Hepatomegaly of the liver: what it is, echo signs, how to treat

Hepatomegaly is an enlargement of the liver, which is a sign of various diseases. Let's consider the main causes of hepatomegaly, types, diagnostic methods and treatment.

The liver is an organ in which chemical reactions occur that neutralize toxic substances. An enlarged liver is called hepatomegaly and can occur with poisoning of various etiologies. Scientists do not classify this pathology as an independent disease, but define it as a hepatomegaly syndrome. Very often, this syndrome is accompanied by an enlarged spleen.

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Causes hepatomegaly

Hepatomegaly is a characteristic sign of liver damage, the nature and stage of which depend on the size of the organ. It occurs in diseases of the cardiovascular system, tumor processes or metabolic disorders. Enlargement, swelling and inflammation occur in cirrhosis and hepatitis.

The causes of hepatomegaly of the liver can be conditionally divided into several groups, each of which depends on the disease that caused its enlargement. [ 4 ]

Let's look at the main causes of hepatomegaly:

• Hepatitis A, B, C, toxic hepatitis.
• Infectious diseases: malaria, [ 5 ]
• Alcohol intoxication of the liver. [ 6 ]
• Non-alcoholic and alcoholic fatty liver disease.
• Cancerous metastases to the liver from other organs and fluid-filled cysts.
• Gaucher disease, glycogenoses. [ 7 ]
• Fibrous changes in the liver.
• Obstruction of the bile ducts and blockage of the hepatic veins.
• Pericarditis.
• Leukemia.
• Malignant tumors of the lymphatic system.
• Benign liver tumors: adenoma, hemangioma.
• The accumulation of abnormal protein in the liver is amyloidosis.
• Metabolic disorders.
• Wilson's disease, which is the deposition of copper in the liver.

Symptoms hepatomegaly

Symptoms of hepatomegaly depend on the disease that caused the liver enlargement and its clinical manifestations. If hepatomegaly is pronounced (the liver reaches large sizes), it can be detected by palpation and even by the contours of the abdomen. The patient feels pain during palpation.

Let's look at the symptoms characteristic of hepatomegaly:

• Pain and a feeling of heaviness in the right side, especially when changing position.
• Skin rashes, itching.
• Accumulation of fluid in the abdominal cavity, ascites.
• Yellowing of the skin (most often occurs with hepatitis).
• Changes in bowel movements (diarrhea or constipation) and abdominal distension.
• Heartburn and bad breath.
• Nausea.
• The appearance of "liver stars" on the skin.

If hepatomegaly occurs against the background of hepatitis, the patient experiences uniform enlargement and compaction of the parenchyma. Because of this, the lower edge of the liver can be palpated under the costal arch. Attempts to palpate the liver cause pain and discomfort. With an exacerbation of hepatitis, the pain becomes constant. Hepatitis causes yellowing of the skin and symptoms of intoxication of the body (weakness, fever, headaches).

A complication of hepatitis is cirrhosis, which is also accompanied by hepatomegaly. In this case, healthy hepatocytes are replaced by connective tissue. The patient has a tendency to bleed, an earthy skin tone, and constant pain in the right hypochondrium.

There are extrahepatic diseases, the main symptom of which is an enlarged liver. These include metabolic disorders of both hereditary and acquired nature. Due to the violation of glycogen catabolism, it begins to accumulate in the liver, which leads to its slow enlargement. But in addition to the liver, the kidneys and spleen suffer, which also increase in size.

Hepatomegaly due to the left or right lobe is caused by hemochromatosis, a metabolic disease that provokes improper functioning of the enzyme systems responsible for the absorption and binding of iron-containing compounds. In this case, the enlargement of the organ develops as cirrhosis. But changes occur not only in the liver, but also in the lungs. The patient suffers from a strong cough with bloody sputum.

Cardiovascular diseases can provoke liver enlargement. Due to insufficient contractility, chronic cardiovascular failure develops, which leads to the development of chronic hypoxia. As a result, congestive liver develops. Long-term hepatomegaly can cause necrosis of hepatocytes and their replacement with connective tissue.

Diffuse hepatomegaly occurs when the size of the liver in an adult exceeds 12-13 cm. Streptococcal, staphylococcal and other infections cause abscesses in the liver, which leads to diffuse hepatomegaly. Treatment in this case is carried out only by surgery, since taking medications is not effective. If diffuse changes in the size and structure of the organ are caused by cirrhosis (intoxication with alcohol or toxic substances, poisons), then hepatomegaly causes pain in the joints and an enlarged spleen.

The cause of diffuse changes in hepatomegaly may be long-term use of medications or abuse of fatty foods. Daily exposure to toxins on the body leads to disruption of liver function, changes in the structure and size of the organ. Even a new diet can provoke mild diffuse changes, by the way, this is a common cause of hepatomegaly in women.

To diagnose diffuse liver enlargement, an ultrasound examination is performed. If a slight enlargement of the organ and uniform compaction of the parenchyma are detected, the patient is tested for hepatitis. The degree of liver dysfunction and severity of liver failure are judged in more detail by the results of a biochemical blood test. If changes in the contours of the organ, a lumpy and uneven structure are detected, this may indicate cirrhosis.

The main treatment for hepatomegaly with diffuse changes is diet. The patient is given a diet that involves giving up fatty, spicy and sweet foods, as well as alcohol and other bad habits. Traditional medicine methods and, of course, medications can be used to cleanse the liver. But the most important thing is to promptly determine the cause of the pathology and begin immediate treatment and comprehensive treatment of the symptoms of the disease.

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Partial hepatomegaly

Partial hepatomegaly is an uneven enlargement of the liver, i.e. a change in the size of individual parts or lobes of the organ. For example, hepatomegaly of the left or right lobe of the liver indicates a partial enlargement of the organ. In rare cases, an uneven change in the lower edge of the liver occurs. When palpated, this pathology feels uneven and lumpy.

Partial hepatomegaly can be diagnosed using ultrasound. The disease has a characteristic echo sign: disruption of the homogeneity of organ tissues. The presence of tumors, cysts or abscesses also indicate partial changes in the liver and progression of the disease.

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Hepatomegaly and splenomegaly

These are two conditions that very often occur simultaneously and one of them can provoke the appearance of the second. Hepatomegaly is an enlargement of the liver, and splenomegaly is an enlargement of the spleen. There is a hepatosplenic syndrome, that is, a combination of pathologies and a change in the size of the spleen and liver.

Hepatomegaly and splenomegaly occur in the following diseases of the body:

1. Chronic liver damage (focal, diffuse), as well as diseases that cause circulatory disorders in the hepatic and splenic vein systems.
2. Hemochromatosis, amyloidosis, Gaucher disease, hepatocerebral dystrophy and other diseases.
3. Parasitic and infectious diseases: abdominal tuberculosis, malaria, alveolar echinococcosis, infectious mononucleosis and others.
4. Diseases of lymphoid tissue and blood: leukemia, lymphogranulomatosis, hemolytic anemia.
5. Cardiovascular diseases accompanied by chronic circulatory failure: coronary heart disease, heart defects, pericarditis.

The involvement of the spleen in the pathological process is explained by the close functional connection of the organs. Hepatosplenic syndrome is more common in pediatric patients than in adults. This is due to the anatomical and physiological characteristics of a growing organism. Hereditary diseases, infectious diseases and congenital anomalies can also provoke hepatomegaly and splenomegaly.

As a rule, diagnostics is not difficult and is carried out by percussion and palpation. The main difficulty lies in determining the cause, that is, the underlying disease that caused hepatomegaly and spleen damage.

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Hepatomegaly against the background of fatty hepatosis

It is an enlargement of the liver caused by the degeneration of the organ cells into fatty ones. Most often, this disease occurs when lipids accumulate in the liver cells (hepatocytes). The pathology develops due to the impact of alcohol, fatty foods, medications and other negative factors on the body.

Left untreated, fatty hepatosis develops into fibrosis and cirrhosis of the liver. There are several stages of this disease:

• At the first stage, foci of cells with a high concentration of simple fats appear. If there are several foci, they can cause diffuse changes in liver tissue.
• In the second stage, the number of fat cells increases, and connective tissue begins to grow between the cells.
• In the last stage, pronounced stripes of connective tissue appear, which subsequently lead to fibrosis and pronounced hepatomegaly.

One of the causes of hepatomegaly against the background of fatty hepatosis is metabolic disorders and obesity. But there are other factors that can cause the disease, let's consider them:

• Diseases that cause lipid metabolism disorders: type 2 diabetes, obesity, hypertriglyceridemia, and others.
• Toxic effects on the liver. Due to the constant neutralization of toxic substances, the liver ceases to fully perform its functions, which leads to its inflammation and enlargement. There is such a thing as alcoholic fatty hepatosis, caused by systematic alcohol consumption.
• Digestive disorders and associated diseases. The liver takes an active part in the digestion process, but if there is a violation of fat absorption or bile acid excretion, this leads to serious pathologies.
• Diseases of the endocrine system. Fatty hepatosis occurs with excessive production of hormones by the adrenal cortex and with a deficiency of thyroid hormone.
• Improper nutrition causes lipid imbalance, which leads to hepatomegaly and fatty hepatosis. Irregular meals, limited protein intake, regular fasting, frequent diet changes. All this leads to exhaustion of the body and to the fact that liver cells stop doing their job.
• Long-term use of drugs or probiotics, as well as radiation, cause liver disease

The main symptom of hepatomegaly against the background of fatty hepatosis is nausea, vomiting, pain in the right hypochondrium. The patient develops dysbacteriosis, the skin condition worsens, and visual acuity may decrease. Pronounced symptoms of the disease occur at the last stage of fatty hepatosis.

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Hepatomegaly in children

Hepatomegaly in children can occur at any age, both in newborns and in adolescents or school-age children. Eating disorders, autoimmune processes in the body and other factors can cause liver and spleen pathologies. For example, in children aged 5-7 years, liver enlargement is age-related, so hepatomegaly is moderate. Such a physiological phenomenon does not require medical intervention and treatment. But if this occurs in older children, the cause may be disorders of the body or diseases. [ 17 ]

It is not just the enlarged liver that is dangerous, but the accompanying symptoms. If the baby complains of pain under the ribs, rashes and changes in skin pigmentation, the appearance of spider veins on the abdomen, nausea and vomiting, fatigue and loss of appetite, then this indicates serious health problems. Any of the above symptoms in combination with an enlarged liver is a reason to immediately seek medical help. The doctor will prescribe tests to confirm or exclude liver damage. [ 18 ]

The causes of hepatomegaly in children are varied, but doctors identify 6 main factors that can lead to problems, let's consider them:

• Inflammatory diseases – congenital infections (herpes, cytomegalovirus, rubella ), toxic and drug-induced organ damage, closure of the bile duct lumen, hepatitis A, B, C, parasitic diseases.
• Metabolic disorders – disorders of the structure and metabolism of glycogen, disorders of protein metabolism, Wilson's disease, disorders of lipid metabolism, mucopolysaccharidoses, porphyria and others.
• Liver damage (infiltrative) – hemolytic diseases of the newborn, lymphoma, leukemia, hepatoma, metastases, hematopoiesis in “atypical” organs, histiocytosis.
• Violation of the outflow of bile and blood - cirrhosis, stenosis, thrombosis, atresia, heart failure, Wilson's disease.
• Primary liver damage – multicystic disease, congenital liver fibrosis, biliary cirrhosis and others.
• Hyperplasia of Kupffer cells, which absorb and process dead cells – granulomatous hepatitis, sepsis, hypervitaminosis.
• False hepatomegaly – develops due to pathologies of the respiratory system, for example, with pulmonary emphysema. Enlarged organs push the liver out from under the ribs

To examine the child, percussion of the abdominal circumference and palpation are performed. Particular attention is paid to the pronounced venous vascular network in the abdominal area, changes in the pigmentation of the skin and mucous membranes, symptoms of intoxication, pain and heaviness. If hepatomegaly is moderate, then there are no objective symptoms.

To reliably confirm liver damage, an ultrasound examination is performed. Such diagnostics are quite justified in the absence of external manifestations of hepatomegaly. Ultrasound allows you to recognize different forms of the disease, detect abnormalities in the structure of the organ. Based on the results of the examination, appropriate treatment is selected. But hepatomegaly itself is not treated; the underlying disease that caused this pathology is subject to treatment.

Hepatomegaly in the fetus indicates that the embryo's liver is larger than normal. This pathology is easily diagnosed, since the enlargement of the organ leads to an enlargement of the abdomen, which is impossible not to notice during an ultrasound of a pregnant woman. The primary task of the doctor is to determine the causes that caused the pathology in the unborn child. The treatment tactics and prognosis depend on this. [ 19 ]

There are many reasons that cause hepatomegaly in the fetus, let's look at them in more detail:

• Intrauterine infections - the negative impact of toxoplasmosis, cytomegalovirus, chickenpox, rubella, Coxsackie virus, syphilis and even rhesus conflict, can lead to liver enlargement.
• Various liver formations.
• Metabolic disorders.
• Heart failure.
• Hemolysis.
• Down syndrome, Beckwith-Wiedemann syndrome, Zellweger syndrome.

If hepatomegaly occurs against the background of intrauterine infection, it leads not only to an increase in the organ, but also to the appearance of small hyperechoic inclusions. As for neoplastic formations in the liver of the fetus, this may be hemangioma, hepatoblastoma, adenoma, mesenchymal hamartoma, and others.

Quite often, liver enlargement is accompanied by spleen pathologies. As a rule, hepatomegaly is detected in the second half of pregnancy. But the most important thing when detecting these problems is to exclude Down syndrome. The tactics of introducing pregnancy directly depends on the causes of the pathology, since isolated hepatomegaly in the fetus occurs very rarely.

Hepatomegaly in newborns

It is considered normal if it is of an unexpressed nature, less than 2 cm. The list of diseases is extensive, since hepatomegaly does not appear on its own, but signals the presence of diseases of the organ or body. Hepatomegaly syndrome can be associated with nutritional disorders, autoimmune processes or a condition after vaccination. [ 20 ]

The main causes of pathology are inflammatory and dystrophic processes in the liver parenchyma. Hepatomegaly in newborns can also be a physiological phenomenon. Let's consider the main causes of liver enlargement in infants:

• Infectious diseases - almost all viral infections in children cause hardening and enlargement of the liver.
• Diseases of the cardiovascular and respiratory systems – pathology can develop due to right ventricular failure.
• Bile duct obstruction and bile duct cysts – this condition is very rare, but also causes liver enlargement. The main symptoms are fever, and when trying to palpate the liver, the child begins to cry.
• Cholangitis - hepatomegaly appears due to inflammation of the bile ducts. The disease is accompanied by high temperature and pain in the right hypochondrium.
• Debre syndrome is a pathology that occurs in children who are developing poorly. Due to developmental delays, glycogen and fat accumulate in the liver, which can cause fatty hepatosis.
• Lipid metabolism disorders – in this case, the newborn develops severe diarrhea, vomiting and skin xanthomas.
• Echinococcosis is a disease caused by the introduction of tapeworm larvae into the liver. The pathology causes nodular enlargement of the organ. The main cause of echinococcosis is contact with animals, especially dogs.
• Woringer syndrome - hepatomegaly occurs in children with vegetative symptoms and abnormal body weight.
• Mauriac syndrome is a complication of diabetes that causes fat to accumulate in the baby's liver.
• Liver tumors - hepatoblastomas and isolated tumors of the organ are extremely rare, but can metastasize and affect one or both lobes of the liver.
• Gierke's disease is a glycogen storage disease. In addition to liver enlargement, it causes seizures, increased lactic acid levels in the blood, and the release of acetoacetic acid in the urine.

Despite such a variety of causes and factors causing hepatomegaly in newborns, there are common symptoms that may indicate the disease, let's consider them:

• Yellowing of the skin – persistent jaundice occurs with many liver diseases. Particular attention should be paid to the color of the child's stool. If the baby has colorless stool, you should immediately seek medical help.
• Spider veins in the abdominal area.
• Nausea, nausea, poor appetite.
• Lethargy, increased fatigue.
• Swelling of the navel - this only happens with severe liver and abdominal diseases. The child's belly greatly increases due to the accumulation of fluid.

Special attention is paid to HIV-infected newborns with hepatomegaly. In some cases, it is the enlargement of the liver that is an early symptom of HIV infection. Such children have an enlarged spleen, upper respiratory tract infections, dermatitis, mumps, and enlarged lymph nodes. If the disease is moderate, the baby may suffer from prolonged oral candidiasis, hepatitis, diarrhea, fever, anemia, meningitis, or sepsis.

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Hepatomegaly in pregnancy

It occurs quite often. As a rule, liver problems occur in the last trimester. Due to the enlargement of the uterus, the liver shifts up to the right, the organ becomes more voluminous and full-blooded. At the same time, the excursions of the diaphragm decrease, which causes difficulties in the removal of bile. In addition, during pregnancy, a number of changes are observed that must be taken into account when examining the organ. For example, the appearance of spider veins on the skin, increased levels of fatty acids, triglycerides in the blood serum or cholesterol. All this is due to the influence of estrogen and progesterone and an increase in the volume of circulating blood. [ 22 ]

All liver diseases that occur during pregnancy and cause hepatomegaly are divided into three groups:

• Organ damage associated with pregnancy (occurs only in pregnant women).
• Intrahepatic cholestasis of pregnancy is a disease that is diagnosed in 20% of women. The pathology is based on a hereditary predisposition to an abnormal cholestatic reaction to estrogens and progesterones produced during pregnancy.
• Liver damage due to toxicosis (with excessive vomiting). This phenomenon occurs in 2% of pregnant women and develops between the 4th and 10th week of gestation, and ceases by the 20th week of pregnancy. Excessive vomiting leads to dehydration, protein catabolism, electrolyte disturbances, and weight loss.

In addition to the above-described reasons, hepatomegaly during pregnancy can occur due to vascular congestion, fatty hepatosis, diabetes, leukemia, inflammatory diseases, tumors and cysts.

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Forms

Hepatomegaly is included in the International Classification of Diseases, 10th revision. That is, a single regulatory document used to record morbidity, causes of death, and reasons for the population seeking medical care.

Mild hepatomegaly

Characterized by an increase in the liver by 1-2 cm. Such changes do not cause painful symptoms, so their presence can only be diagnosed using ultrasound. But the process of liver deformation sooner or later begins to make itself known with characteristic clinical symptoms. Since without proper treatment, unexpressed hepatomegaly progresses.

Typical symptoms of mild hepatomegaly are weakness, rapid fatigue, which occurs without physical or other exertion. Unpleasant sensations of heaviness and discomfort appear in the abdominal cavity, heartburn, bad breath, itchy skin and dyspepsia are possible. If the above symptoms appear, it is necessary to undergo a full examination, since palpation is ineffective. The patient is prescribed an ultrasound examination, the results of which can be used to assess the condition and size of the liver. In addition to ultrasound, a computed tomography of the abdominal cavity may be prescribed, which provides more complete and reliable information about the condition of the organ.

If liver changes are detected, the patient is prescribed a diet and medication. The first step to recovery is proper nutrition and giving up bad habits. If the pain in the right hypochondrium becomes stronger, the doctor prescribes drugs to strengthen the liver cell membrane: Karsil, Ursosan, Essentiale-forte and others.

Moderate hepatomegaly

It is diagnosed in patients with minor diffuse changes in the liver and corresponding clinical symptoms. Doctors use this term to describe deviations in the structure and size of the organ that do not correspond to the norm.

Moderate liver enlargement occurs with long-term alcohol abuse and unbalanced nutrition. As a rule, this diagnosis can be seen after an ultrasound examination or CT scan of the abdominal cavity. Without proper treatment and a healthy lifestyle, the pathology progresses and becomes pronounced.

Severe hepatomegaly

Indicates pathological, but still reversible changes in liver size. As a rule, this is observed in hemoblastoses and leukemia, due to massive infiltration of organ tissues by malignant cells. This provokes the appearance of necrosis foci and proliferation of connective tissue. In these cases, the liver reaches enormous sizes, occupying most of the abdominal cavity, thereby disrupting the work of other internal organs.

In case of pronounced hepatomegaly, doctors evaluate not only the size of the organ, but also the structure, contours and pattern of the tissue. A significant increase in certain areas, the appearance of a stony consistency or tumor foci, indicates certain diseases. Rapid enlargement of the liver is possible with fatty infiltration and cardiovascular diseases.

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Diagnostics hepatomegaly

The doctor examines the patient, palpates and percusses the liver. Particular attention is paid to collecting the anamnesis of the disease. The patient should tell the doctor about abdominal pain, vomiting and nausea, unusual color of stool, yellowing of the skin, a feeling of excessive heaviness or a lump in the abdomen. To prescribe further examination, the doctor will find out whether the patient takes any medications, how much alcohol he drinks and about his diet.

Symptoms characteristic of hepatomegaly provide every reason to conduct a detailed examination of the body. As a rule, patients are prescribed:

• Biochemical blood test (serum bilirubin, thymol test, alkaline phosphatase, total protein and proteinogram, ALT and AST).
• Computed tomography and magnetic resonance imaging of the abdominal cavity.
• Ultrasound examination of abdominal organs.
• Radiography.
• Liver function tests, including blood clotting tests.

In some cases, a biopsy is performed to clarify the processes in the liver. This analysis is done using laparoscopy. All of the above diagnostic methods allow you to understand the situation and accurately determine the cause of hepatomegaly.

Ultrasound signs of hepatomegaly

They appear on scanograms as focal lesions. An enlarged liver is characterized by the presence of zones with reduced accumulation of radionuclides. During the examination, the doctor identifies topographic changes in the position, size of the organ, and changes in the structure of the liver segments.

Ultrasound examination allows to detect any focal liver lesions. Diagnostics makes it possible to determine the degree of hepatomegaly, the condition of the spleen and other internal organs. More extensive information for studying the causes of liver enlargement is obtained using echohepatography. [ 26 ]

Echo signs of hepatomegaly

They play an important role in identifying diseases that cause liver enlargement.

• If the pathology is caused by heart failure, acute hepatitis or parasitic diseases, then the homogeneous echostructure of the organ is preserved.
• If a heterogeneous echostructure of the liver is detected, this may indicate fatty hepatosis, cirrhosis, or chronic hepatitis.
• If foci of inflammation or necrosis occur in liver tissue, causing disturbances in the echogenic structure, we can speak of the presence of tumors, cysts or abscesses.

Echo signs of hepatomegaly allow us to accurately determine the degree of pathology: mild, moderate and severe enlargement of the liver.

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Differential diagnosis

Differential diagnostics of hepatomegaly is necessary to accurately determine the cause of liver damage and to distinguish it from other diseases with similar symptoms. Particular attention is paid to the size of the organ lobes. Thus, an increase in the edge of the right lobe without differential diagnostics can be mistaken for neoplasms of the colon, gall bladder or kidney. Another important stage of diagnostics is to distinguish hepatomegaly from hepatoptosis and hepatosis. To accurately determine the causes of liver enlargement, palpation in different positions and ultrasound examination are performed. [ 28 ]

• When diagnosing hepatomegaly with acute viral hepatitis, information about recent transfusions of blood or its components is important. Multiple injections, parenteral manipulations, as well as the patient's belonging to a risk group or the presence of an unfavorable epidemiological history. In order to exclude acute viral hepatitis, a study of markers of viruses B, C, D, G is carried out. This allows us to establish the phase of virus replication and detect its presence.
• Hepatomegaly is one of the first symptoms of liver cirrhosis, so it is also important to differentiate this disease. Cirrhosis causes portal hypertension, functional insufficiency and liver compaction.
• Portal hypertension is accompanied by circulatory disorders, which causes an enlargement of the organ. To identify this disease, gastroscopy is performed, which reveals the expansion of the veins of the stomach and esophagus, and a biopsy may be performed.
• Liver enlargement and pain in the right hypochondrium are also characteristic of obstruction of the hepatic veins, which leads to disturbances in the outflow of blood from the organ ( Budd-Chiari syndrome ). The patient complains of fever, weakness and ascites. For diagnosis, ultrasound Dopplerography is performed with an assessment of blood flow. The main symptom of this disease is hepatomegaly with complete impairment of liver function. A puncture biopsy is mandatory.
• It is extremely important to recognize storage diseases (amyloidosis, fatty hepatosis, hepatocerebral dystrophy, hemochromatosis), which at the initial stage give only one symptom - hepatomegaly. CT and ultrasound are used to detect fatty hepatosis. When diagnosing hemochromatosis, special attention is paid to the results of blood tests. To confirm the diagnosis of hepatocerebral dystrophy, attention is paid to the presence of neurological symptoms and puncture biopsy data.
• When diagnosing cardiovascular diseases that cause hepatomegaly, it is necessary to remember about possible pericarditis in the area of the right ventricle. As a rule, in this case, there was a history of trauma in the heart area or tuberculosis. The first signs of the disease cause pain in the right hypochondrium, enlargement of the left lobe of the liver, shortness of breath, and high blood pressure.

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Treatment hepatomegaly

Treatment of hepatomegaly depends entirely on the diagnostic results and the etiological component of the pathology. Treatment should be aimed at eliminating the causes of liver damage and combating painful symptoms. It is necessary to follow a special diet, a gentle regime of physical activity, and preventive hepatoprotective therapy.

If hepatomegaly is caused by hepatitis, then antiviral and hepatoprotective therapy leads to complete recovery and restoration of normal liver size. Prescription of betaine, pentoxifylline, rosuvastatin, orlistat, ursodeoxycholic acid and atorvastatin for non-alcoholic steatohepatitis. [ 31 ], [ 32 ], [ 33 ], [ 34 ], [ 35 ]. Studies have shown that the use of vitamin E and vitamin C reduces fibrosis in patients with non-alcoholic steatohepatitis [ 36 ]. In cirrhosis, which causes irreversible replacement of liver cells with connective tissue, complete restoration of the liver is impossible. Treatment is aimed at replenishing the organ's enzyme deficiency and maintaining normal functioning. Treatment is reduced to palliative therapy, against which hepatomegaly slowly progresses and the patient's condition steadily worsens.

If the patient has an enlarged liver against the background of compensated cirrhosis, it is recommended to limit physical activity, follow a diet with sufficient vitamins and protein, and completely abstain from alcohol. Active viral cirrhosis B and C causes replication of the virus, so treatment is carried out with medications. [ 37 ], [ 38 ]

In hepatomegaly caused by liver failure with ascites and sodium chloride deficiency, diuretics are prescribed for treatment. If the underlying disease progresses, is accompanied by liver cirrhosis or the patient is under 60 years old, organ transplantation is possible. [ 39 ], [ 40 ]

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Nutrition for hepatomegaly

Nutrition for hepatomegaly is one of the most important conditions for restoring liver health. A healthy, balanced diet has a beneficial effect on the liver and the body as a whole. Let's look at the basic rules of nutrition for hepatomegaly:

• It is necessary to eat at least 6 times a day, that is, three main meals and three snacks. It is recommended to eat food fractionally, in small portions.
• It is necessary to completely give up fatty and fried foods. It is better to steam, boil or bake dishes. It is allowed to consume no more than 70 g of fat per day, and it is better to replace animal fats with vegetable fats.
• You should completely exclude bakery products, sugar and any sweets from your diet.
• It is forbidden to eat fatty meat and fish, lard, smoked, spicy, canned or salted foods.
• The diet should include stewed and boiled vegetables, porridge, steamed or baked fish, poultry. It is recommended to eat more seasonal vegetables and fruits.

Diet for hepatomegaly

The diet for hepatomegaly is aimed at normalizing liver function. The diet consists of five meals a day every 3-4 hours with certain restrictions in the choice of products. Diet No. 5 according to Pevzner fully meets these requirements. In addition to the prescribed medications for the treatment of hepatomegaly, recovery can be accelerated with food. Failure to comply with the rules of the diet can have very serious consequences for the body and provoke liver inflammation, which will only worsen hepatomegaly.

Allowed products:

• Vegetable oils.
• Lean sea and river fish.
• Fresh vegetables and fruits, herbs.
• Milk and dairy products.
• Honey, pastila, jam.
• Dried fruits.
• Cereals.
• Lean poultry.
• Vegetable, cereal and milk soups.
• Sauerkraut.

Nutrition for hepatomegaly requires having dinner no later than seven o'clock in the evening. Overeating is strictly prohibited, there should be intervals of 2.5-3 hours between meals, but no more.

Contraindicated products:

• Butter (more than 50 g per day) and margarine.
• Eggs (no more than 2 per week).
• Sausage and sausage products.
• Pork, goose, lamb.
• Cheese with high fat content.
• Pickled and fried foods.
• Hot spices, sauces, vinegar.
• Legumes and onions.
• Tomato juice.
• White refined sugar and any confectionery products.
• Chocolate.
• Canned goods.
• Bakery products.

Diet and hepatomegaly are two inseparable concepts. Since without proper nutrition it is impossible to fully restore liver function and the health of the body. After diagnosis, the doctor may add additional restrictions to the diet that are associated with a specific disease that caused the enlargement of the organ. The duration of the diet is also determined by the attending physician, but some recommendations will have to be followed throughout life. [ 43 ], [ 44 ]

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Prevention

Prevention of hepatomegaly depends on the underlying disease that caused the liver to enlarge. To prevent hepatomegaly, it is necessary to follow a healthy diet, give up bad habits (alcohol, smoking) and control your weight. With special caution and only after a doctor's permission, you can take medications, as they can also cause toxic liver damage. [ 46 ]

For preventive purposes, it is recommended to lead an active lifestyle and play sports. A prerequisite for good health is a full, healthy sleep and timely medical attention.

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Forecast

The prognosis of hepatomegaly depends on the nature of the pathology and the severity of the disorders. If the liver enlargement is due to viral and infectious lesions, it is curable. Antiviral therapy is especially effective in the early stages, while the risk of transition to a pronounced form is 5%. In liver pathologies caused by toxic damage, the prognosis worsens. Cirrhosis, uncontrolled fatty hepatosis, fulminant forms of hepatitis have an unfavorable prognosis.

Any disease that causes not only an increase in the organ, but also changes in the liver parenchyma are characterized by rapid progression and the development of severe consequences. In 30% of cases, a fatal outcome occurs from complications of the underlying disease that caused hepatomegaly. These may include intraperitoneal bleeding, severe infectious diseases, disorders of the liver's antitoxic function, etc. [ 48 ]

Hepatomegaly is a sign of problems with the liver and the body. Regular medical examinations and ultrasound examinations allow you to detect liver enlargement at an early stage. Thanks to this, you can begin timely treatment of the underlying disease and return the organ's size and functionality to normal.

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