Hepatomegaly of the liver is a pathological increase in the organ and a diffuse change in its tissues. With this pathology, the liver can easily be palpated under the ribs, while a healthy organ is difficult to feel. When palpation, the patient feels pain, which is also a sign of the disease. Hepatomegaly is a symptom that indicates that the liver needs treatment.
An increase in this organ can occur due to inflammatory processes, viruses or toxins. Inflammation entails swelling of the liver and the death of some healthy cells. The disease appears and with cirrhosis, viral hepatitis or prolonged intoxication of the body (chronic alcoholism). Violations of the formation of glycogen causes the accumulation of this substance in the liver, which leads to hepatomegaly, an increase in the spleen and kidneys.
Diseases of the cardiovascular system lead to ventricular failure, causing stagnation of blood in the organs and tissues. In chronic or congenital heart failure, the liver suffers first. Hepatomegaly is provoked by oncological diseases, cancerous growths that lead to organ proliferation and disruption of its functioning.
The hepatomegaly syndrome indicates an increase in liver size. There are many reasons for this pathology. Very often this syndrome is accompanied by an increase in the spleen. The enlargement of the liver indicates signs of other diseases of the body. There are a number of factors that increase the risk of hepatomegaly syndrome, consider them:
- Alcohol abuse increases the risk of liver damage, cancers and cirrhosis.
- Elevated doses of drugs, dietary supplements and vitamins cause intoxication and liver damage.
- Many infectious diseases, for example, malaria, viral hepatitis and others.
- Malnutrition and overweight are another factor that causes liver enlargement. Abuse of fat, sweet, spicy or salty foods is a direct way to increase the liver.
Symptoms of hepatomegaly depend on the disease that caused the enlargement of the liver and its clinical manifestations. If it is pronounced (the liver reaches a large size), then it can be found on palpation and even on the outline of the abdomen. If the organ is not enlarged, then for diagnosis it is necessary to seek medical help and undergo a series of examinations. With the help of palpation and percussion, the doctor will determine the size and extent of the organ enlargement.
Consider the symptoms characteristic of hepatomegaly:
If hepatomegaly occurs against the background of hepatitis, the patient will experience a uniform increase and consolidation of the parenchyma. Because of this, the lower edge of the liver can be palpated under the costal arch. Attempts to feel the liver cause pain and discomfort. With exacerbation of hepatitis, the pain becomes permanent. Hepatitis causes jaundice of the skin and symptoms of intoxication (weakness, fever, headaches). With timely diagnosis and properly selected antiviral treatment, hepatomegaly gradually returns to normal body size.
Complication of hepatitis is cirrhosis, which is also accompanied by hepatomegaly. In this case, the increase in organ tissues is due to the destruction of hepatocytes and the formation of a scar from the connective tissue in their place. Because of multiple foci of necrosis, total replacement of healthy tissue with a connective tissue takes place. The liver increases, causes disturbances in the functioning of the body. The patient has a tendency to bleeding, an earthy skin tone and a constant throbbing pain in the right hypochondrium.
There are extrahepatic diseases, the main symptom of which is an increase in this organ. These include metabolic disorders of both hereditary and acquired character. Due to the violation of glycogen catabolism, it begins to accumulate in the liver, which leads to its slow increase. But besides the liver, the kidneys and the spleen suffer, which also increase in size.
Hepatomegaly causes hemochromatosis, an exchange disease that provokes the malfunctioning of enzyme systems responsible for the absorption and binding of glandular compounds. In this case, the increase in the organ develops according to the type of cirrhosis. But changes occur not only in the liver, but in the lungs. The patient suffers from a strong cough with red phlegm.
To provoke an increase in the liver can the diseases of the cardiovascular system. Due to lack of contractility, blood circulation stagnates, which leads to a violation of the outflow of blood from the internal organs. As a result, the liver and other organs form a prolonged puffiness, which provokes the growth of the organ. Long-term hepatomegaly can cause necrotizing hepatocytes and their replacement with connective tissue.
Hepatomegaly due to the left lobe
Hepatomegaly due to the left lobe of the liver occurs rarely. An increase in the organ may be caused by infectious agents or diseases of the internal organs. The left share of the liver is located very close to the pancreas, so diseases and diffuse changes in the pancreas can cause hepatomegaly due to the left lobe.
In this case, the patient is fully diagnosed by the body with a detailed study of the functioning of the organs. Cholestasis, pancreatitis and other pancreatic lesions affect not only the liver, but also the gallbladder and spleen.
Hepatomegaly of the right lobe of the liver
Hepatomegaly of the right lobe of the liver is observed quite often. The increase can have a natural character, since the right share carries a high functional load. In this case, any infectious lesions, inflammatory processes, exposure to toxins or malnutrition affect the right lobe of the organ.
But all the negative factors can cause violations in the work of the liver, which negatively affects the functioning of the whole organism. Therefore, during the examination, special attention is paid to the right lobe, as it is 60% responsible for the liver. If hepatomegaly is detected, a comprehensive treatment of the entire organ is performed.
Diffuse hepatomegaly occurs when the liver size in an adult exceeds 12-13 cm. This organ consists of two parts - the right and left, each of which has its own blood supply, nerve fibers and bile excretion. The tissue of the lobules is formed from elongated cells, which are permeated with blood vessels and capillaries. Each share has a central vein, arteries and bile ducts. Diffuse changes, that is, hepatomegaly can affect any of the above elements.
Streptococcal, staphylococcal and other infections cause abscesses in the liver, which leads to diffuse hepatomegaly. The patient suffers from tachycardia, aching pain in the right hypochondrium, which give in the shoulder and arm, a strong chill. Treatment in this case is carried out only by a surgical method, 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 joint pain and an increase in the spleen.
Hepatomegaly with diffuse changes
Hepatomegaly with diffuse changes indicates inflammatory processes in the liver. The normal structure of the organ is uniform, there are no deformations of the tissue or any seals. Changes can cause mild abnormalities in the structure of the liver with complete preservation of the organ functions. But, as a rule, this condition is accompanied by hepatic insufficiency, increasing intoxication and frequent bleeding. Diffuse changes are a symptom of the underlying disease, which provokes abnormalities. It can be as a hepatic disease, as well as lesions of a general nature that cause metabolic disorders and inflammation.
The cause of diffuse changes in hepatomegaly may be the prolonged use of medicines or the abuse of fatty foods. Daily exposure to toxins on the body leads to a disturbance of the liver function, a change in the structure and size of the organ. Light diffuse changes can provoke even a new diet, by the way, this is a common cause of hepatomegaly in women.
To diagnose a diffuse increase in the liver, ultrasound is performed. If there is a slight increase in the organ and a uniform compaction of the parenchyma, the patient is checked for hepatitis. More details about the degree of disturbances in the work of baking the severity of liver failure are judged by the results of a biochemical blood test. If changes in body contours are detected, a tuberous and uneven structure, this may indicate cirrhosis.
The main treatment for hepatomegaly with diffuse changes is compliance with the diet. The patient is a diet that means giving up fatty, spicy and sweet foods, as well as alcohol and other bad habits. For the purification of the liver can use the methods of alternative medicine and, of course, medication. But the most important thing is to determine the cause of the pathology in a timely manner and begin immediate treatment and a comprehensive impact on the symptoms of the disease.
Partial hepatomegaly is not a uniform increase in the liver, that is, a change in the size of individual parts or parts of the organ. For example, hepatomegaly of the left or right lobe of the liver, indicates a partial increase in the organ. In rare cases, there is an uneven change in the lower edge of the liver. When palpation, this pathology is felt uneven and bumpy.
Partial hepatomegaly can be diagnosed by ultrasound. The disease has a characteristic echospresign: a violation of the uniformity of the tissues of the organ. The presence of tumors, cysts or abscesses, also indicate a partial change in the liver and the progression of the disease.
Hepatomegaly and splenomegaly
Hepatomegaly and splenomegaly are two diseases 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 hepatolyenal syndrome, that is, a combination of pathologies and a change in the size of the spleen and liver.
Hepatomegaly and splenomegaly occur with such diseases of the body:
- Chronic liver damage (focal, diffuse), as well as diseases that cause circulatory disorders in the systems of hepatic and splenic veins.
- Hemochromatosis, amyloidosis, Gaucher's disease, hepato-cerebral dystrophy and other diseases.
- Parasitic and infectious diseases: abdominal tuberculosis, malaria, alveococcosis, infectious mononucleosis and others.
- Diseases of lymphoid tissue and blood: leukemia, lymphogranulomatosis, hemolytic anemia.
- Diseases of the cardiovascular system, accompanied by chronic circulatory failure: ischemic heart disease, heart defects, pericarditis.
Involvement in the pathological process of the spleen is explained by the close functional connection of the organs. Hepatolienal syndrome is more common in patients of childhood than in adults. This is due to the anatomical and physiological characteristics of the growing organism. Hereditary diseases, infectious diseases and congenital anomalies, can also provoke hepatomegaly and splenomegaly.
As a rule, the diagnosis 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 involvement.
Hepatomegaly in the context of fatty hepatosis
Hepatomegaly against a background of fatty hepatosis is an increase in the liver caused by the degeneration of the body cells into fat. Most often, this disease occurs when accumulating in the liver cells (hepatocytes) simple fats. Pathology develops due to the impact on the body of alcohol, fatty foods, medications and other negative factors. All toxic substances enter the liver, where they are neutralized and degenerated into simple fats. But since enough fat is supplied with food, its excess accumulates in the liver cells, causing slow hepatomegaly.
Over time, cells can degenerate. This suggests that left without treatment fatty hepatosis is generated in fibrosis and cirrhosis of the liver. There are several stages of the disease:
- At the first stage, foci of cells with a high concentration of simple fats appear. If there are several lesions, they can cause diffuse changes in liver tissue.
- In the second stage, the number of fat cells increases, and the connective tissue begins to grow between the cells.
- At the last stage, pronounced striations of connective tissue appear, which subsequently lead to fibrosis and severe hepatomegaly.
One of the reasons for hepatomegaly against the background of fatty hepatosis is metabolic disorders and obesity. But there are other factors that can cause disease, consider them:
- Diseases that cause lipid metabolism disorders: type 2 diabetes, obesity, hypertriglyceridemia and others.
- Toxic effects on the liver. Due to the permanent neutralization of toxic substances, the liver ceases to fully perform its functions, which leads to its inflammation and increase. There is such a thing as alcoholic fatty hepatosis caused by the systematic use of alcohol.
- Digestive disorders and concomitant diseases. The liver takes an active part in the process of digestion, but if there is a violation of fat absorption or excretion of bile acids, it leads to serious pathologies.
- Diseases of the endocrine system. Fatty hepatosis occurs with excessive production of hormones of the adrenal cortex and with a deficiency of the thyroid hormone.
- Malnutrition causes lipid impairment, which entails hepatomegaly and fatty hepatosis. Irregular meals, a limited amount of protein, regular fasting, frequent change of diets. All this leads to the exhaustion of the body and to the fact that the liver cells stop doing their work.
- Long-term use of drugs or probiotics, as well as radiation, causes liver disease
The main symptom of hepatomegaly against the background of fatty hepatosis is nausea, vomiting, pain in the right upper quadrant. The patient develops a dysbiosis, the skin condition worsens, and visual acuity may fall. Strongly expressed symptoms of the disease occur at the last stage of fatty hepatosis.
Hepatomegaly in children
Hepatomegaly in children can occur at any age, as in newborns, and in adolescents or school-age children. The incidence of hepatomegaly in children is carefully studied by pediatricians. Dysfunction of the diet, autoimmune processes in the body and other factors can cause liver and spleen pathologies. For example, in children aged 5-7 years, the increase in the liver is of an age-specific character, therefore, hepatomegaly is moderate. Such a physiological phenomenon does not require medical intervention and treatment. But if this occurs in older children, then the cause may be in disorders of the body or diseases.
The danger is not just an enlarged liver, but the accompanying symptomatology. If the baby complains of pain under the ribs, rashes and changes in skin pigmentation, the appearance of vascular asterisks on the abdomen, nausea and vomiting, fatigue and loss of appetite, this indicates serious health problems. Any of the above symptoms in combination with an enlarged liver is an excuse to seek medical help immediately. The doctor will prescribe a test to confirm or exclude liver damage.
The causes of hepatomegaly in children are diverse, but doctors identify 6 main factors that can lead to problems, consider them:
- Inflammatory diseases - congenital infections (herpes, cytomegalovirus, rubella), toxic and medicinal damage to the body, closing of the lumen of the biliary tract, hepatitis A, B, C, parasitic diseases.
- Metabolic disorders - a violation of the structure and metabolism of glycogen, a violation of protein metabolism, Wilson's disease, lipid metabolism disorders, mucopolysaccharidosis, porphyria and others.
- Liver damage (infiltrative) - hemolytic diseases of newborns, 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.
- The primary damage to the liver is multicystosis, 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 pathology of the respiratory system, for example, with pulmonary emphysema. Enlarged organs expel the liver from under the ribs
Hepatomegaly in children is a state of the body, not a disease. Therefore, special attention is paid to the symptomatology and diagnosis of the causes of this pathology. For examination, the child is given a percussion of the abdominal circumference and palpation. Particular attention is drawn to a pronounced venous vasculature in the abdomen, changes in pigmentation of the skin and mucous membranes, symptoms of intoxication, pain and heaviness. If the hepatomegaly is moderate, then there are no objective symptoms.
For reliable confirmation of liver damage, an ultrasound is performed. Such a diagnosis is fully justified in the absence of external manifestations of hepatomegaly. Ultrasound can detect various forms of the disease, detect abnormalities in the structure of the organ. Based on the results of the examination, suitable treatment is selected. But hepatomegaly itself is not treated, the treatment is subject to the underlying disease that caused this pathology.
Hepatomegaly in the fetus
Hepatomegaly in the fetus indicates that the liver of the embryo is more than normal. This pathology is easily diagnosed, as the increase in the organ leads to an increase in the abdomen, which can not be ignored during the ultrasound of the pregnant woman. The primary task of the doctor is to determine the causes that caused the pathology of the unborn child. It is on this depends the tactics of treatment and prognosis.
There are many reasons that cause hepatomegaly in the fetus, consider them in more detail:
- Intrauterine infections - the negative effects of toxoplasmosis, cytomegalovirus, chicken pox, rubella, Coxsackie virus, syphilis and even rhesus conflict, can lead to an increase in the liver.
- Various hepatic formations.
- Metabolic disorders.
- Heart failure.
- Syndrome Datsna, Beckwita - Wiedemann, Zellweger.
If hepatomegaly occurs against the background of intrauterine infection, this leads not only to an increase in the organ, but also to the appearance of small hyperechoic inclusions. As for neoplastic lesions in the liver in the fetus, it can be hemangioma, hepatoblastoma, adenoma, mesenchymal hamartoma and others.
Quite often, the enlargement of the liver is accompanied by pathologies of the spleen. As a rule, hepatomegaly is detected in the second half of pregnancy. But the most important thing in finding these problems is to exclude Down syndrome. The tactics of the introduction of pregnancy directly depends on the causes that caused the pathology, since isolated hepatomegaly in the fetus occurs very rarely.
Hepatomegaly in newborns
Hepatomegaly in newborns is considered the norm if it is of an unexpressed nature. But if the liver protrudes more than 2 cm, then this indicates an organ disease. The list of diseases is extensive, since hepatomegaly does not appear by itself, but signals the presence of diseases of the body or organism. The hepatomegaly syndrome can be associated with eating disorders, autoimmune processes, or a condition after vaccination.
The main causes of pathology are found in 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 - virtually all viral infections in babies cause compaction and enlargement of the liver.
- Diseases of the cardiovascular and respiratory system - pathology can develop due to right ventricular failure. •
- Blockage of the biliary tract and bile duct cysts - this disease is very rare, but also causes an increase in the liver. The main symptoms are fever, and when trying to palpate the liver, the baby begins to cry.
- Cholangitis - hepatomegaly appears due to inflammation of the bile duct. The disease is accompanied by high fever and pain in the right hypochondrium.
- The Debra syndrome - pathology occurs in children who develop poorly. Due to the developmental lag in the liver, glycogen and fat accumulate, which can cause fatty hepatosis.
- Disorders of lipid metabolism - in this case the newborn has severe diarrhea, vomiting and skin xanthomas.
- Echinococcosis is a disease caused by the introduction into the liver of larvae of tapeworms. Pathology causes nodal enlargement of the organ. The main cause of echinococcosis is contact with animals, especially dogs.
- The Voringer syndrome - hepatomegaly occurs in children with autonomic symptoms and abnormal body weight.
- Mauriac's syndrome is a complication of diabetes mellitus, which causes the accumulation of fat in the baby's liver.
- Liver tumors - hepatoblastomas and isolated organ tumors are extremely rare, but can metastasize and affect both one and both lobes of the liver.
- Disease Girke - a disease of accumulation of glycogen. In addition to enlarging the liver, causes convulsions, increased lactic acid in the blood and the release of acetoacetic acid in the urine.
Despite such a variety of causes and factors that cause hepatomegaly in newborns, there are common symptoms that can point to the disease, consider them:
- Jaundice of the skin - persistent jaundice appears with many liver diseases. Particular attention should be paid to the color of the feces of the child. If the baby has a colorless stool, you should immediately seek medical help.
- Vascular asterisks in the abdomen.
- Nausea, company, poor appetite.
- Lethargy, increased fatigue.
- Navel swelling - this happens only with severe liver and abdominal cavity diseases. The abdomen of the child is greatly increased due to the accumulation of fluid.
Particular attention is paid to HIV-infected newborns with hepatomegaly. In some cases it is the enlargement of the liver that serves as an early symptom of HIV infection. In such children, the spleen is enlarged, upper respiratory tract infections, dermatitis, parotitis, enlarged lymph nodes appear. If the disease is in a moderate course, the baby may suffer from prolonged candidiasis of the oral cavity, hepatitis, diarrhea, fever, anemia, meningitis, or sepsis.
Hepatomegaly in pregnancy
Hepatomegaly during pregnancy occurs quite often. As a rule, problems with the liver occur in the last trimester. Due to the increase in the uterus, the liver is shifted up to the right, the organ becomes more voluminous and full-blooded. At the same time, excursions of the diaphragm are reduced, which causes difficulties in excretion of bile. In addition, during pregnancy, a number of changes are observed, which must necessarily be taken into account when examining the organ. For example, the appearance of vascular asterisks on the skin, increased content of fatty acids, triglycerides in serum or cholesterol. All this is due to the influence of estrogen and progesterone and an increase in the volume of circulating blood.
All liver diseases that occur during pregnancy and cause hepatomegaly are divided into three groups:
- Lesions of the organ associated with pregnancy (occur only in pregnant women).
- Intrahepatic cholestasis of pregnant women is a rare disease that is diagnosed in 20% of women. At the heart of the pathology lies a hereditary predisposition to an incorrect cholestatic reaction to estrogens and progesterones produced during gestation.
- Lesion of the liver due to manifestations of toxicosis (with excessive vomiting). A similar phenomenon occurs in 2% of pregnant women and develops between the 4th and 10th week of gestation, it stops by the 20th week of pregnancy. Excessive vomiting leads to dehydration of the body, protein catabolism, electrolyte disorders and weight loss.
In addition to the above-described reasons, hepatomegaly during pregnancy can arise due to vascular stagnation, fatty hepatosis, diabetes, leukemia, inflammatory diseases, tumoral neoplasms and cysts.