Diagnosis of the liver and gallbladder
Last reviewed: 23.04.2024
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Among diseases of the liver and bile ducts, chronic diffuse lesions of the liver - chronic hepatitis and cirrhosis of the liver, as well as cholecystitis (stone and non-calcified) and cholangitis, are of the greatest clinical importance. In addition, one should keep in mind, including differential diagnosis, a real possibility of focal liver lesions - abscesses, echinococcosis, but especially primary liver tumors and metastases of tumors of other localization.
At the present time, a number of genetically determined diseases are also developing in which progression of the liver develops with the outcome of cirrhosis : hepatocerebral dystrophy ( Wilson-Konovalov's disease ), hereditary hemochromatosis (the accumulation of iron in the liver may also be secondary in some anemia , alcoholic disease), liver damage with a1-antitrypsin deficiency.
Timely detection of these diseases is now of great practical importance, especially if it is possible to clarify the etiology or individual links of the pathogenesis of the disease - for example, for a real impact on the cause of the disease: use of antiviral drugs in chronic viral hepatitis; the means that remove copper from the body, with Wilson-Konovalov disease; stopping the use of drugs that caused the development of hepatitis, and, of course, alcohol, leading to severe liver damage.
Resolve
When examining patients with diseases of the liver and biliary tract, a constant "etiologic alertness" is necessary, which, of course, should be manifested even when the patient is questioned.
An epidemiological history is very important, for example, the possibility of contracting the hepatitis B, C, D, E, F, G and GV with blood and blood transfusions, donations, as well as in homosexuals, drug addicts, medical workers (eg, chronic hemodialysis departments, stations blood transfusions), with surgical interventions, including dental, blood transfusions, various solutions. In the epidemiological plan, one should bear in mind the patient's instructions for being in endemic foci of opisthorchiasis, leptospirosis, yellow fever. Of great importance is the identification of medicinal effects: prolonged use of furadonin, tetracycline, certain antihypertensive drugs (dopegit), anti-tuberculosis drugs (isoniazid, ethambutol) can cause chronic hepatitis, some psychotropic drugs - cholestasis, estrogens (including oral contraceptives) - syndrome Buddha-Chiari and the formation of gallstones, as well as jaundice of pregnant women in the third trimester as a result of cholestasis. Special mention should again be made of alcohol as the cause of a large group of chronic progressive liver diseases.
Important information is provided by the study of the family history, since a number of progressive liver diseases, which are often found in the stage of far-reaching cirrhosis and manifesting with common hepatic traits, have certain genetic features. So, it is important to reveal the hereditary nature of the Wilson-Konovalov disease, hemochromatosis, a1-antitrypsin deficiency leading to cirrhosis ; specially allocate family benign hyperbilirubinemia.
Complaints
In patients with liver disease, very often complaints are absent before the stage of severe damage, but a thorough inquiry allows you to detect some of them at an earlier stage of the disease. Common complaints, besides poor appetite, unpleasant, usually bitter taste in the mouth, include complaints of eructations, nausea, vomiting, often provoked by the ingestion of fatty or fried foods, they are disturbed by an unstable stool (constipation is replaced by diarrhea), bloating. In vomit, pure blood may be present, which usually indicates bleeding from varicose veins of the esophagus or the presence of erosive gastritis as a manifestation of portal hypertension caused by liver disease with stagnation of blood in the portal vein system; the same genesis has also the detection of scarlet blood in the stool ("upper" hemorrhoids), and a tarry stool.
The cause of bleeding can be erosive esophagitis and gastritis of alcoholic origin.
Painful sensations can be associated either with irritation of the peritoneum covering the liver, or with spastic contraction of the smooth muscles of the gallbladder and bile ducts; patients are often disturbed also by the feeling of heaviness, pressure in the right hypochondrium.
Pain in the right hypochondrium occurs with perihepatitis (for example, due to swelling, liver abscess) and pericholecystitis, they are usually intense, irradiate upward (into the region of the right shoulder), amplified by palpation of the right hypochondrium. The stretching of the liver capsule due to the increase in the organ (hepatomegaly) also causes a similar nature of 6ols, which is most often observed with a stagnant liver (congestive heart failure).
Painful sensations in patients with diseases of the liver and biliary tract can be associated with dyskinesia of the biliary tract or caused by spasmodically contracting smooth muscles of the gallbladder and bile ducts in biliary colic. Usually, biliary colic causes the stone to move along the bile ducts. These pains appear, as a rule, suddenly, quickly become intolerable, often irradiate upward, accompanied by nausea and vomiting, which does not bring (as distinct from other causes of vomiting) relief. Patients may also have aching or dull pain in the right upper quadrant, which are amplified by palpation of the point of the gallbladder (angle [between the right costal arch and the outer edge of the right rectus abdominus) and the points on the neck on the right between the legs of the m. Sternocleidomastoideus - the so-called point of the diaphragmatic nerve (frenicus-symptom).
When liver diseases are often accompanied by chronic chronic pancreatitis, peptic ulcer of the stomach and duodenal ulcers can also be the cause of abdominal pain.
Skin itching refers to a fairly typical manifestation of liver disease, accompanied by jaundice. The extreme degree of skin itching is painful, aggravating at night, depriving a sick sleep, with a mass of skin combs, often infected, is observed in the presence of intra- and extrahepatic obstruction of the bile duct (cholestasis syndrome).
A number of complaints can be associated with intoxication resulting from a violation of the basic functions of the liver, which is usually manifested by violations of the central nervous system - fatigue, headaches, irritability. With the growth of intoxication, these signs intensify, sleep disorders (sleep inversion - night insomnia and daytime sleepiness) join, then loss of consciousness ( hepatic coma ). Patients with liver diseases may complain of decreased potency and libido, menstrual cycle disorders.
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