Hepatomegaly is a physiological or pathological increase in the metric parameters of the liver, manifested diffusely or localized and not in all situations accompanied by damage to the hepatocytes. Hepatomegaly of the liver can observed in an isolated version, which is most often due to organic pathology of this organ or in combination with splenomegaly, which is a manifestation of systemic changes in the human body ( heart failure , endophlebitis of the hepatic veins).
Diagnosis of hepatomegaly does not present difficulties for experienced specialists even during the primary objective examination of the patient's liver, in case of a significant increase in its size, a tumor-like formation localized in the right hypochondrium is displaced when performing respiratory movements. In a situation where hepatomegaly syndrome in the patient has a long period of time and a pronounced character, even a deformation of the chest is noted.
Diagnosis of hepatomegaly solely on the basis of percussion and palpation is extremely doubtful, therefore, for reliable verification of the diagnosis, the use of instrumental imaging techniques is mandatory. Palpation gives more definite data. Under normal conditions palpation, the edge of the liver has a soft consistency and is absolutely painless. When hepatomegaly, due to the organic lesion of the hepatic parenchyma, there is a simultaneous increase in the organ and its compaction.
Causes of hepatomegaly
The fundamental function of the liver, as an organ, is the cleavage of metabolic products into components that do not show signs of toxicity, which are freely isolated from the body by the natural process of bowel movements and urination. The cleavage of metabolic products is a complex chemical process aimed at neutralizing toxic substances and poisons. The disease "hepatomegaly" in most cases is accompanied by a disruption of the detoxification function of hepatocytes, so the body excessively accumulates poisons and / and toxins that poison the patient's body. Many doctors do not consider hepatomegaly as an independent nosology and use the term "hepatomegaly syndrome", which reflects pathological changes in the state of a macroorganism.
All the etiological factors provoking the development of hepatomegaly are divided into three broad categories: organic liver pathologies, pathological conditions, accompanied by a violation of metabolic processes in the body, diseases of the cardiovascular profile.
Organic liver damage develops as a result of direct damage to hepatocytes, accompanied by edema of surrounding tissues, and the initiation of regenerative processes in the hepatic parenchyma. In a situation where liver hepatomegaly is caused by swelling, anti-inflammatory measures quickly stop this process and liver sizes are normalized in a short time. Regenerative processes occurring in the liver with damage to hepatocytes provoke more persistent hepatomegaly, and due to the growth of the interstitial sclerosing component of the focal character, the surface of the liver becomes bumpy.
As a background liver disease for the development of hepatomegaly, various organic pathologies can occur in the form of inflammatory hepatitis, cirrhosis of the liver, echinococcal hepatic cysts, cancer, the presence of a multitude of liquid containing structures in the liver parenchyma, a general toxic poisoning of the organism, with the role of a poison agent being various substances (medicines, alcohol, food toxins).
Systemic diseases accompanied by the development of metabolic disorders in the body, in almost 90% of cases are accompanied by the development of hepatomegaly, which can be both moderate and severe. The disease of hepatomegaly in this situation develops as a result of excessive accumulation of metabolic products, in connection with which, these pathologies are combined into a single concept of "accumulation disease".
The most common etiopathogenetic forms of accumulation diseases accompanied by hepatomegaly include: hemochromatosis , steatosis, amyloidosis and hepatocellular degeneration. Some of these pathologies are genetically determined, and as a triggering mechanism for the development of hemochromatosis, for example, modifiable etiological factors act, eliminating which can level the manifestations of hepatomegaly. In the emergence of hepatomegaly due to metabolic disorders, the most important is the alimentary factor ( obesity , alcoholism, uncontrolled intake of medicines).
Insufficiency of blood circulation, which accompanies the course of constrictive pericarditis, provokes blood stasis, hypoxia and swelling of all organs, not excluding the liver. The result of the edema of the hepatic parenchyma is the destruction and squeezing of hepatocytes, in the place of which connective tissue develops, accompanied by hepatomegaly. The outcome of hepatomegaly in most situations is cirrhosis of the liver , which is a terminal condition, followed by a reverse organ reduction.
Often hepatomegaly can develop during pregnancy, especially in the third trimester, as a significant increase in the uterus provokes a shift of the liver up and to the right, and the parenchyma becomes more full-blooded. As a result of a decrease in the motor function of the diaphragm, the excretion of bile is difficult. Intrahepatic cholestasis , which is observed in 20% of pregnant women, which is a hereditary pathology, is always manifested by hepatomegaly.
Hepatomegaly in the first trimester of pregnancy is a reversible physiological process due to toxicosis. A similar situation is observed in 2% of cases and completely leveled at 20 weeks of pregnancy .
Physiological hepatomegaly in a child of the newborn period also occurs quite often, however, in the normal course of its manifestation disappear quickly enough. Among the causes of pathological hepatomegaly in infants, infectious diseases and biliary duct obstruction are most often observed. Hepatomegaly in a child with age is much less common and develops more often with intoxication.
Symptoms and signs of hepatomegaly
Clinical manifestations of hepatomegaly directly depend on the etiopathogenetic factor of its occurrence. Common symptoms for all diseases accompanied by hepatomegaly are the appearance of painful sensations and feelings of stiffness in the right hypochondrium arising from movements and breathing. Dyspeptic phenomena often accompany the course of hepatomegaly and manifest as nausea, heartburn and bad breath, stools in the form of diarrhea or constipation.
Specific manifestation of hepatomegaly in inflammatory lesions of the hepatic parenchyma is the appearance of icterus of the skin and skin itching . An enlarged liver is accompanied by an increase in the density of the parenchyma, in connection with which, the edge of the liver is easily palpable under the right costal arch, and palpation causes unpleasant sensations in the patient. Painful sensations in hepatitis with hepatitis provoked by the hepatitis are permanent and cause severe discomfort on the part of the patient. Hepatomegaly of the liver with hepatitis is always accompanied by the development of icteric skin and intoxication symptoms, manifested by weakness, subfebrile fever, headache. Timely diagnosis of hepatomegaly, verification of the cause of its occurrence and selection of an adequate scheme of drug treatment can completely eliminate the hepatomegaly syndrome.
Cirrhosis of the liver at an early stage of development is also accompanied by the development of hepatomegaly, but its occurrence is due not to the swelling of the parenchyma, but to the massive destruction of hepatocytes and the replacement of the hepatic parenchyma by connective tissue. With the continuing pathological process, the hepatic parenchyma is completely replaced by connective tissue. Specific manifestations of hepatomegaly in liver cirrhosis are frequent episodes of bleeding, an earthy color of the skin and a throbbing pain syndrome in the right hypochondrium of a permanent character.
In a situation where hepatomegaly is triggered not by damage to the hepatic parenchyma, but by metabolic disturbances of a hereditary or acquired character, there is an excessive accumulation of glycogen accompanied by a slow increase in liver size. In addition to damaging effects on the liver, there is a lesion of the spleen and kidneys, which also increase. Hepatomegaly with hemochromatosis develops like cirrhosis of the liver, but in addition to liver damage, there is damage to the pulmonary parenchyma, so in addition to the symptoms of hepatomegaly, the patient develops an intense cough with bloody sputum.
An objective examination of a patient suffering from hepatomegaly, consisting in the use of palpation and percussion, does not allow to fully appreciate the size of the organ and pathomorphological changes in the structure of the liver. However, ultrasound diagnosis allows to establish the cause of hepatomegaly and the presence of focal lesions of the parenchyma. With ultrasound scanning, the doctor of radiation diagnostics evaluates not only the enlargement of the liver, but also its topographic position, changes in the hepatic structure.
Ultrasound scanning allows you to assess the degree of increase in the liver, as well as the state of other organs of the abdominal cavity. More detailed information on the liver status in hepatomegaly can be obtained with the help of such a technique as echogepatografiya.
Echo signs of hepatomegaly are of great importance in the verification of the background disease, which was the cause of the development of this pathological condition. Hepatomegaly with heart failure, acute hepatitis or parasitic diseases is not accompanied by a change in the echostructure of the liver, which remains homogeneous. In a situation where hepatomegaly is provoked by fatty hepatosis , cirrhosis and chronic hepatitis, the echostructure of the organ and the echocardiogram of hepatomegaly are disturbed by a focal character.
Based on the evaluation of echoes of hepatomegaly, the extent of liver damage can be reliably estimated. Thus, expressed hepatomegaly is a sign of a pathological but reversible increase in liver parameters, which is observed with hemoblastosis and leukemia , for example. Subsequently, foci of necrosis and interstitial growth appear in the hepatic parenchyma. The liver in this case reaches extremely large sizes and occupies a significant part of the abdominal cavity, exerting a compressive effect on adjacent organs.
The detection of severe hepatomegaly must necessarily be accompanied by an evaluation of its structure, contour and vascular pattern. In a situation where pronounced hepatomegaly is accompanied by the appearance of areas of stony density, tumor-like lesions of the liver should be considered.
The term "diffuse liver hepatomegaly" should be used when the liver parameters exceed 130 mm. The liver parenchyma is divided into two large lobes, and each of them is supplied with blood from various vessels, and also has a separate innervation and bile excretion. Diffuse hepatomegaly implies the defeat of all parts of the hepatic parenchyma.
Streptococcal and staphylococcal flora provokes the development of a variety of abscesses in the hepatic parenchyma, which refers to the diffuse form of hepatomegaly. Manifestations of hepatomegaly in this case consist in tachycardia , aching pain in the right hypochondrium, radiating into the upper humeral girdle, severe chills. The treatment of diffuse hepatomegaly due to abscessed infection implies the use of surgical aids, since drug treatment in this situation does not give the proper effect.
Diffuse lesions of the liver parenchyma, accompanied by hepatomegaly, can also occur with toxic damage to the body and cirrhosis. In this situation, hepatomegaly often combines with an increase in the size of the spleen and the appearance of signs of portal hypertension .
Diffuse hepatomegaly often develops as a result of inflammatory organ damage. Under normal conditions, the liver is uniform in structure and there are no deformations or densities in it. With diffuse hepatomegaly, moderate changes in liver structure develop with complete preservation of liver function. With severe diffuse hepatomegaly, hepatic insufficiency gradually develops, intoxication develops and a tendency to recurrent bleeding is noted. Diffuse hepatomegaly can develop both against a background of hepatic diseases, and with systemic damage to the body, caused by metabolic disturbances or intoxication.
Among the reasons for the development of diffuse hepatomegaly should also be considered long-term use of drugs or alcohol abuse, the toxic effect of which inevitably provokes a violation of the liver function, a change in the structure and metric parameters of the organ.
Diagnosis of the diffuse form of hepatomegaly is based on an ultrasound examination, and in the presence of any changes in the structure of the hepatic parenchyma, an additional laboratory examination (biochemical blood test, markers of viral hepatitis, oncomarkers) is shown to the patient.
The basic link in the treatment of diffuse hepatomegaly is strict adherence to the diet with a complete rejection of fatty foods, alcohol, and the use of funds whose action is directed at detoxification of the body as a whole and the liver in particular.
By moderate hepatomegaly means a slight increase in the metric parameters of the liver, not exceeding 20 mm, which can only be diagnosed with the use of instrumental imaging techniques. Clinical signs of moderate hepatomegaly, as a rule, are minimal, which makes it difficult to diagnose this condition early. Clinical manifestations of moderate hepatomegaly appear only with prolonged course and organic lesion of the parenchyma, accompanied by a violation of the function of the organ. Thus, moderate hepatomegaly tends to progress and provoke a significant disorder of the patient's health.
Typical signs of moderate hepatomegaly are generalintoxication manifestations in the form of unmotivated weakness, rapid fatigue, which have nothing to do with physical activity of a person. Moderate hepatomegaly almost never causes an intense pain syndrome in the abdominal cavity; however, some patients suffering from this pathology note the periodic appearance of unpleasant sensations of gravity in the epigastrium on the right, heartburn and a violation of appetite in the form of its decrease. The appearance of even such nonspecific manifestations of moderate hepatomegaly should be the cause of further instrumental examination of the patient in order to eliminate the cause of its occurrence. The initial link in the diagnosis of moderate hepatomegaly is ultrasound scanning of the abdominal cavity, however, it should be borne in mind that in some patients, echography can be difficult, and in addition, a computer tomographic examination of the abdominal cavity organs should be performed additionally.
Symptoms of mild hepatomegaly can often be of a partial nature, that is, the increase in the liver is not diffusive, but due to changes in the limited areas of the hepatic parenchyma, whose echoes are the detection of areas of structural damage in the form of abscesses, tumors, metastases.
Moderate hepatomegaly is most often provoked by a disease such as fatty hepatosis, the pathomorphological basis of which is the degeneration of hepatocytes into fat cells. The main etiopathogenetic factor in the development of moderate hepatomegaly due to fatty hepatosis is alimentary obesity, that is, human consumption of a large number of simple fats. Fat hepatosis refers to the slowly progressing form of hepatomegaly and several stages are distinguished in the pathogenesis of its development.
Treatment of hepatomegaly
The choice of an adequate treatment regimen for hepatomegaly largely depends on the etiopathogenetic form of this pathology and the individual characteristics of the patient's body. The primary task of the attending physician observing the patient with hepatomegaly is to determine the root cause of the development of this syndrome and the use of empirical therapy, that is, medical or surgical treatment aimed at eliminating the etiologic factor. Therapeutic measures of symptomatic orientation are of secondary importance, but should also be included in the basic therapy for hepatomegaly to alleviate the patient's condition.
Therapeutic measures of non-drug use in hepatomegaly include adherence to strict dietary intake, a sparing regimen of physical activity and traditional medicine.
In a situation where hepatitis develops against the background of hepatitis, the antiviral drug treatment, as well as hepatoprotective agents, whose effect is to improve the regenerative function of the hepatic parenchyma (Heptral in a daily dose of 800 mg perorally a long course) is the main link in the treatment.
In hepatomegaly caused by cirrhotic changes in the liver parenchyma, the development of irreversible pathomorphological damage to the liver is noted, and therefore, the patient can recover only after transplantation of a healthy organ, and drug therapy in this situation is exclusively symptomatic. In the viral nature of hepatomegaly, immunomodulating medications such as Interferon should be used, and in the autoimmune nature of cirrhosis, immunosuppressive therapy with Imuran administered orally at a dose of 2 mg per kg of body weight is indicated.
Hepatomegaly, accompanied by the development of hepatic insufficiency, ascites is an indication for the use of active diuretic therapy (Furosemide orally or intravenously at a dose of 40 mg), and in the presence of indications - Laparocentesis.
Treatment of hepatomegaly with the use of traditional medicine is allowed at any stage, but these drugs should be considered solely as additional to basic therapy. A good hepatoprotective effect is possessed by a crude pumpkin, so patients suffering from moderate hepatomegaly show daily consumption of raw or baked pumpkin.
? Hepatomegaly - which doctor will help ? If there is or suspected development of hepatomegaly, you should immediately seek advice from such physicians as a therapist, a gastroenterologist.