What is hepatomegaly of the liver?

Many diseases are accompanied by an increase in the size and weight of the liver. Hepatomegaly( literally "large liver") - is an integral part of a different pathology, as the organ participates in all biochemical processes of the body.

Hepatomegaly of the liver is not a disease, but a symptom of a primary or secondary lesion. It is revealed by certain objective features. Therefore, those who are interested in what this diagnosis means, we immediately warn: do not look for it in the classification of diseases as a separate nosology, it is considered in the section "Symptoms and Syndromes".

Criteria for the determination of hepatomegaly

We are already so used to the most objective assessment of liver size by ultrasound or computed tomography, which we forget, the first signs of hepatomegaly are determined by the attending physician using old methods of palpation and percussion.

Normally, when examining an adult, percussionally the width of the organ on the right median-clavicular line should not exceed 12 cm. The lower edge of the right lobe can be palpated in incomplete people, it is soft, glides over the fingers of the doctor's fingers.

With respect to the right costal arch, a protrusion of 1-2 cm is allowed. This is typical for people with asthenic physique. The left lobe of the liver is not palpable. It is located at the top of the epigastrium behind the stomach. If in this zone it is possible to determine a dense formation, then hepatomegaly can be suspected.

To be sure of the increase in the liver, the doctor should exclude the organ failure in chronic bronchitis, expressed pneumosclerosis. For the right lobe of the liver, an unclear compaction can be made with a tumor of the kidney, intestine, and enlargement of the gallbladder.

What causes pathology?

The causes of hepatomegaly are very diverse. They are associated with both diseases of the liver itself and with other pathologies. The most common increase in the organ is caused by the following liver diseases:

• viral and non-viral hepatitis;
• hepatosis( fatty hepatosis - a common pathology in fat people), alcohol and nonalcoholic fatty degeneration;
• tumors( adenoma, hemangioma, carcinoma, cancer metastases from other organs, focal hyperplasia);
• formed cysts;
• amyloidosis;
• of liver fermentopathy( with a deficiency of lysosomal lipase, hepatomegaly appears in 87% of cases);
• Gaucher disease, which caused the accumulation of fats;
• cirrhosis with irreversible fibrotic disorders with necrosis of hepatocytes;
• thrombosis of hepatic veins, blockage of the bile ducts with inflammation of the bladder.

Hepatomegaly is caused by chronic infections and intoxications. The liver provides neutralization of toxic substances, poisons, some pathogens "settle" directly inside the body: with malaria, echinococcosis, granulomatous hepatitis develops in tuberculosis, sarcoidosis, cytomegalovirus, mononucleosis, septic pericarditis.

When the cardiac activity in the liver is decompensated, the venous blood of the inferior vena cava system is trapped, the body swells, a prolonged process causes squeezing of the hepatocytes and their necrosis followed by replacement with fibrous tissue, cardiac cirrhosis of the

is formed. As the liver suffers from a pathology associated with a metabolic disorder, hepatomegaly is detectedwith hemochromatosis( iron deposition in cells), Wilson-Konovalov's diseases( copper particles are in hepatocytes).

Decompensation of cardiac activity caused by right ventricular failure, contributes to overflow and increased pressure in the inferior vena cava and its basin. The congestive form of hepatomegaly is observed:

• with consequences of acute myocardial infarction;
• myocardial dystrophy;
• cardiomyopathies;
• heart defects.

The most pronounced hepatomegaly in malignant tumors of the lymphatic system( leukemia, leukemia).At the same time in the liver foci of additional extraostemia hemopoiesis are formed or the tissue is impregnated with lymphoblastic cells. The liver reaches enormous sizes, occupies the most part of the abdominal cavity, its mass reaches 20 kg.

How is hepatomegaly syndrome manifested?

Upon examination, the physician identifies the signs of hepatomegaly and treats them in favor of a particular diagnosis. For example,

• "stony" consistence of the liver edge, tuberosity of the surface indicate the probability of cirrhosis or tumor( new cells grow faster, so the mounds form);
• pain during palpation is more typical for hepatitis( inflammation), moderate edge sensitivity is observed with steatosis;
• rapid organ enlargement is typical for the development of heart decompensation, with the expansion of the capsule, which is accompanied by pain;
• with marked pain differs during the liver abscess, echinococcal cyst.

With a significant increase in the liver, the patient experiences the following symptoms of hepatomegaly:

• severity, dilated pains persistent under the ribs on the right or in the epigastrium with irradiation in the side, right side of the abdomen, intensified during movements;
• increase in the volume of the abdomen due to accumulation of fluid in the abdominal cavity( ascites);
• itching rashes on the skin;
• yellowing of sclera and skin;
• nausea, heartburn;
• stool disorder( alternating diarrhea and constipation);
• small angiomas on the skin of the face, chest, abdomen in the form of "spiders" or vascular "stars".

Jaundice is one of the possible symptoms of

pathology. Special symptomatology depends on the cause of hepatomegaly. With hepatitis in the patient, the liver increases evenly, a condensation appears, which is felt along the lower edge. Palpation is painful. There is jaundice of the skin, signs of general intoxication and inflammatory process( fever, weakness, headaches, dizziness).

Treatment of hepatomegaly caused by viral hepatitis requires antiviral drugs, immunostimulants. With good efficiency, the liver returns to normal size. Cirrhosis differs from hepatitis by the mechanism of destruction of the hepatic tissue. Due to diffuse changes in the liver with areas of necrosis, the working hepatocytes are replaced with scar tissue.

Disrupted functions are accompanied by a tendency to bleeding, the skin assumes an earthy shade, in connection with portal hypertension, ascites grows. Around the navel appears an enlarged venous ring with outgoing vessels in the form of a "jellyfish head".

In metabolic disorders characteristic of metabolic diseases, enzymopathies simultaneously with hepatomegaly show:

• renal and spleen lesion( glycogenosis);
• copper deposition and colored ring around the iris, tremor of hands( Wilson-Konovalov's disease);
• yellow-brown spots on the body and xantelasm on the eyelids, the association of clinical manifestations with the period of fasting( pigmentary hepatosis with Gilbert's syndrome);
• cough with hemoptysis( hemochromatosis).

The patient has the first signs of heart disease: dyspnea, edema on the legs, ascites, palpitations and arrhythmia, pains by the type of angina, cyanosis of the feet, hands, lips, in children - the nasolabial triangle.

Can hepatomegaly develop in only one lobe of the liver?

The liver consists of two parts, each has its innervation, blood supply, ways of biliary excretion( central artery, vein, bile duct).Isolated hepatomegaly of the right lobe of the liver is observed more often than the left. Functionally, the right share is loaded more, performs 60% of the body's work, so it primarily affects any violations.

The left share is rarely affected, it is closer to the pancreas, respectively, pancreatic disorders can cause an increase in the proportion of

With an uneven increase in the body, they speak of partial hepatomegaly. The lower edge of the liver rarely changes, so ultrasound is needed to identify it. A characteristic echo sign is the change in the homogeneity of the tissue structure. Usually found with tumors, cysts, abscess.

How does the enlargement of the liver and spleen?

Enlargement of the spleen( splenomegaly) may accompany hepatomegaly. It is noted that these two signs of pathology support each other. Simultaneous increase is expressed in hepatolienne syndrome. It is more typical for children, because it is aggravated by the peculiarities of the anatomy and physiology of the growing organism.

It is provoked by hereditary diseases, infections, congenital anomalies. The syndrome is observed:

• in vascular diseases of the arteries and veins of the liver, spleen( vasculitis, thrombosis);
• of chronic focal and diffuse liver pathology;
• hemochromatosis;
• of amyloidosis of the liver;
• of Gauchers disease;
• hepatocerebral dystrophy.

Chronic parasitic and infectious diseases always, except for the liver, affect the spleen( intestinal tuberculosis, alveococcosis, malaria, infectious mononucleosis).Both organs significantly increase in the pathology of lymphoid tissue and blood( leukemia, lymphogranulomatosis, hemolytic anemia).Heart diseases less often contribute to the growth of the spleen.

The organs have a pronounced functional connection

Types of hepatomegaly according to the conclusion of ultrasound

After the ultrasound, the specialist specialist gives an opinion using the accepted terms. Hepatomegaly is considered "unexpressed" if the organ size exceeds normal by 1-2 cm. It is usually detected by chance, since it does not cause any symptoms( rarely on a questioning reference there is a slight weakness, heartburn, odor, diarrhea or constipation).

Important for early treatment, preventing further progression. The term "moderate hepatomegaly" is used if, in addition to increasing the size, there are small diffuse changes. They occur with alcoholism, unbalanced nutrition.

"Expressed" is called hepatomegaly, if liver sizes are estimated as huge, obvious pathology is visible, the functions of neighboring organs are disrupted. The structure of the tissue is changed due to more dense foci.

Sometimes the changes are reversible. It is observed in diseases of the blood, tumors. Rapid negative dynamics of liver growth is possible with fatty hepatosis, cardiovascular diseases.

How does hepatomegaly occur in pregnant women?

Doctors say that problems with the liver during pregnancy occur in the third trimester. The enlarged uterus displaces the liver up to the right. The movements of the diaphragm are limited, this makes it difficult to remove bile, and overflows the liver with blood.

The functioning of the liver is affected by hormones, which is manifested by yellowish spots on the woman's face, with "stars" on the skin. In the blood of a pregnant woman, an increase in fatty acids, cholesterol, triglycerides is observed.

Pathological hepatomegaly can be caused by:

• toxicosis with prolonged vomiting, observed in 2% of pregnant women at the period from the fourth to the tenth week, discontinued by the twentieth week, due to vomiting, dehydration, electrolyte disturbances may occur, the weight of a woman decreases;
• intrahepatic stasis of bile, is found in every fifth pregnant woman, the cause is associated with hereditary predisposition.

Hepatomegaly may occur during pregnancy due to exacerbation of existing chronic diseases( cardiac decompensation, fatty hepatosis, diabetes, neoplasms, leukemia, hepatitis)

When does hepatomegaly occur in children?

Hepatomegaly in the fetus manifests an enlarged abdomen, which is revealed on ultrasound during pregnancy. Already at this stage, doctors are trying to determine the cause, the course of pregnancy depends on it, the health of the future baby.

The most frequent are:

• intrauterine infection with viruses and bacteria( toxoplasma, cytomegalovirus, Coxsackie, causative agents of varicella, rubella, syphilis, HIV), small hyperechoic inclusions appear in the enlarged fetal liver;
• Rhesus-conflict, when the mother's blood is Rh-negative, and the fetus takes the father's Rh factor;
• various tumoral formations( the fetus is diagnosed with hemangioma, hepatoblastoma, adenoma);
• increased hemolysis of erythrocytes;
• is a malformation of the heart with insufficiency;
• genetic manifestations of impaired metabolism;
• congenital anomalies.

Isolated hepatomegaly of the fetus develops rarely, more often it is accompanied by an increase in the spleen and other vices. The most successful period for identification is the II-III trimesters. By full examination, Down syndrome should be excluded.

In newborns and infants up to a year, a small increase in the liver is normal. If the palpation of the lower edge protrudes from the hypochondrium more than 2 cm, the condition refers to pathology and needs clarification of the cause.

Hepatomegaly syndrome may accompany eating disorders, complicate vaccination, point to autoimmune processes in the body of the child

Of the pathological causes more often:

• infectious diseases, any viral infections;
• heart defects with right ventricular failure - pay attention to the heavy breathing of the baby, cyanosis of the face and limbs, tachycardia;
• respiratory system diseases - the child has severe shortness of breath, wheezing in the lungs;
• cysts of the bile duct with obstruction of the biliary tract, inflammation - accompanied by high fever, painful palpation in the hypochondrium on the right;
• Debre's syndrome, Girke's disease - the accumulation of glycogen in the hepatic tissue contributes to the early development of fatty hepatosis, accompanied by convulsions, the blood raises the lactic acid content, urine releases acetoacetic acid;
• impaired metabolism of lipids - is expressed by persistent diarrhea, vomiting, yellow spots on the skin;
• Mauriac syndrome - complicates the course of diabetes, the child's liver accumulates fat;
• tumors( hepatoblastoma, hemangioma) are benign and malignant are rare.

In a small child with hepatomegaly, all the classic symptoms appear. They are transported heavily. When the abdomen is enlarged, the umbilical ring does not overgrow, the hernial gates are formed, through which the navel and loops of the intestine bulge. Persistent jaundice.

HIV-infected infants sometimes differ from healthy children only by hepatomegaly. From an early age there are frequent viral infections of the respiratory tract, parotitis, dermatitis, lymph nodes increase, the oral cavity affects the fungi. Any infection can lead to sepsis, meningitis, anemia.

Echinococcosis is affected by older children. The main reason is contact with dogs. At 5-7 years, a moderate increase in the liver is observed, which is considered a physiological phenomenon and does not require intervention.

In older groups, the cause may be hepatitis( viral, toxic, medicinal), complications after congenital infection with herpes viruses, rubella, parasitic diseases, bile outflow, biliary cirrhosis.

There may be metabolic changes in diabetes mellitus, Wilson-Konovalov disease, porphyria, liver damage caused by hemolysis, lymphoma, leukemia, tumors of the hemangioma type, carcinomas with metastases.

In the presence of respiratory diseases, it is necessary to distinguish false hepatomegaly, it appears in connection with the expulsion of the liver from the ribs with increased lightness of the lungs.

How is the diagnosis carried out?

The above reasons for the increase in liver size indicate the difficulty of finding the underlying disease, the importance of differential diagnosis. This means that, in addition to detecting hepatomegaly, all possible types of research are used: blood and urine tests, general tests for bilirubin, sugar, protein, liver function tests on biochemical tests for basic enzymes.

Assign control over the blood coagulation system, enzyme-linked immunosorbent assay for viral and bacterial infections. The doctor establishes a presumptive body growth using percussion and palpation techniques.

Much more accurate and objective are the hardware methods: ultrasound, computer and magnetic resonance tomography, less informative radiography, scanning with preliminary administration of hepatotropic radioactive substances gives a complete picture of cell damage, it is possible to calculate the fraction of the remaining intact tissue.

Modern equipment allows you to identify not only the change in size, but also accurately contrast the boundaries, the structure of the tissue, the nature of the changes( focal, diffuse).Finally, the morphological changes can be judged from the biopsy study.

The ultrasound method is the most accessible to the population, it is based on the principle of recording wave reflection from a dense organ.

ultrasound allows you to compare the structure of the liver in all areas, identify denser foci, size of lobes. Echoscopic observation can be visualized as a visual examination on the screen without recording. It is more important when observing a contracting organ( heart).The liver is examined using echographic criteria, and the pictures are printed in different projections.

Features of treatment

In the treatment of hepatomegaly, it is very important to know whether it is caused by liver pathology or triggered by concomitant diseases. This determines the prognosis and effectiveness of therapy. In inflammatory processes, it is possible to return the organ to a healthy state with the help of strong means.

How to treat hepatomegaly in a particular case is decided by the doctor after a full examination and finding out the cause. The scheme of therapy depends on the primary disease. These can be:

• antibacterial, antiviral agents, corticosteroids for inflammation of the liver;
• cardiac glycosides and coronarolytics in cardiac pathology;
• cytostatics and radiation therapy in leukemia, tumors;
• hepatoprotectors;
• vitamins;
• cholagogue.

If there is active growth of connective lymphoid tissue, tumor cells, then complete replacement of dead hepatocytes is impossible, therapy consists in stopping the progression of the pathology of

. It is compulsory for the patient to prescribe a diet according to table number 5.From the diet exclude all foods that are irritating to the liver: animal fats, light carbohydrates. With cardiac decompensation, salt is sharply limited. It is forbidden to eat fried and smoked meat, fish products, canned food, sweets.

All cook only in cooked form or for a couple, you can bake in the oven. Patients are recommended a sufficient amount of protein and vitamins from dairy products, fruits, vegetables.

Identifying even minor hepatomegaly should alert a person and force them to find out the cause. Treatment of the liver depends on the degree of damage, the main pathology. The diet will have to be observed almost all my life.