Past exam of the medicine course of the University of Oxford / 1866 / First examination / Anatomy and physiology / 4 / Solution

The liver has a substantial normal range of size, determined by age, body dimensions, nutritional state and its variable contents; there is no universal absolute minimum and maximum valid for every healthy person. One must also distinguish true organ volume from the position of its lower border, which moves with the respiratory diaphragm during breathing.

An ordinary adult liver is on the order of 1.5 kg and roughly a few percent of body mass, but neither figure is a diagnostic boundary. As an explicitly modern example, an autopsy study of adult men reported a mean hepatic mass of 1561 g and observed values from 838 to 2584 g in its selected population. Those are sample observations, not a declaration that every liver inside those limits is healthy or that every one outside is diseased. A newer large-sample study similarly found an association of liver mass with body mass; much of an apparent sex difference disappears when body size is taken into account.^[ref][ref]

Age changes the proportion as well as the absolute size. The fetal and infant liver is relatively large; the adult organ is smaller in proportion to the whole body. Its fetal role in haematopoiesis and subsequent changes of growth and function make an adult mass standard inappropriate for an infant. Constitutional body size and normal anatomical shape also vary: a long lower projection is not necessarily the same thing as an enlarged total organ.

Reversible differences within one person arise because the liver is a store and a vascular organ:

A meal therefore changes hepatic activity and splanchnic blood flow without requiring a large immediate increase in total liver volume. In a modern paired study of 20 healthy volunteers, single-photon emission computed tomography before and after a standardized meal showed a nonsignificant 1.5% decrease in estimated liver volume. The authors judged the change to be within methodological error. This is a useful check against assuming that greater digestive activity proves gross swelling.^[ref]

The experimental approach is to compare like with like: specify age and body mass, use a fixed interval after food, standardize hydration, posture and respiratory phase, and distinguish a volume measurement from a palpable edge or a single linear dimension. Magnetic resonance imaging can measure volume while magnetic resonance spectroscopy measures glycogen or lipid signals; the two observations answer different questions. The size of an excised organ additionally depends on how much blood remains in it. The physiological point appropriate to the 1866 question is reversible variation with growth, alimentation and vascular filling. Modern imaging results refine that point; they are not numerical standards that the historical exam could have expected.