What Causes an Enlarged Liver?
Liver enlargement can be caused by many diseases and is an important clinical sign. The normal liver size is 25cm long x 15cm up and down x 16cm front and back. The liver is often palpable, the edges are sharp and soft without tenderness. Sometimes the liver that is touched under the ribs is not due to hepatomegaly but because the position of the liver is shifted down. This can be seen in women who have loose abdominal walls, sings or performers who have moved through the diaphragm to emphysema, have a large amount of pleural effusion, and axillary Inferior abscesses can sometimes cause gallbladder enlargement, transverse colon tumors, pancreatic cysts, gastric cancer, right kidney ptosis, right hydronephrosis, right kidney cysts, pheochromocytoma, etc. can also be mistaken for hepatomegaly, but the respiratory movement is not as good as the large margin of the liver. The liver is clear, so it should be combined with the history, location and shape of the liver, and texture. The presence or absence of tenderness and other examination results to determine pathological liver enlargement.
Hepatomegaly
- Liver enlargement can be caused by many diseases and is an important clinical sign. The normal liver size is 25cm long x 15cm up and down x 16cm front and back. The liver is often palpable, the edges are sharp and soft without tenderness. Sometimes the liver that is touched under the ribs is not due to hepatomegaly but because the position of the liver is shifted down. This can be seen in women who have loose abdominal walls, sings or performers who have moved through the diaphragm to emphysema, have a large amount of pleural effusion, and axillary Inferior abscesses can sometimes cause gallbladder enlargement, transverse colon tumors, pancreatic cysts, gastric cancer, right kidney ptosis, right hydronephrosis, right kidney cysts, pheochromocytoma, etc. can also be mistaken for hepatomegaly, but the respiratory movement is not as good as the large margin of the liver. The liver is clear, so it should be combined with the history, location and shape of the liver, and texture. The presence or absence of tenderness and other examination results to determine pathological liver enlargement.
Hepatomegaly
- The lower edge of the normal human liver can often be touched at the edge of the right costal arch or slightly lower. If the patient's liver can be touched, the upper limit of the liver should be diagnosed to rule out liver sagging. Continuous monitoring of liver size is of great value in judging prognosis, such as fulminant hepatitis Rapid liver atrophy and liver enlargement at the time of tumor metastasis indicate poor prognosis. Rapid enlargement of the tender liver may be accompanied by intrahepatic cystic or substantial bleeding.
- The texture of the liver is just as important as its size when palpated. Normal livers are soft, with sharp edges and smooth surfaces. These features are often present in acute hepatitis, liver fat infiltration, liver congestion, and early biliary obstruction caused by hepatomegaly. Cirrhosis At the time, the edges of the liver usually become hard, dull, and irregular. Occasionally, a single sclerosing nodule can be touched. If obvious masses can be touched, it indicates malignant infiltration. Friction and murmurs in the liver area, although rare, indicate the presence of tumors. Another important clue.
- During palpation of the liver, liver tenderness is often suspected due to patient anxiety. Hepatic tenderness (a type of deep pain) can be well induced by impact diagnosis or compression of the liver rib area. Acute hepatitis, hepatic congestion, and liver malignancies Often accompanied by hepatic tenderness, but rarely spontaneous right upper quadrant discomfort, occasionally severe liver pain and tenderness resembles surgical acute abdomen.
HepatomegalyIs hepatomegaly hepatitis?
- Hepatomegaly is not necessarily hepatitis, and hepatitis does not necessarily have liver enlargement. Many patients with severe hepatitis and cirrhosis will shrink their livers. Therefore, the diagnosis of hepatitis based on hepatomegaly alone is not rigorous.
Causes of hepatomegaly
- In general, liver enlargement often occurs in patients with viral hepatitis. In contrast, not all patients with hepatomegaly are caused by viral hepatitis. It is necessary to carry out detailed clinical data and analyze carefully to determine its true cause. In addition to viral hepatitis, the following diseases often cause liver enlargement.
- Infectious hepatomegaly
- (A) viral infection
- Hepatitis A, B, and C virus and infectious mononucleosis yellow fever rubella cytomegalovirus simple sore virus coxsackie virus adenovirus band malaria virus measles virus
- (Two) Chlamydia infection
- Like parrot fever
- (3) Rickettial infection
- Typhus typhoid fever
- (IV) Bacterial infection
- Acute obstructive suppurative cholangitis chronic cholangitis primary sclerosing cholangitis bacterial liver abscess liver tuberculosis
- (5) Borrelia infection
- Leptospirosis returns to fever liver syphilis Lyme disease, etc.
- (6) Fungal infections
- Actinomycosis, Bacterial disease, Coccidiomycosis, Cryptococcus disease, Tissue plasma disease, Candida disease, Aspergillosis, Mucor, etc.
- (7) Protozoal infection
- Amoebic liver abscess, black fever, malaria, toxoplasmosis, trypanosomiasis, piriformis, etc.
- Infectious hepatomegaly
- (A) poisoning
- Carbon tetrachloride, chloroform, ethanol, phenol, acetaminophen, sodium propionate, heavy metal, phosphorous, arsenic, isothiocyanate, trinitrotoluene, monoamine oxidase inhibitor, p-aminosalicylate, phenolamine, ethylthioisonicotamine, thiomethylamine Amphetamine Dicyclohexyl ethoxylate Amiodarone Aminophen Junlin Oxidation Needle Polyvinyl Aflatoxin Poison Alarm Isoniacob Sincofen Butapine Rifampicin Tetracycline Biacetol Chloropropionate Methyl Testosterone Oral Contraceptive Ketoconazole methyldopa phenytoin sodium phenobarbital taste sulfa drug sulfide late phenethyl double fertilizer
- (Two) congestive
- Congestive heart failure tricuspid stenosis or insufficiency myocarditis or cardiomyopathy congenital heart disease constrictive pericarditis pericardial stuffing hepatic vein obstruction etc.
- (Three) bile stasis
- Intrahepatic cholestasis, extrahepatic cholestasis, common bile duct stones, bile duct cancer, pancreatic head cancer, ampulla, etc.
- (D) metabolic disorders
- Hepatic amyloidosis Hepatolenticular degeneration Hemochromatosis Yerin disease Hepatic glycogenemia Lipid histiocytosis Familial splenic anemia Cholesterol ester storage disease Ganglion Lipidosis Polysaccharide deposits Galactemia Fructose intolerance cystic fibrosis mountain trypsin deficiency tyrosine metabolism disorder
- (E) Cirrhosis
- Primary bile secondary biliary cirrhosis after portal necrosis of schistosomiasis
- (6) Lunar tumors and cysts
- Primary liver cancer Secondary liver cancer Hepatoblastoma Carcinoid liver mixed tumor Liver adenoma Cyst adenoma Liver Angiosarcoma Liver Hemangioendothelioma Liver cavernous hemangioma Adult liver Polycystic disease Parasite liver cyst, etc.
- (7) Other
- Such as granulomatous liver disease, sarcoidosis, autoimmune hepatitis, hematoma, various blood diseases, multiple myeloma, bone marrow fibrosis, AIDS, etc.
Hepatomegaly mechanism
Hepatomegaly infection
- Vascular congested tissue edema, infiltration of inflammatory cells, and infiltration of other inflammatory substances due to inflammation during various pathogenic microbial toxic hepatitis
- Hepatomegaly
Hepatomegaly and congestion
- In congestive heart failure * pericardial tamponade, constrictive pericarditis, pericardial effusion, and obstruction of hepatic vein return
Hepatomegaly cholestasis
- Liver enlargement due to cholestasis in primary bile cirrhosis of pancreatic head cancer with intrahepatic and extrahepatic biliary obstruction
Hepatotoxicity
- In certain systemic infections of certain drugs and hepatoxins, in addition to direct invasion of the liver, pathogens can cause toxic hepatitis through toxemia, hyperthermic dystrophy, and hypoxia and other factors, causing hepatocyte necrosis to produce microencapsulated fatty deposits, hepatitis-like damage to the liver Fibrotic hepatic veins block capillary biliary cholestasis and cause liver enlargement
Hepatomegaly metabolic abnormalities
- Fatty liver liver amyloidosis and other diseases Fatty glycogen lipid amyloid deposits copper or iron in the liver and enlarges it
Hepatomegaly and Tumor
- Tumor sarcoma benign tumors and various swellings infiltrate liver cells to make them swollen
Hepatomegaly other
- Immune damage, connective tissue disease, blood disease, etc. can cause liver enlargement
Diagnosis of hepatomegaly
History of hepatomegaly
- Medical history often can provide clues to the diagnosis of liver disease. Pay attention to the history of exposure to infectious diseases. Receiving blood products. History of living in endemic areas. This can help diagnoses of infectious diseases and parasitic diseases. History of exposure to drugs or poisons can cause toxic liver tumors. Patients with liver cirrhosis often have a history of chronic alcohol poisoning such as hepatitis and jaundice, and those with liver pain are more common in intrahepatic inflammation, acute liver congestion, intrahepatic mass lesions are mostly dull, but the pain of liver cancer can be quite severe with fever. Prompt hepatitis liver abscess biliary infection liver cancer or other acute infectious diseases blood diseases connective tissue disease and other viral or drug-induced hepatitis accompanied by anorexia
Physical examination of liver enlargement
- (A) the extent of the lesion
- 1 diffuse enlargement due to universal liver disease seen in various hepatitis J fatty liver liver amyloidosis liver stasis liver cirrhosis hepatocellular carcinoma metastasis cancer bile duct cell carcinoma
- 2 Localized enlargement due to intrahepatic mass lesions seen in liver abscess liver cyst liver tumor liver hydatid etc.
- (Two) liver stiffness
- Normally thin people can touch the edge of the liver and the liver is soft and moderately hard. It is seen in hepatitis liver abscess schistosomiasis fatty liver malaria and other liver textures. It is hard in liver cirrhosis in patients with advanced schistosomiasis.
- (3) The edges and surfaces of the liver
- Chronic hepatitis congestion The edges of the liver are blunt and the surface is smooth. The edges of cirrhosis are sharp and nodular.
- (Four) tenderness
- Acute hepatitis Acute hepatic congestion Acute cholangitis or biliary colic onset Tenderness is obvious Bacterial or amoebic liver swelling Tenderness is more severe Mainly localized tenderness Liver cancer often without obvious tenderness In chronic hepatitis, tenderness is milder liver cirrhosis Liver liver amyloidosis and syphilis liver generally without tenderness
- (5) Jaundice
- Extrahepatic biliary obstruction is common in viral hepatitis, biliary cirrhosis
- (Six) weight loss
- Liver cancer with cirrhosis can be accompanied by significant weight loss
- (VII) Ascites
- Liver cancer, liver cirrhosis, acute subacute liver necrosis, circulation disorders, etc. can be seen
- (8) Spiderman and Moon Palm
- Found in chronic liver parenchymal lesions
- (9) abnormal blood clotting function such as purple epilepsy gum bleeding
- Seen in severe liver disease, long-term obstructive jaundice blood disease, leptospirosis, etc.
Hepatomegaly diagnosis
- Medical history can often provide clues to the diagnosis of liver disease. Pay attention to the history of exposure to infectious diseases, the history of receiving blood products, and the history of living in endemic areas.
- Hepatomegaly
Hepatomegaly lesion range
- 1. Diffuse enlargement is caused by general liver disease, and it is found in various types of hepatitis J fatty liver, hepatic amyloidosis, liver stasis, liver cirrhosis, hepatocellular carcinoma metastasis, and bile duct cell carcinoma.
- 2. Localized enlargement is caused by intrahepatic space-occupying lesions. It is seen in liver abscesses, liver cysts, liver tumors, and liver hydatids.
Hepatomegaly liver stiffness
- Normally thin people can touch the edge of the liver and soft and moderate liver can be found in hepatitis, liver abscess, schistosomiasis fatty liver, malaria, etc. Liver texture is seen in liver cirrhosis, advanced schistosomiasis, malignant tumors of congestive cirrhosis, leukemia, liver amyloidosis and syphilis liver.
Hepatomegaly
- Chronic hepatitis congested liver has a blunt edge and a smooth surface. The sharp edge of cirrhosis is nodular.
Hepatomegaly tenderness
- Acute hepatitis: Tenderness is obvious during the onset of acute hepatic congestion, acute cholangitis, or biliary colic. Tenderness is more severe when bacterial or amoebic liver is swollen. It is mainly localized tenderness. Hepatocellular carcinoma usually does not have obvious tenderness, and it is milder in chronic hepatitis. Cirrhosis * Fatty liver, liver amyloidosis, and syphilis liver are generally not tender.
Hepatomegaly jaundice
- Viral hepatitis is common in biliary cirrhosis and extrahepatic biliary obstruction.
Hepatomegaly equipment examination
Liver enlargement ultrasound
- In the diagnosis of hepatobiliary diseases, ultrasound can be used to measure the size and shape of the liver, spleen and gallbladder, and to observe changes in the hepatic veins * veins and their branches;
- Hepatomegaly
X X-ray examination of liver enlargement
- 1. Chest radiography can determine the position, shape, and movement of the right septum.
- 2. Gastrointestinal barium meal can detect esophageal varicose veins, and is helpful for the discovery of biliary obstruction caused by pancreatic head cancer or ampulla cancer.
- 3 Gallbladder or biliary angiography has diagnostic value for gallbladder disease or biliary obstruction, but it is not suitable for patients with jaundice. At this time, percutaneous transhepatic cholangiopancreatography should be performed to determine the presence of stones or tumorous obstruction. Endoscopic retrograde cholangiopancreatography is good but contraindicated when prothrombin time is significantly prolonged. Duodenal fibroendoscopy has a similar effect on percutaneous puncture.
CTMRI CT and MRI of hepatomegaly
- MRI is not as good as CT for the diagnosis of fatty liver and adenoma of liver cirrhosis, but it is worse than CT for the diagnosis of liver cysts and hepatic hemangioma.
- Hepatomegaly
Liver enlargement radionuclide scan
- It can dynamically observe the concentration and passage of radioactivity in the hepatobiliary duct and gallbladder. It can display the size, location and shape of the liver. It is mainly used to diagnose intrahepatic mass lesions. The filling of blood pools has a diagnostic significance for hemangiomas and can also help identify the liver. Internal cholestasis is also extrahepatic obstructive jaundice. Better than X-ray hepatobiliary angiography.
Laparoscopy of hepatomegaly
- It has certain help for the diagnosis and differential diagnosis of various liver diseases. It is used to confirm the diagnosis of hepatitis, the stage of hepatitis, and complications of hepatitis; the nature and extent of the cause of liver cirrhosis; the nature and extent of tumors; No resection; it also helps to distinguish extrahepatic obstruction and intrahepatic cholestasis.
Hepatomegaly liver angiography
- Portal angiography, hepatic venography, hepatic arteriography, and umbilical vein portal angiography are available to understand portal obstruction and measure portal pressure. Hepatic venography can understand the obstruction of the hepatic vein. Hepatic arteriography can help estimate the possibility and extent of surgical resection of liver tumors. MRI can replace some of the invasive angiographic examinations.
Hepatomegaly liver blood flow diagram
- It is a method for non-invasively examining liver and blood vessel function. It measures the impedance change of liver tissue to high-frequency current to reflect the blood circulation status of the liver, and to judge liver function and pathological changes to diagnose and understand the evolution of the disease. . Prognosis and outcome, although the liver blood flow chart is not specific to the etiology, it has significance in reflecting the degree of liver lesions. It is useful for the judgment of chronic hepatitis and early portal hypertension of cirrhosis, cardiogenic liver congestion, and the diagnosis and localization of liver cancer. Have some value.
Liver biopsy
- The indication is that the hepatomegaly of unknown cause has a clear effect on the diagnosis and removal of prognosis, understands the evolution of various liver diseases, and provides a reliable scientific basis. It is contraindicated in severe jaundice, ascites or coagulopathy.
Hepatomegaly viral infection
- 1. The incubation period of hepatitis A virus is mostly 15-40 days. HAV can be detected from feces from 9 days before the onset of disease to 17 days after the onset of disease. SGPT often reaches a peak of more than 500 units in the first week. SGPT> SGOT, AKP does not increase so SGPT / AKP7, serum anti-HAV-
- Hepatomegaly
- 1. Acute jaundice type: It can be divided into three stages d. The pre-stage of jaundice usually takes 2-16 days. In the stage of jaundice, about one week after the onset of liver and splenomegaly, jaundice reached a peak within one to two weeks of each other, and then gradually reduced. Generally, children subsided within two to four weeks. In the recovery period, the jaundice fades and the liver and pain and other symptoms are reduced. The appetite is normal, but there is still fatigue and mild hepatic pain. This period is about one month. Children are lighter, and adults with more severe jaundice can last about 3-4 weeks.
- 2. Acute jaundice-free hepatitis: The disease is similar to jaundice, except that there is no jaundice, but it is generally milder and shorter in duration. If you do not take appropriate rest in time, the course may be prolonged, but it does not become chronic.
- 3 Fulminant hepatitis: Rarely onset and acute hepatitis, but the disease develops rapidly, the course of disease does not exceed 2-3 weeks, the mortality rate is high, mental symptoms or personality changes may occur first, and it is easy to misdiagnose whether there is high fever, liver dullness Reduced, mild ascites and continuous observation of serum bilirubin and transaminase daily. Most died of liver failure, impaired coagulation mechanism, gastrointestinal bleeding, cerebral edema, and hernia.
- 2. Hepatitis B virus Hepatitis B virus has a longer incubation period of 6 weeks to 6 months, and its onset is related to the body's immune response and immune regulatory dysfunction. Serum GPT can increase HBsAg-positive, anti-HBcIgM antibody-positive, and e-antigen-positive persons who are infectious. E-antigen-positive DNA polymerase is also positive. DNA polymerase positive in serum is an indicator of viral activity, and chronic e-antigen-positive chronic Chronic active inflammation in the liver of HHV-infected patients basically has HB-SAg titers ranging from high to low, and anti-HBS positive after disappearance; or high levels of anti-HBC-IGM titers in the acute phase, and anti-HBC-IGG negative or A low level can be diagnosed as acute hepatitis B clinically consistent with chronic hepatitis, and more than one positive marker of HBV infection is chronic hepatitis B. Hepatic function was normal without any clinical symptoms and signs, and those who were positive for more than 6 months were chronic carriers of HBSAG.
- 3 Hepatitis C virus The incubation period of hepatitis C virus is mostly 5-9 weeks, and there are as short as 2 weeks and up to 26 weeks. Although most patients have a history of blood transfusion or injection, it is reported that 58% of patients with anti-HCV antibody are injected. history. Onset is usually slow, the clinical manifestations are generally not severe but they are more likely to become chronic. Blood aminotransferases fluctuate greatly in a relatively short period of time. Polymerase chain reactions detect HCV on average 15 weeks after the onset of antibodies. The early positive rate of RNA is higher.
- 4 Hepatitis D virus Hepatitis D is transmitted in the same way as hepatitis B virus. It can be transmitted through blood transfusion, blood product injection, acupuncture, close contact and perinatal transmission. Chronic active hepatitis in China is combined with toxic hepatitis There are many cases, and the diagnosis is based on: serum anti-HD-IGM, or anti-HD or HDA positive. HDV-RNA was positive in serum. HDAG or HDV-RNA positive clinical manifestations of liver tissue can be divided into HBV / HDV combined infection; HBV and HDV overlapping infection.
- 1. Combined infection: There are two common cases. The course of HBV / HDV combined infection is benign and self-limiting. The clinical manifestation is similar to that of simple HBV acute infection. Sometimes, the first peak of the double peak of glutamic acid aminotransferase is caused by HBV, and the second peak is seen. Caused by HDV. Another combined HBV / HDV infection is severe or fulminant hepatitis.
- 2. Overlapping infections: The clinical manifestations are also divided into two types. When acute hepatitis occurs in asymptomatic carriers of HBSAG, it shows typical HBSAG.
- Hepatomegaly
- 5. Formed viral hepatitis The prevalence of type E viral hepatitis is very wide. In some areas, shaped viral hepatitis can account for 50% of clinical viral hepatitis. It can be prevalent all year round but is more common in autumn and winter. It often occurs after rain or flood. Later, the epidemic caused by water pollution can be detected in the feces 1-4 days before the onset of detoxification within 2 weeks after the onset of HEV. About half of the patients with fever, joint pain, jaundice, cholestasis, and clay-like stools are more common than viral hepatitis A. Symptoms are generally more severe than viral hepatitis A and viral hepatitis A and viral A Although hepatitis is also an orally transmitted RNA virus, the main clinical difference is that the infection rate of hepatitis A virus is high and the incidence rate is low. It often invades young children and children with hepatitis E virus infection. The highest mortality rate is 30-40 years old, with a mortality rate of about 1% -2%, which is 10 times that of viral hepatitis A. The mortality rate of viral hepatitis E in pregnant women can reach I20% -30%, especially in the middle and late pregnancy. Most are outbreaks of type I.
- 6. Infectious mononucleosis The disease often has hepatomegaly and abnormal liver function, but the fever is higher than hepatitis, and the duration is longer. It often has throat pain, congestion and endocrine secretions, and lymph nodes in the neck and other parts often swell and spleen. Larger and more tenderness. White blood cell count is normal or increased, mononuclear cells are above 0.50, abnormal lymphocytes are above 0.10, heterophilic agglutination test is positive, anti-EB virus antibody titer is increased by more than 4 times or specific IGM antibody is positive, and diffuse mononuclear cells can be seen on liver biopsy Cell infiltration and focal liver necrosis.
- 7. Cytomegalovirus infection Infected monocyte-like symptoms, signs, and typical hemograms may appear in normal adults after infection. However, the heterophilic agglutination test is negative, liver swelling and abnormal liver function are milder, and liver biopsy shows inflammation. Sexual infiltration and mild hepatocellular necrosis or small granulomas and giant cells, but the chance of finding giant cell inclusions in the liver is rare. Immunosuppressed patients may be asymptomatic or have most organs affected after infection, such as hepatitis, pneumonia, arthritis, and many other lesions, fever, leukopenia, lymphocytosis, abnormal lymphocytes, and hepatosplenomegaly myalgia And joint pain. The diagnosis depends on the isolation of virus from blood, urine, sputum or feces, fresh urine centrifugation or oropharyngeal secretion smear staining microscopic examination of inclusion bodies, or double serum for complement binding test or neutralization test with increasing anti-CMV titer. Anti-EBV-negative fever is rickettsial infection, which may include fatigue, anorexia, nausea, and vomiting. Most are associated with right upper quadrant pain and hepatomegaly, and tenderness may not be significant. Some patients are accompanied by splenomegaly and jaundice. Positive flocculation reaction and serum aminotransferase. Alkaline phosphatase activity increased, often similar to viral hepatitis, but the following points can help identify: onset of chills, fever is significant, high fever lasts 1-3 weeks, headache, lower back and visceral bowel muscle pain; part Patients may be associated with atypical pneumonia; have a history of contact with cattle and sheep and other livestock, especially the staff in the affected areas such as pastures, slaughterhouse meat processing plants, tanneries, etc. are more likely to get sick; reverse indirect hemagglutination and enzyme-linked immunoassay Adsorption detection of antigens can help early diagnosis.
Hepatomegaly
- 1. Right heart failure caused by any cause of right heart failure can significantly increase venous pressure, jugular venous bulge, positive signs of hepatic jugular vein reflux, enlarged heart, weakened pulsation, marked hilar vascular shadow, hepatomegaly, tenderness, brand It can be slightly swollen, rare in jaundice or mild varicose veins in the thorax and abdomen, edema in the lower extremities, small increase in ascites volume, and yellow leakage. Hepatomegaly is characterized by an increase in heart failure and a significant contraction when the heart failure improves. Sulfur sodium phthalate retention increased, urine bilirubin excretion increased, serum glutamyl aminotransferase was generally normal. B-ultrasound revealed hepatic vein dilatation.
- 2. Chronic constrictive pericarditis usually has tuberculous pericarditis, purulent pericarditis, viral pericarditis, or a history of cardiac trauma. There is a significant jugular vein filling, elevated venous pressure, and positive hepatic jugular vein reflux signs. A heart is normal or slightly larger, the heart beat is significantly weakened, and the heart sounds are distant with a pericardial throbbing sound. X-ray examination showed that the hilar vascular shadow was clear, the normal contour of the pericardium was changed or the pericardial calcification shadow was significantly enlarged and painless, and the brand could be slightly enlarged with normal liver function or mild abnormality.
- 3 The incidence of Parkinson's syndrome in men aged 20-45 is high. The clinical manifestations are different due to the etiology, location range, extent, the onset of the onset, and the length of the disease that cause hepatic vein or inferior vena cava obstruction. The acute phase is characterized by rapid onset of pain in the liver area and progressive ascites with progressive hepatomegaly. The abdominal wall is dilated and severe liver damage with varying degrees of liver damage or rapid death occurs. Except for some patients who are transferred from the acute phase in the chronic phase, most of them show latent symptoms and signs appear slowly. Elderly patients with splenomegaly and esophageal varicose veins, and inferior vena cava obstruction chest. Venous varicose veins in the abdominal wall are very obvious. The direction of blood flow is edema from both sides of the lower extremities, tan pigment spots on the calf skin, severe varicose veins in the lower extremities and even nutritional ulcers in the feet and ankles, and venous pressure in the lower extremities increases. Liver function was only mildly impaired by the sulforphtal sodium test, and alkaline phosphatase was elevated. B-ultrasound can show the diameter of the inferior vena cava to determine whether there is stenosis or obstruction, the location and scope of the obstruction, the size and shape of the liver and spleen, and the presence of ascites. Scanning of the nuclide liver enlarges the abnormal morphology of the liver, and the tracer gathers in the congested and enlarged liver tail lobe, showing a "central concentration" phenomenon. The tracer in the right lobe of the liver is sparsely distributed or significantly reduced. Angiography can identify the site of the blockage. The scope and degree of nature not only provide important diagnostic evidence, but also provide an important basis for clinical typing and the selection of the correct surgical method is an indispensable examination.
Biliary stasis
Intrahepatic cholestasis
- Includes hilar and intrahepatic bile duct obstructive lesions and those mainly caused by functional disorders. Common in young and middle-aged people who have hepatitis or liver poisoning
- Hepatomegaly
Extrahepatic cholestasis
- 1. Common bile duct stones: biliary tsutsugamushi disease and recurrent history of paroxysmal epigastric or right upper quadrant colic, fever, chill jaundice are volatile, gallbladder
- Hepatomegaly
- 2. Cholangiocarcinoma: The clinical manifestations are obstructive yellow, the most prominent is the sustainable rise of jaundice, which can also be temporarily reduced, accompanied by epigastric pain, weight loss of gastrointestinal symptoms, physical weakness, cachexia in fatigue, liver enlargement, sometimes accessible The enlarged gallbladder may have ascites, and the specific performance varies depending on the location of the cancer and the course of the disease. Hematuria and feces were checked for bilirubin, urinary (feces), biliary protozoa (feces), and serum alkaline phosphatase. Duodenal guidance fluid contains very little blood or bile, and cancer cells found in the drained bile fluid can be clearly diagnosed by B-ultrasound showing gallbladder enlargement and obvious fluid accumulation, but no stone shadow pancreaticobiliary angiography, a section of the bile duct Percutaneous hepatobiliary angiography can show stenosis and filling defects, which can show intrahepatic bile duct dilatation, filling defect of a part of extrahepatic bile duct, lumen stenosis and roughening.
- 3 Pancreatic head cancer: pain in the upper abdomen or umbilicus radiates to the left lower back, progressive jaundice, skin cancer rarely seen in itching of the liver and biliary enlargement, often with duodenal drainage of pancreatitis, cancer cells or red blood cells are seen. Duodenal barium imaging showed enlarged duodenal ring. B-ultrasound revealed a dilated gallbladder with a common bile duct and a parenchymal mass in the head of the pancreas. Endoscopic retrograde cholangiopancreatography showed that the bile duct was interrupted, narrowed, displaced, and filled with acinar defects.
- 4 Ampulla: It may have a history of chronic cholecystitis and cholelithiasis, which is more common in men over 50 years of age. Deep upper abdominal pain or faint pain radiates to the back, jaundice progresses progressively, may have fluctuating common skin cancers, hepatomegaly, hard, tenderness, palpable mass in the upper abdomen, and may be accompanied by gastrointestinal bleeding Cholangitis and pancreatitis, the metastasis is late, the feces show a normal white clay color, the number of white blood cells is normal, the fecal occult blood test is positive, the urobilin-positive aminotransferase is normal, and the alkaline phosphatase is elevated. Duodenal drainage showed cancer cells and bleeding in the descending section of duodenal angiography with an inverted "3" shape. B-ultrasound showed dilatation of the bile duct above the obstruction, and uneven hypoechoic endoscopic retrograde cholangiopancreatography showed a shadow of the tumor in the nipple area. CT examination showed dilated bile ducts and pancreatic ducts, and the dilated ducts remained round.
Liver enlargement prevention and care
- 1. Diet should provide adequate nutrition, food should be diversified, high-protein protein containing amino acids, multi-vitamins, low-fat, low-residue diet should be provided to prevent rough multi-fiber food from damaging esophageal veins and causing major bleeding.
- 2. People with high blood ammonia or poor liver function should limit protein intake to avoid liver coma. People with ascites should eat a low or no salt diet.
- 3. Daily measurement of abdominal circumference and urine output, abdominal obesity is a great way to self-identify fatty liver.
- 4. Pay attention to changes in bleeding, purpura, fever, and neurological symptoms, and contact your doctor in time.
- 5. Selenium supplementation, selenium supplementation can make the activity of glutathione peroxidase in the liver reach normal levels, and it has a good effect on nourishing the liver and liver. Liver and liver protection play a good role in regulating immunity and have a good effect on nourishing and protecting the liver.