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Hepatomegaly, what is it? Signs of liver changes, treatment and prognosis

The liver is a very important organ for the human body. However, a large number of pathological processes accompanying various diseases lead to the impairment and depression of the liver function. The range of its functions is very diverse:

  • Synthesis of plasma proteins.
  • The formation of bile and bile acids.
  • Detoxification function.
  • Utilization of blood cells (leukocytes and red blood cells).
  • Synthesis of cholesterol, which is used later for the synthesis of steroid hormones.
  • Participation in carbohydrate metabolism (glycogen storage, etc.), fats and proteins.
  • Ensuring the exchange and excretion of hemoglobin degradation products.

Thus, any pathology that causes a violation of the functions or changes in the liver, leads to serious consequences for the human body.

Therefore, the task of any physician is to suspect the disease in time, which may result in a complication in the form of disruption of the normal functioning of this organ. The patient's task is to identify the symptoms that indicate pathology in oneself - and for this, they need to be known.


Hepatomegaly - what is it?


Hepatomegaly is a process of increasing the size of the liver, initiated by various painful conditions. It can cause diffuse changes of the liver or focal, but it is always pathological, since it is the diseases that lead to such a dramatic change in the size of an organ that it is not characteristic even in a period of increased functional load.

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

With a lesion of even 70-80%, clinical symptoms of liver failure may not be observed. However, enlargement of the liver is quite simple to detect both by palpation (by the method of palpation — normally, the liver does not extend beyond the costal arch), and thanks to the ultrasound examination.

Each patient should understand that hepatomegaly is a reversible process (unlike cirrhosis, hepatocarcinoma) and, if properly treated, causes of hepatomegaly, the size and function of the organ return to normal. But for this you need to consult a doctor promptly.

Unfortunately, in some cases, it is such a pernicious habit of patients, as excessive drinking and leads to the disease. The latter may 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 it can lead to the formation of fatty hepatosis , leaving irreversible traces in the liver.

Signs of hepatomegaly - how is liver enlarged?

Signs of Hepatomegaly It is quite difficult for a person to determine that the liver began to slightly increase in size on its own. Normally, the edge of the liver is hidden under the costal arch, which protects the organ, as well as the rib cage as a whole.

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

Often, an enlarged liver can be hidden behind the accompanying pathological processes to which the pathology of the hepatobiliary system (liver, gall bladder, biliary ducts) leads. These processes are:

  • Ascites - accumulation of fluid in the abdominal cavity;
  • The inflammatory process in the abdominal cavity, which is accompanied by muscular defence (tension of the abdominal muscles);
  • Bleeding in the abdominal cavity;
  • Abdominal mass formations (benign gastrointestinal tumors);

In such cases, hepatomegaly is detected already in the 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 to diagnose and detect hepatomegaly:

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

causes of hepatomegaly Each approach has its own advantages and disadvantages. Therefore, to increase the accuracy of diagnosis, they try to use both approaches, and the manual methods are primary, and the visualization methods are secondary.

Such a manual technique, like percussion of the anterior abdominal wall, allows determining the approximate boundaries of the liver by the change in percussion sound (Kruglov technique). In modern medicine, this technique loses its relevance for the diagnosis of hepatomegaly, since it is extremely inaccurate, and its reliability varies from the skills of a particular doctor and the state of the patient’s abdominal cavity organs.

In addition, notice an increase in the body can only be with moderate and severe. Kurlov does not define a light degree of percussion.

Reception of a palpation of a stomach - classical medical diagnostic reception. Thanks to him, it is possible to determine whether the edge of the liver protrudes above the costal arch and how many centimeters. The basics of the technique of palpation of the abdomen and liver laid Samples, even the beginning of the twentieth century. She is still used by all surgeries and therapists of the CIS countries.

The main advantage of the method of palpation of the liver is its simplicity, accessibility and almost unmistakable determination of an enlarged liver in almost every patient. It is thanks to palpation and hepatomegaly is detected at the first stage, especially if it is asymptomatic.

An enlarged liver is considered when both its lobes (right and left) above the costal arch are palpated 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 of the furnace (soft, elastic, stony, hilly, pastous, etc.). With some probability this may indicate the nature of the pathological process.

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

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

The different position of the sensor of the ultrasound apparatus can introduce its own errors and give a false measurement result. Therefore, a threefold definition of each ultrasound distance is recommended.

Causes of Hepatomegaly

The causes and mechanisms causing hepatomegaly are very different in nature. Therefore, when such a syndrome is found in a patient, a whole range of diagnostic studies is shown and all the circumstances of his history are ascertained. Generally, all the reasons that cause hepatomegaly in humans can be represented as follows:

  • The inflammatory process in the liver is hepatitis. By nature, hepatitis can be viral, bacterial, toxic, medicinal, autoimmune, and idiopathic (of unknown origin). Liver abscesses, which are most often caused by bacterial or fungal flora, are also inflammatory processes and can lead to hepatomegaly.
  • Vascular (venous) blood stasis. Most often observed in right ventricular heart failure. However, it can also be triggered by the development of portal hypertension (an increase in venous blood pressure in the portal vein of the liver).
  • Diseases of the blood and hematopoietic system (lymphoma and leukemia). The liver contains in its composition reticular tissue, which destroys blood cells that perform their function. In oncological processes of the hematopoietic system, the abnormal cells and accumulate in the liver, causing it to increase. Therefore, the exclusion of oncology is the first direction of the diagnostic search with an enlarged liver.
  • Hepatomegaly in a child can be caused by various toxic poisonings, including foodborne toxicoinfections.
  • Pregnancy. In this case, we are talking about HELLP syndrome. This is a severe form of preeclampsia , which is characterized not only by an enlarged liver, but also by a decrease in the activity of its enzymes, a decrease in the number of platelets in the blood and red blood cells due to their destruction.
  • Hepatomegaly due to fatty hepatosis. This is the process of accumulation of fat in the liver cells, which leads to a decrease in the functional activity of the organ. Pathology is triggered by the use of alcohol, toxins in the body, diabetes, glycogenosis.
  • Cirrhosis of the liver at an early stage (at a later stage, wrinkling of the body occurs with a decrease in its size).
  • Oncological processes in the liver (adenomas, carcinomas, metastases).
  • Polycystic liver.
  • Echinococcal cysts of the liver.
  • Genetic liver disease ( Gilbert syndrome , enzyme deficiency, etc.)
  • Granulomatous inflammation caused by tuberculosis , syphilis , etc.
  • Infectious diseases affecting the blood and lymphatic system ( malaria , typhoid fever , yellow fever, etc.). When they are often observed concomitant enlargement of the spleen. Then it is customary to talk about hepatosplenomegaly.

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

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

Sometimes an enlarged liver can be associated with the pathology of the neighboring organs of the gastrointestinal tract. Hepatomegaly of the liver due to the pancreas with an inflammatory process is not uncommon.

How to treat hepatomegaly? - diet, drugs and techniques

How to treat hepatomegaly

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

After installing the final cause of the development of the syndrome, the doctor prescribes a complex of therapeutic measures, including not only the medication:

  • Diet with the exception of high fat, with a normal level of protein and carbohydrates. Refusal to use any form of alcohol, as well as the rejection of other bad habits - smoking, drug use, etc.
  • The appointment of hepatoprotective drugs. Their task is to stimulate regenerative processes and protect hepatocytes from toxins. In milder forms of hepatomegaly, herbal medicines are used (milk thistle extracts, etc.). For more severe pathologies, essential phospholipids and urodesoxycholic acid preparations are used.
  • Etiotropic treatment of hepatomegaly is aimed at eliminating the cause of the development of liver pathology and its increase (as a consequence). Depending on the causative agent of the infection, antibiotics, antivirals, interferons, antifungals, etc. are used. Pathology of the circulatory system requires more complex treatment using hormonal preparations and cytostatics, as well as bone marrow transplantation. Cancer pathology is treated by surgery, chemotherapy and radiation of the tumor process.
  • Symptomatic treatment is designed to eliminate the specific symptoms of the disease - pain, heaviness in the abdomen, swelling, heartburn, etc.

The 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 prognosis is favorable.

All known diseases that lead to such a condition are successfully treated, incl. and viral hepatitis C. If the main disease of the patient is at the stage of progression, the prognosis is relatively favorable.

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


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