Physical methods of examination of the liver

When a general examination of a patient with liver diseases reveals a number of signs that allow you to suspect not only liver damage, but also presumably speak about his etiology. It is important to bear in mind that these signs can be identified by examining a variety of organs and systems: skin, face, eyes, salivary glands, palms and feet, breast glands, testicles. Isolate small and large hepatic signs.

Signs of liver damage, revealed by general examination of the patient

Chronic hepatitis and cirrhosis of any etiology.	Fingers in the form of drumsticks; "Hepatic" palms and feet; vascular asterisks; jaundice, ascites, swelling.
Alcoholic hepatitis and cirrhosis of the liver.	Facies alcoholica; fields of vascular asterisks; intensive palmar erythema; Dupuytren's contracture; gynecomastia; testicular atrophy; an increase in parotid salivary glands.
Primary biliary cirrhosis.	Xanthelasms, xanthomas, hyperpigmentation of the skin.
Biliary duct obstruction, primary sclerosing cholangitis (cholestasis).	Combs; hyperpigmentation of the skin.
Cirrhosis of the liver with portal hypertension.	Expansion of the veins of the abdominal wall; ascites.
Cirrhosis of the liver with hepatic-cellular insufficiency.	Intense jaundice; edematous-ascitic syndrome; hemorrhagic syndrome (bruises, purpura); "Hepatic" smell (factor hepaticus); tremor of brushes, tongue.
Wilson-Konovalov's disease.	Ring of Kaiser-Fleischer (when examined by the ophthalmologist).

To small hepatic signs, first of all skin changes are referred to : vascular sprouts ( telangiectasia ) - from single to scattered in large numbers (fields of vascular asterisks), peculiar enhancement of skin vascular pattern (skin areas resembling paper money assignment), and so-called hepatic palms (palmar erythema) and feet caused by hyperestrogenemia and, possibly, the functioning of arteriovenous anastomoses, which is indicative primarily of liver cirrhosis with viral and alcoholic etiolo and less often, acute hepatitis. Vascular changes in the skin can also take the form of classical hemorrhagic vasculitis ( purpura Shenlaine-Henoch ), often very common, and usually reflect the activity of chronic hepatitis or cirrhosis of the liver, sometimes in places of vascular changes ulcers are formed.

On the skin with liver diseases, it is possible to detect manifestations of hemorrhagic syndrome (from small petechiae to bruising), often detected in connection with low prothrombin content or thrombocytopenia. A peculiar kind of skin is attached to the cholesterol depot - xanthomas with typical localization in the eyelid region (xanthelasm), which may indicate primary biliary cirrhosis of the liver. The increased content of estrogen, poorly metabolized by the affected liver, causes the development of gynecomastia - a common sign of alcoholic cirrhosis of the liver. On alcoholic liver cirrhosis show parotid salivary glands; sometimes very pronounced (giant parotitis), as well as peculiar scar-fibrous seals of the palmar aponeurosis - Dupuytren's contracture. With alcoholic liver damage, testicular atrophy sometimes occurs . Often, with a long-term cirrhosis of a different etiology, changes in the end phalanges of the fingers are identified as the drumsticks.

Finally, it is necessary to specifically name one more feature, which is revealed during general examination, the presence of the Kaiser - Fleischer ring , which is easily detected by the oculist in the form of a peculiar change in the cornea. This sign with a high degree (reliability allows us to establish a long-term (genetically determined) violation of copper metabolism, leading to the development of cirrhosis in Wilson-Konovalov's disease.

At the general or common survey the attention is paid to the degree of exhaustion, especially expressed at far gone cirrhosis or a cancer of a liver, thus the general weight loss is often combined with the big sizes of a stomach due to an ascites. Important for understanding the genesis of isolated ascites is the detection of dilated veins of the abdominal wall (the so-called head of Medusa), which is very likely to allow the discussion of portal hypertension.

Finally, it should be noted that some liver diseases, especially actively progressing (the so-called chronic active hepatitis and cirrhosis in the stage of activity), can be accompanied by a number of common (systemic) nonspecific syndromes - noninfectious fever (naturally, with cholecystitis, cholangitis, liver abscess fever is typically infectious, often hectic, with chills and profuse sweats), arthritis, vascular changes with Reynaud's syndrome (the "dead fingers" syndrome), the so-called dry syndrome ohm ( Sjögren's syndrome - no formation of saliva - xerostomia, tears - keratoconjunctivitis, common dental caries). Sometimes liver disease manifests itself precisely these signs, reminiscent of or repeating another disease, for example scleroderma, systemic lupus erythematosus, rheumatoid arthritis, and only a careful examination of the history and results of liver tests, including biopsies, can diagnose a primary liver disease.

The so-called large hepatic signs are signs of the syndromes characteristic for liver diseases ( jaundice, portal hypertension, etc.).

The main method of physical examination of the liver, as well as of other organs of the abdominal cavity, including the spleen, is palpation, but it is preceded by examination and percussion, which allows us to roughly estimate the size of these organs. Usually, the spleen is examined after a liver test.

When examining the liver region, only a significant increase in the liver ( hepatomegaly ) can be ascertained , better detected with a thin abdominal wall, due to volume formations (tumor nodes, echinococcal cysts, large abscess), sometimes with cirrhosis, congestive liver with heart failure. In all these cases, attention is drawn to the asymmetry of the abdomen due to bulging and lag when moving the abdominal wall in the right hypochondrium and epigastrium. You can also see the pulsation of the enlarged liver due to a wave of blood regurgitation in the case of a tricuspid valve deficiency.

An enlarged gallbladder (dropsy, empyema of the gallbladder) can cause visible protrusion and is easily probed with a large accumulation of bile in it (no adhesions, excluding recurrent chronic cholecystitis ), the outflow of which is complicated by the compression of the common bile duct with a pancreatic head tumor or in the region of the large papilla of the duodenum guts (the nipple of the nipple - the place where the common bile duct enters the duodenum), is known as the symptom of Courvosier.