Diffusive liver changes

Diffuse liver changes is a term indicating a kind of organ damage. In contrast to local, focal abnormalities of the structure, they assume the spread of pathological changes to the entire hepatic tissue( parenchyma).The causes and nature of the morphological changes in the liver depend on the specific disease

. They are not functional, they are always caused by changes in the cell structure, hepatic bile ducts, vessels. To reveal diffuse changes in the structure of the liver can be in vivo only by echo signs during an ultrasound examination. Significantly less often - with histological analysis of the removed organ. Changes are detected by pathologists in persons who died from severe liver diseases.

How does the anatomical structure of the liver manifest in ultrasound?

There is a rational lobed structure in the working liver. Inside each lobule fit arterial and venous vessels, in addition, the blood circulation is supported by intra-lobular( sinusoidal) and interlobular( inside the connective-tissue partitions) capillaries.

Inflow of blood brings into the hepatic cells( hepatocytes) the substances that need to be processed, the outflow - supplies useful internal ingredients to all internal organs, removes slags. Lobules have the form of prisms. Scientists suggest the presence of a diffusion mechanism for the penetration of plasma into the hepatocytes through the wall of the vessels.

Each hepatocyte secretes the produced bile into a special outflow duct, which, coarsening and merging with others, reaches the gallbladder. In parallel with the venules lie intrahepatic bile ducts, which merge in each lobe, then both into a single hepatic bile duct, which flows into holedoch. Thus, part of the bile is "dumped" bypassing the gallbladder.

To see and evaluate what each structural unit means is possible only under a microscope. For diagnostics, it is important to find out the status of the functional usefulness of the apparatus of hepatocytes and surrounding tissues. A great help is provided by the study of the ability to reflect the ultrasonic wave obtained by echographic signs. They reveal undeniable areas of liver damage or diffuse spread.

What are the symptoms of diffuse disorders?

Sound waves pass through a healthy liver, without lagging or reflecting, as its density represents a uniform mass. On the screen, the ehostruktura looks like a uniformly dark( homogeneous) zone, it is called hypoechoic.

Vessels and ducts show with even darker shades( anechogenous), although the walls form a light contour, since they can reflect sound. This principle allows you to see the direction and size of the portal vein, bile ducts.

Various changes in structure, deposition of biochemical substances, microelements, and replacement of the parenchyma with scar tissue lead to a change in the echogenicity of the tissue. Transformations cause an increase in the property of echogenicity and the liver on the monitor becomes light( specialist doctors say "bright liver").

Diffusive changes in the liver parenchyma can be manifested by a different dark shade of different areas, "granularity".It depends on the heterogeneous manifestations of various areas of inflammation, metabolic changes. For a correct assessment of the degree of hypoechoinality, the doctor simultaneously looks at the right kidney and is guided by the dark shade of her parenchyma.

On ultrasound, you can see a dense cirrhotic tissue emerging from connective tissue membranes, replacing a healthy parenchyma with the products of the body's vital activity( fatty inclusions, copper deposits, iron).

The nature of the picture suggests the causes of hyperecho. For example, with infectious diseases( viral hepatitis), vascular changes predominate, experts call the general appearance of the liver a "snow storm" or "starry sky."

In cases of metabolic accumulation, the lower part of the echogram looks lighter and brighter due to compaction of the liver parenchyma

To find out the diagnosis, the patient needs to compare the results, study the symptoms and the course of the disease. The detection of diffuse changes in the liver parenchyma will require a detailed examination with a comparative analysis of the clinical and biochemical features of various diseases, immunological responses.

Morphological causes of

echocardiography The signs of diffuse liver changes detected by the echoscopic method do not reflect true histological abnormalities, but the accumulated experience of functional diagnostics makes it possible to isolate and target physicians to certain causal connections of parenchyma lesions. Distinguish the following options for change.

Metabolic - always associated with the pathology of metabolism. This is promoted by: hereditary diseases, hormonal changes, malnutrition. The group of diseases include: Gaucher's disease, glycogeneses, diabetes mellitus, fructose intolerance, tyrosinemia, hereditary hepatolenticular insufficiency or Wilson-Konovalov's disease( lesions of the liver, brains accumulated with copper), galactosemia, fatty infiltration with impaired fat metabolism.

Infectious - inflammation of the parenchyma in viral hepatitis( acute and chronic), miliary tuberculosis, mononucleosis( caused by the Epstein-Barr virus), AIDS, brucellosis, cytomegalovirus infection, certain helminthiases, fungal diseases.

Toxic - arise from the action on the hepatic tissue of toxic substances( alcohol, nicotine dependence, the effects of steroid therapy, the use of cytostatics, radiation exposure, antibiotics, poisoning with salts of heavy metals, foods with high content of trans fats, free radicals).

Malignant tumors - in case of extensive dissemination( seeding).Chronic heart failure - due to venous stagnation of blood in the liver and portal vein system. Autoimmune - hereditary and acquired diseases of an allergic nature.

Morphological changes affect the echogenicity of the

tissue. Among the diffuse changes in the liver of an exchange character, the following conditions can be distinguished in more detail. Steatosis( a synonym for fatty infiltration) - in the hepatocytes gradually accumulate fatty inclusions, the cells break down and form cysts. It has been found that violations of the type of fatty infiltration are caused by the accumulation of a significant amount of triglycerides, which the hepatic cells are not able to process.

Intermediate sediments - iron( hemochromatosis, complicated blood transfusion, consequences of hemolytic anemia), copper( Wilson-Konovalov's disease), hyaline( alcoholic cirrhosis).Changes can be both focal and diffuse. Discovered in people of different ages, including children. Nonalcoholic steatosis is more often found in people with excess weight.

According to the type of morphological changes, the structure of the liver changes to the side:

• of swelling and swelling of the parenchyma( depending on the severity of the inflammatory process);
• sclerosing( replacement on scar tissue);
• hypertrophy( proliferation of structural elements);
• dystrophy.

Similar changes may alternate and cause exacerbation or remission of the disease, but speak of pathology, even if poorly identified. The initial stage of the disease according to ECHO-signs can not be seen. Unexpressed symptoms reflect little the degree of disruption in the structure of the liver parenchyma.

Causes of pathology in childhood

Diffuse liver changes in a newborn child are suspected with prolonged severe jaundice, hepatomegaly, splenomegaly. Ultrasound can be used to exclude or confirm a diagnosis. Changes are usually associated with a congenital metabolic disorder, mother-borne diseases during pregnancy( hepatitis, toxic effects of drugs).

If necessary, doctors choose antibiotics with minimal damaging effects on the liver, check the individual sensitivity of the organism. Any allergic manifestations, diathesis, are reflected in the structure of the hepatic cells.

To find out the reasons, the child primarily excludes developmental anomalies and hereditary diseases, blood tests, urine, if necessary biopsy

Forms of ultrasound findings

Description The ultrasound of a doctor is based on his experience. Distinctive shades and forms of liver diseases are treated by a doctor in appearance, the degree of change in echogenicity. The conclusion about diffuse changes can be formulated by the following phrases:

• "insignificant";
• "moderate";
• "pronounced".

The more pronounced the echoes, the more usually the picture of the disease is brighter and the clinical course is heavier. To the defeat of the liver is often associated with inflammation of the pancreas, an organ highly dependent on the functioning of the liver cells and the biliary system. In the "Conclusion" the doctor necessarily indicates an increase in the size of the liver, spleen, the condition of the gallbladder and ducts( concrements, permeability, anatomical narrowing), the walls of large vessels.

"Diffusively heterogeneous changes" - emphasize the different degree of echogenicity disturbance of individual parenchyma sites. Such damage to the structure of the liver is associated with accumulation in the cells of calcinates, iron, copper, uneven cirrhotic process, obstruction of the intrahepatic bile ducts, tumors, tuberculosis, parasitic infections.

The sign of heterogeneity can be regarded as a positive moment, indicating the preservation of the compensatory capabilities of the organ. For doctors and patients, this indicates the advisability of using all available therapies.

Inhomogeneous nodular changes( granulomas) cause medications in 30% of cases. These include: Allopurinol, Carbamazepine, Alpha-methyldopa, sulfonamides, Isoniazid, Quinidine, Procainamide."Diffusively dystrophic changes" - arise with various diseases of organs and systems, which are accompanied by loss of protein, vitamins, complete exhaustion of energy reserves.

They often accompany chronic blood diseases, anemia, but can be the outcome of viral hepatitis, the result of the damage to the liver itself( poisoning with fungi, nitro compounds, soothing drugs), caused by an overdose of diuretics.

Variants of changes for different diseases

The defeat of the digestive system is characterized by mutual complications, a clear connection of functioning. Therefore, in some diseases, diffuse changes in the hepatic parenchyma can occur.

With cirrhosis of the liver

Signs of cirrhosis in the US-study are divided into basic and indirect. The main ones are: an increase in size, an uneven lower edge, a multitude of hyper- and hypo-echogenic small areas due to the replacement of healthy cells with connective tissue, thickening of the portal vein walls and deterioration of visibility of the vascular contours. Among the indirect signs: portal hypertension is indicated by an increase in the diameter of the splenic and portal veins, an increase in the spleen, and the presence of fluid in the abdominal cavity( ascites).

In chronic cholecystitis

Influence on hepatocytes of infection, congestion in bile ducts, changes in bile properties and formation of stones is important. On ultrasonography, the widening or spasm of the ducts is revealed( dyskinesia of the bile ducts), enlargement of the liver and gallbladder size.

With hepatomegaly

A significant increase in liver size is accompanied by a diffuse structural disorder. In differential diagnosis, the role of chronic infections( malaria, tuberculosis, echinococcosis), sarcoidosis, and mononucleosis should be excluded.

With pancreatitis

In response to inflammation of the pancreas, the liver reacts with reactive diffuse changes. In the clinic it is important to find out this mechanism and to exclude the development of the tumor process, stones in the bile ducts. Simultaneously, changes in the structure of pancreatic tissue are revealed.

In diseases of the kidneys

Diffusive liver changes are sometimes detected simultaneously with an increase in the kidney, an enlargement of the pelvis, inflammation, thrombosis of the renal artery, stones in the urinary tract. The connection of the two organs is ensured by mutual "revenue" in the event of a violation of the excretion of slag substances, the accumulation of metabolic products. Therefore, with hepatic insufficiency, the kidneys suffer and vice versa.

Nodular formations may have a different origin

In spleen diseases

The spleen is the main lymph node of the body, responsible for blood circulation, immunity. It is affected together with the liver with increasing pressure in the portal vein system. The fault is the possibility of discharging blood and increasing the load. On ultrasound they detect hepato- and splenomegaly. Treatment of cirrhosis of the liver, prompt additional shunting of blood flow helps restore the function of the spleen.

Treatment of diffuse changes in the liver

Therapy is prescribed by a doctor depending on the particular type of disease. The conclusion about diffuse liver damage is not a diagnosis, therefore, does not have a specific treatment.

An antituberculous agent capable of inducing nodular multiple formations in the liver by the type of granule

This information is taken into account for inclusion in the prescribing scheme:

• dietary food in accordance with table number 5( excluding all irritating acute, fatty, fried foods, condiments, clear regime, balanceby weight of a person, unloading days);
• recommendations for changes in lifestyle and habits( exclusion of any alcohol, smoking, mandatory walks, exercise);
• antiviral or antiparasitic treatment, antituberculosis drugs, cholagogue;
• cytostatics;
• most suitable hepatoprotectors, vitamins;
• of the people's recommendations.

Having received the conclusion of ultrasound research with incomprehensible phrases, do not try to decode it yourself or go to non-professionals. The diagnosis will be correct only after additional functional tests, showing the quality of the liver, identifying specific causes of pathology.