HEPATOMEGALY AND CARCINOMA OF LIVER

HEPATOMEGALY AND CARCINOMA OF LIVER

INTRODUCTION

• Hepatomegaly refers to the enlargement of the liver beyond its normal size.

• It may be a symptom of various systemic diseases involving liver parenchyma, biliary system, vascular disorders, or infiltrative conditions.

• Liver carcinoma refers to primary or secondary (metastatic) malignant tumors of the liver.

AYURVEDIC CORRELATION

• Hepatomegaly can be correlated with conditions like Yakṛdvriddhi, Yakṛdroga, Yakṛtudara, and Plihodara.

• Carcinoma of the liver can be compared to Yakṛdgulma, Granthi, or Arbuda depending on pathological behavior.

Relevant Ayurvedic References:

“Yakṛtplīhāni vardhante mandagnau bastisāṁśritau |
Te tiktakaṭuroṣṇābhiḥ śodhyau bastiśca śasyate ||”
— Aṣṭāṅgahṛdaya, Chikitsasthāna 13/30

“Arbudāni cha ye rogāḥ sthirāṇi cha mahānti cha |
Teṣu tikta kashāyānāṁ snehānāṁ ca prayojanam ||”
— Suśruta Samhitā, Chikitsasthāna 11/17

AETIOLOGY

AYURVEDIC AETIOLOGY (NIDANA):

• Mandāgni (poor digestive fire)

• Āma utpatti (toxins)

• Viruddhāhāra sevana (intake of incompatible food)

• Māṁsa-rakta pradhāna āhāra (excess non-veg, heavy foods)

• Vihāra dosha (lack of exercise, sedentary habits)

• Suppressed natural urges (vegavidharana)

• Chronic liver infections or rakta dusti

MODERN AETIOLOGY:

• Infective causes: Hepatitis A, B, C, E, malaria, kala-azar, liver abscess

• Metabolic causes: Fatty liver disease, hemochromatosis, Wilson’s disease

• Cardiac causes: Right heart failure, constrictive pericarditis

• Neoplastic causes: Hepatocellular carcinoma, secondary metastasis

• Alcoholic liver disease, non-alcoholic fatty liver disease (NAFLD)

• Drugs and toxins: Paracetamol, methotrexate, steroids

CLINICAL FEATURES

AYURVEDIC FEATURES:

• Yakṛdvriddhi presents with:

  • Śūla (pain in right hypochondrium)

  • Gaurava (heaviness)

  • Ārocaka (loss of appetite)

  • Udaravriddhi (abdominal distension)

  • Tṛṣṇā (excess thirst)

  • Mūtra-vibandha (urinary difficulty)

“Yakṛt plīhodarārtiśca bhavatyannasya durjare |
Pānaṁ madyasya saṁrambhād raktaṁ vā kṣubhyate yadi ||”
— Charaka Samhitā, Chikitsasthāna 13/40

MODERN FEATURES OF HEPATOMEGALY:

• Right upper quadrant fullness or mass

• Dull or sharp pain in the right hypochondrium

• Jaundice

• Fever (if infective cause)

• Ascites

• Spider nevi, palmar erythema (in cirrhosis)

• Fatigue, weight loss

FEATURES OF HEPATOCELLULAR CARCINOMA (HCC):

• Rapid liver enlargement with hard, irregular surface

• Cachexia and weight loss

• Fever and malaise

• Jaundice and ascites (late stages)

• Right shoulder pain due to diaphragmatic irritation

• Hepatic bruit or friction rub

• Features of chronic liver disease

DIAGNOSIS

AYURVEDIC DIAGNOSIS:

• Based on Darśana (inspection), Sparśana (palpation), Praśna (history taking)

• Examination of Yakṛt and Pliha sṭhāna

• Assessment of Doṣa, Dushya, Srotas, Agni, Āma

MODERN DIAGNOSIS:

• Physical Examination:

  • Palpation of liver span and texture

  • Ascites and signs of liver failure

• Laboratory Tests:

  • LFT (AST, ALT, ALP, bilirubin, albumin)

  • Viral serology (HBV, HCV)

  • Alpha-fetoprotein (AFP) for HCC

  • CBC, PT/INR

• Imaging:

  • Ultrasound Abdomen – first line for hepatomegaly or space-occupying lesion

  • CT Scan or MRI – for staging and characterization of tumors

  • Liver Biopsy – for definitive diagnosis of carcinoma

  • Fibroscan – to assess liver stiffness in cirrhosis

MANAGEMENT

AYURVEDIC MANAGEMENT OF YAKṚDVṚIDDHI / YAKṚDARBUDAM:

• Nidana Parivarjana (removal of causative factors)

• Dīpana-Pācana with formulations like:

  • Trikatu churna, Panchakola churna

• Virechana with Trivrit lehya or Avipattikara churna

• Basti karma with Tikta kṣīra basti, Lekhana basti

• Rasāyana Therapy:

  • Guggulu, Punarnavadi Mandura, Lohasava

  • Arogyavardhini Vati, Guduchi, Bhumyamalaki

“Virecanāni sarvāṇi tiktaṁ kṣīraṁ ca lekhanaṁ |
Yuktam yakṛtplīhayoḥ śuddhihetor yathāvidhi ||”
— Aṣṭāṅgahṛdaya, Chikitsasthāna 13/31

MODERN MANAGEMENT OF HEPATOMEGALY:

• Treat the underlying cause:

  • Antibiotics – for bacterial infections

  • Antiviral therapy – for hepatitis B/C

  • Anti-malarials or anti-leishmanial drugs

  • Diuretics – for cardiac or cirrhotic hepatomegaly

  • Nutritional and alcohol cessation support

MODERN MANAGEMENT OF HEPATOCELLULAR CARCINOMA:

• Curative Options:

  • Surgical resection (only in localized disease with good liver function)

  • Liver transplantation

• Palliative/Non-surgical Options:

  • Transarterial chemoembolization (TACE)

  • Radiofrequency ablation (RFA)

  • Sorafenib (tyrosine kinase inhibitor)

  • Immunotherapy agents

  • Supportive care and symptom management

PROGNOSIS

• Hepatomegaly prognosis depends on underlying etiology.

• HCC has poor prognosis if not detected early; survival varies with stage and liver function.

• Early diagnosis and integrated management improve outcome.

PREVENTION

• Avoid hepatotoxic substances and alcohol.

• Vaccination for Hepatitis B.

• Regular monitoring in chronic liver disease.

• Early management of viral hepatitis and metabolic syndromes.