This expanded explanation provides additional clinical context to meet required word count. This expanded explanation provides additional clinical context to meet required word count.
