Hepatomegaly - what is it, how to treat? Signs of a liver change

The liver is a very important for the human body unpaired organ. But, a large number of pathological processes accompanying various diseases lead to the violation and inhibition of the liver function. The spectrum of its functions is very diverse:

• Synthesis of plasma proteins.
• The formation of bile and bile acids.
• Detoxification function.
• Disposal of blood cells( leukocytes and erythrocytes).
• Synthesis of cholesterol, which is used later for the synthesis of steroid hormones.
• Participation in the metabolism of carbohydrates( glycogen storage, etc.), fats and proteins.
• Providing for the exchange and removal of hemoglobin degradation products from the body.

Thus, any pathology that causes impaired function or changes in the liver leads to severe consequences for the human body.

Therefore, the task of any doctor - in time to suspect a disease that can give a complication in the form of a violation of the normal functioning of this body. The task of the patient is to determine the symptoms that indicate the pathology - and for this they need to be known.

Hepatomegaly - what is it?

Hepatomegaly is a process of increasing the size of the liver, triggered by various painful conditions. It can cause diffuse changes in the liver or focal, but it is always pathological, because it is the diseases that lead to such a sharp change in the size of the organ, which is not typical for it even in the period of increased functional load.

In itself, the change in size, unfortunately, does not reflect in any way the degree of functional disorders in the liver. This body, unlike others, has very large regenerative( restorative) reserves.

In case of lesion, even at 70-80%, there may be no clinical symptoms of hepatic insufficiency. However, the enlargement of the liver is fairly easy to detect as palpation( by palpation - the liver does not normally extend beyond the edge of the costal arch), and thanks to ultrasound.

Each patient should understand that hepatomegaly is a reversible process( unlike cirrhosis, hepatocarcinoma) and with competent treatment of the cause of hepatomegaly, the size and function of the organ come back to normal. But for this it is necessary to consult a doctor in a timely manner.

Unfortunately, in a number of cases, it is precisely such a pernicious habit of patients as excessive consumption of alcohol that leads to the disease. The latter can be the only organic manifestation of the toxic effect of alcohol on the body. In the initial stage, it is reversible, and in the future can lead to the formation of fatty hepatosis, leaving irreversible traces in the liver.

Signs of hepatomegaly - how is the liver enlarged?

To determine that the liver began to increase slightly in size alone to a person is quite difficult. Normally, the edge of the liver is hidden under the costal arch, which protects the organ, as does the chest as a whole.

Only a large increase in the liver in children, whose edge of the liver is not normally hidden behind the costal arch, can be determined visually when viewed. Then the right subcostal area asymmetrically will rise above the surface of the abdomen.

Often, the enlargement of the liver can be concealed behind the accompanying pathological processes, to which the pathology of the hepatobiliary system( liver, gall bladder, bile ducts) is leading. Such processes are:

• Ascites - accumulation of fluid in the abdominal cavity;
• Inflammatory process in the abdominal cavity, which is accompanied by a muscular defension( tension of the muscles of the abdominal press);
• Bleeding in the abdominal cavity;
• Volumetric abdominal cavity formations( benign GI tract);

In such cases, hepatomegaly is detected already in a complex of diagnostic and therapeutic measures to eliminate these pathological processes and diseases that led to their development.

In fact, the doctor has only two approaches for diagnosis and detection of hepatomegaly:

1. Manual techniques( palpation and percussion of the abdomen).
2. Methods of visualization of internal organs( ultrasound, CT, MRI).

Each of the approaches has its own advantages and disadvantages. Therefore, to increase the accuracy of diagnosis, try to apply both approaches, with manual methods being primary, and visualizing - secondary.

This manual technique, like percussion of the anterior abdominal wall, allows you to determine the approximate boundaries of the liver by the change in percussion sound( Kruglov's method).In modern medicine, this method loses its relevance for the diagnosis of hepatomegaly, since it is extremely imprecise, and its reliability varies from the skills of a particular doctor and the conditions of the abdominal organs of the patient.

In addition, notice the increase in the body can only be moderate and severe. An easy degree of percussion on Kurlov does not define.

The abdominal palpation reception is a classic medical diagnostic device. Thanks to him you can determine whether the edge of the liver protrudes above the costal arch and how many centimeters. Basics of the technique of palpation of the stomach and liver laid Obraztsov, as early as the beginning of the twentieth century. All surgeons and therapists of the CIS countries still use it.

The main advantage of the method of palpation of the liver is its simplicity, accessibility and practically error-free definition of enlarged liver in almost any patient. It is due to palpation and hepatomegaly is detected in the first stage, especially if it is asymptomatic.

An enlarged liver is considered when both its lobes( right and left) are palpable over the costal arch in an adult.

The advantage of palpation over the methods of visualization of the hepatobiliary system is the possibility of simultaneous determination of the consistency and the treatment( soft, elastic, stony, bumpy, pasty, etc.).With a certain degree of probability, this may indicate the nature of the pathological process.

Methods for visualization of the liver allow the doctor during diagnosis to accurately determine the size of the liver and establish a syndrome such as hepatomegaly. The main thing in this diagnosis is the ultrasound of the liver and the biliary system.

It is prescribed both for patients with diseases of these organs, and for the general diagnosis of complex pathologies and abdominal injuries. The disadvantage of ultrasound in the diagnosis of hepatomegaly is only a possible error in measuring liver size in order to monitor the condition of the organ.

Different position of the ultrasound probe can make its own errors and give a false measurement result. Therefore, three times the definition of each ultrasound distance is recommended.

Causes of development of hepatomegaly

The causes and mechanisms causing hepatomegaly are very different in nature. Therefore, if such a syndrome is found, the patient shows a whole range of diagnostic studies and conducts an elucidation of all the circumstances of his anamnesis. Generalized all the causes that cause a person to hepatomegaly, you can imagine this:

• The inflammatory process in the liver is hepatitis. By its nature, hepatitis can be viral, bacterial, toxic, medicinal, autoimmune and idiopathic( of unknown origin).Liver abscesses, which are caused most often by bacterial or fungal flora, are also inflammatory processes, and can lead to hepatomegaly.
• Vascular( venous) stagnation of blood. Most often observed with right ventricular heart failure. However, it can also be provoked by the development of portal hypertension( increased venous blood pressure in the portal vein of the liver).
• Diseases of blood and hematopoietic system( lymphomas and leukemia).The liver contains in its composition the reticular tissue, which destroys the blood cells that have fulfilled their function. In cancer processes of the hematopoietic system, pathological cells accumulate in the liver, causing it to increase. Therefore, the exclusion of oncology is the first direction of diagnostic search for an enlarged liver.
• Hepatomegaly in a child can be caused by various toxic poisonings, including food-borne diseases.
• Pregnancy. In this case we are talking about HELLP-syndrome. This is a severe form of preeclampsia, which is characterized not only by an increase in the liver, but also by a decrease in the activity of its enzymes, a decrease in the number of platelets in the blood and erythrocytes, as a result of their destruction.
• Hepatomegaly due to fatty hepatosis. This is the process of accumulation of fat in the cells of the liver, which leads to a decrease in the functional activity of the organ. The pathology is provoked by the use of alcohol, the intake of toxins into the body, diabetes, glycogenoses.
• Cirrhosis of the liver at an early stage( at the later stage, the organ wrinkles with a decrease in its size).
• Oncological processes in the liver( adenomas, carcinomas, metastases).Polycystic liver.
• Echinococcal cysts of the liver.
• Genetic diseases of the liver( Gilbert's syndrome, enzyme deficiency, etc.)
• Granulomatous inflammation caused by tuberculosis, syphilis, etc.
• Infectious diseases that affect the blood and lymphatic system( malaria, typhoid fever, yellow fever, etc.).).With them, there is often a concomitant increase in the spleen. Then it is customary to talk about hepatosplenomegaly.

Most of these causes diffuse liver changes or diffuse hepatomegaly - this is a uniform increase in the liver due to equally common pathological foci. In this case, we can say that the disease covers the entire liver.

The focal form of pathology is caused by diseases prone to form one or more inflammatory or cancerous transformations - abscesses, cysts, tumors or metastases.

Sometimes the enlargement of the liver can be associated with the pathology of the adjacent organs of the digestive tract. Hepatomegaly of the liver due to the pancreas with the inflammatory process is not uncommon.

How to treat hepatomegaly?- diet, drugs and techniques

Therapy of such a syndrome is not difficult and largely depends on the cause that triggered the development of the pathological enlargement of the liver. Hepatomegaly, the treatment of which is carried out outside the medical institutions, rarely regresses on its own.

After the final cause of the syndrome is established, the doctor prescribes a set of therapeutic measures, including not only taking medications:

• Dietary meals with the exception of high fat, with a normal level of protein and carbohydrates. Denial of use of any form of alcohol, as well as the rejection of other bad habits - smoking, drug use, etc.
• Purpose of hepatoprotective drugs. Their task is to stimulate regenerative processes and protect hepatocytes from toxins. For mild forms of hepatomegaly, drugs of plant origin( extracts of milk thistle, etc.) are used. In more severe pathology, essential phospholipids and preparations of urodeoxycholic acid are used.
• Etiotropic treatment of hepatomegaly - aimed at eliminating the cause of the development of liver pathology and its increase( as a consequence).Depending on the pathogen of the infection, antibiotics, antiviral agents, interferons, antifungal agents, etc. are used. The pathology of the circulatory system requires more complex treatment with the use of hormonal drugs and cytostatics, as well as bone marrow transplantation. Oncological pathology is treated by surgery, chemotherapy and irradiation of the tumor process.
• The symptomatic treatment is designed to eliminate specific symptoms of the disease - pain, heaviness in the abdomen, leakage, heartburn, etc.

Prognosis for the life of patients

The medical prognosis for the life of patients with hepatomegaly is determined depending on the cause of the development of this condition. If the process is diagnosed at an early stage, then the outlook is favorable.

All known diseases leading to this condition are successfully treated, incl.and viral hepatitis C. If the underlying illness of the patient is at the stage of progression, then the prognosis is relatively favorable.

Doubtful prognosis in case of hepatomegaly is exhibited only for patients with oncological pathology at the 2-4th stage of the process, as well as for patients with genetic diseases.