Normally, an adult liver is about the size of a small football. Sometimes, however, the liver becomes enlarged. This is known as enlarged liver, or hepatomegaly (hep-uh-to-MEG-uh-le).

Enlarged liver isn't a disease. It's a sign of an underlying problem, such as hepatitis, congestive heart failure or cancer. Treatment of an enlarged liver depends on the cause.

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Enlarged liver

Often no signs or symptoms
An enlarged liver often causes no signs or symptoms.

Possible signs and symptoms

• Tenderness. If the liver enlarges quickly, it may be tender to the touch.
• Pain. A markedly enlarged liver may cause abdominal pain or fullness.
• Jaundice. If the cause of enlargement affects liver function, it may lead to yellowing of the skin (jaundice).

Many conditions may cause an enlarged liver, including:

• Alcohol abuse. Abusing alcohol may cause an enlarged liver.
• Nonalcoholic fatty liver disease. This includes a range of conditions — such as fat accumulation in the liver followed by inflammation of the liver and the formation of fibrous tissue in the liver — which can affect people who drink little or no alcohol. 
• Hepatitis. Hepatitis A, hepatitis B and hepatitis C are all contagious viral infections that affect your liver.
• Heart failure. Also called congestive heart failure, this condition means your heart can't pump enough blood to meet your body's needs.
• Liver cancer. Cancer of the liver is often metastatic cancer, which occurs when tumors from other parts of the body spread (metastasize) to the liver.
• Infections such as mononucleosis. Mononucleosis (mono) is an infection with the Epstein-Barr virus.
• Excessive iron in the body (hemochromatosis). This condition causes your body to absorb too much iron from the food you eat. The excess is stored in your organs, especially your liver, heart and pancreas. Sometimes the stored iron damages these organs, leading to life-threatening conditions such as cancer, heart problems and liver disease.
• Blood disorders such as leukemia. Leukemia is cancer of the white blood cells.

Each underlying problem that can lead to enlarged liver has a distinct set of risk factors. For example:

• Alcohol abuse. Men are more likely to abuse alcohol than women are. The risk of alcoholism is higher if you have a family history of the disease. Depression and anxiety also increase the risk of alcohol abuse.
• Nonalcoholic fatty liver disease. Being overweight or obese is a major risk factor for nonalcoholic fatty liver disease. Having diabetes or abnormal cholesterol levels also increases the risk.
• Hepatitis A. You're at increased risk of hepatitis A if you travel to or work in regions with high rates of hepatitis A. You're also at risk if you're a sexually active gay or bisexual man, you use illicit drugs, you work in a research setting where you may be exposed to the virus or you have hemophilia or receive clotting-factor concentrates for another medical condition.
• Hepatitis B. You're at increased risk of hepatitis B if you have unprotected sex with more than one partner, you have a sexually transmitted disease, or you share needles during intravenous drug use. You're also at risk if you live with someone who has a chronic hepatitis B infection, you have a job that exposes you to human blood or you received a blood transfusion or blood products before 1970.
• Hepatitis C. You're at increased risk of hepatitis C if you inject or snort illicit drugs, you received an organ transplant before 1992, you've been exposed to infected blood or you received clotting factor concentrates before 1987. You're also at risk if you have hemophilia and received blood products before 1992 or you're receiving hemodialysis for kidney failure.
• Heart failure. Various factors increase the risk of heart failure, including high blood pressure, coronary artery disease, diabetes, kidney failure and congenital heart defects.
• Liver cancer. Chronic infection with hepatitis B or C is the most important risk factor for liver cancer. Cirrhosis — an irreversible scarring of the liver — diabetes, smoking and excessive alcohol consumption may increase risk as well.

Consult your doctor if you notice abdominal pain or fullness, swelling in your abdomen or yellowing of the skin.

Most cases of enlarged liver are detected during a physical exam. The doctor can estimate the size of your liver by feeling how far it extends below your rib cage. The texture of your liver will also be noted. Depending on the underlying cause, an enlarged liver may feel soft, firm or irregular. Sometimes lumps are present as well.

Your doctor may recommend various diagnostic tests to help determine what's causing the enlarged liver, including:

• X-ray. An X-ray examination uses electromagnetic radiation to make images of internal organs, including your liver.
• Ultrasound. Ultrasound is an imaging method that uses high-frequency sound waves to produce images of internal structures, such as your liver.
• Computerized tomography (CT). CT is an X-ray tool that produces images of your internal organs that are more detailed than are those produced by conventional X-ray exams. CT scans use an X-ray-generating device that rotates around your body and a very powerful computer to create cross-sectional images, like slices, of the inside of your body.
• Liver function tests. These generally refer to blood tests that evaluate the presence of liver damage or disease. The tests usually can be done on a single blood sample.
• Liver biopsy. Examining a sample of liver tissue (biopsy) can help your doctor determine the health of your liver.

Treatment of an enlarged liver depends on the cause.

• Alcohol abuse. If the enlarged liver is alcohol-related, it's essential to stop drinking alcohol. Discuss the best way to stop drinking with your doctor. Although liver damage from cirrhosis is irreversible, treatment can often help prevent further damage and reduce complications.
• Nonalcoholic fatty liver disease. Weight loss and exercise are often an essential part of treatment. It's also important to avoid alcohol and keep your cholesterol under control. If you have diabetes, manage your blood sugar carefully.
• Hepatitis. There's no specific treatment for hepatitis A, but the infection usually resolves. Medication may be recommended for hepatitis B or C. If your liver has been severely damaged, a liver transplant may be an option.
• Heart failure. Various medications are used to treat heart failure. Some take the burden of extra fluid off the liver.
• Liver cancer. Depending on the type and stage of the disease and various other factors, liver cancer may be treated with surgery, radiation therapy or chemotherapy.
• Blood disorders. With hemochromatosis, regularly drawing blood can reduce the amount of iron the liver has to process. Treatment for leukemia is complex. Therapies may include chemotherapy and radiation.

To protect your liver, take good care of yourself.

• Drink alcohol in moderation, if at all. Too much alcohol can lead to fat accumulation, inflammation and scarring in the liver. If drinking continues, liver damage may be fatal.
• Don't mix alcohol with other drugs. Acetaminophen (Tylenol, others) can be toxic to the liver even if you drink in moderation.
• Use medications wisely. Take medication only when you need it. Limit yourself to the recommended doses. Talk to your doctor before mixing herbal supplements with prescription or nonprescription medications.
• Be cautious with supplements. Some supplements can damage the liver, including kava, comfrey, chaparral and pennyroyal. Avoid high doses of vitamins A, D, E and K.
• Reduce the risk of hepatitis. Avoid contact with other people's blood and body fluids. If you're at risk of contracting hepatitis A or B, ask your doctor about immunization.
• Limit contact with toxins. Use aerosol cleaners, insecticides and other toxic chemicals only in well-ventilated areas. In addition, wear gloves, long sleeves and a mask.
• Make good choices about diet and exercise. Eating healthy foods and exercising regularly can help you control your weight — and help your liver do its job.

Simple steps can keep your liver healthy for a lifetime.