Hundreds of suppliers bring hepatitis C medicines from India to Russia, but only M-PHARMA will help you buy sofosbuvir and daclatasvir, while professional consultants will answer any of your questions throughout the therapy.

Related diseases and their treatment

Descriptions of diseases

Titles

Title: Hepatomegaly.

Description

A syndrome characterized by an increase in the size of the liver. The cause may be viral hepatitis, infectious mononucleosis, alcoholic disease, cirrhosis, accumulation pathology (hemochromatosis), Budd-Chiari syndrome (hepatic vein thrombosis), fatty degeneration, oncological, cardiovascular and other diseases. The main manifestations are a feeling of heaviness, pain in the right hypochondrium, signs of compression of neighboring organs, dyspeptic disorders. Diagnosis is based on the results of liver tests, abdominal ultrasound, MSCT, puncture liver biopsy and other methods. Treatment is determined by the cause of the syndrome.

Additional facts

Hepatomegaly is a pathological syndrome consisting in a true enlargement of the liver (the size along the right midclavicular line exceeds 12 cm or the left lobe is palpated in the epigastric region). Normally, the liver is soft, easily palpable under the costal arch. With various diseases, the size of the organ can increase significantly, the structure becomes more dense. Hepatomegaly may be due to dystrophic changes in the liver cells (in hepatoses), lymphomacrophage infiltration (in the case of acute or chronic hepatitis), nodule formation and fibrosis (in cirrhosis), blood stasis (with damage to the liver veins, constrictive pericarditis, heart failure) or focal changes (with abscesses, tumors, cysts). This syndrome is often the leading one that determines the clinical picture. Hepatomegaly is not an independent disease, but a sign of a certain pathology.

Causes

An increase in the size of the liver can occur in many diseases. One of the most common etiological factors is diseases of the vascular bed of the organ. More often, hepatomegaly develops with lesions of the portal and hepatic veins due to thrombosis, Budd-Chiari syndrome, much less often with lesions of the hepatic artery.
The second most important group of causes are infectious and viral lesions, which may result in damage to the liver parenchyma, portal vein and bile ducts (with viral hepatitis, infectious mononucleosis, amoebic abscess, purulent thrombophlebitis of the portal vein, nonspecific cholangitis due to choledocholithiasis). Hepatomegaly is a characteristic sign of a neoplastic process (oncological pathology). Primary tumor damage to the liver is quite rare, more often metastatic lesions develop; from benign tumors, adenomas and hemangiomas of the liver can be detected.
Hepatomegaly also occurs with degenerative lesions of the liver tissue (steatohepatosis, non-alcoholic steatohepatitis, secondary changes in the pathology of the cardiovascular system), amyloidosis, the action of hepatotoxic substances (alcohol, drugs, some synthetic and natural compounds). Less commonly, the cause of hepatomegaly is congenital pathology, autoimmune, endocrine diseases (diabetes mellitus, endocrinopathy during pregnancy) and traumatic damage to the liver tissue (liver injury).

Classification

Most often, gastroenterologists use the etiological classification of this syndrome. Depending on the diseases that caused the liver enlargement, hepatomegaly is distinguished due to circulatory disorders, metabolic disorders, primary liver diseases, infiltrative processes in the organ, some hematological diseases and local lesions.
Also, when verifying the diagnosis, the anatomical and morphological classification of hepatomegaly is taken into account: damage to the parenchyma, bile ducts, connective tissue or vascular network. For a differential diagnosis, the classification reflects whether a given symptom is combined with splenomegaly (enlarged spleen), jaundice, or ascites.
Depending on the degree of enlargement of the organ, moderate hepatomegaly is distinguished (a slight change in size and structure that does not fit into the norm), pronounced (an increase of 10 cm from the norm) and diffuse (more than 10 centimeters). A separate form is partial hepatomegaly, when the liver enlarges unevenly - only part of it or one lobe.

Symptoms

Symptoms of liver enlargement are determined by the underlying disease. Moderate hepatomegaly, which develops with acute viral infections and malnutrition in children, may not manifest itself in any way. When the liver reaches a significant size, discomfort in the right hypochondrium, pain, aggravated by movement, is possible. Also characteristic are skin itching, rashes, dyspeptic complaints (nausea, stool disturbance, flatulence), bad smell from mouth.
In the case of hepatomegaly against the background of viral hepatitis, a thickening of the liver parenchyma is determined, which is easily detected even with palpation. An increase in the liver is accompanied by icterus of the sclera and skin, intoxication. With timely effective treatment the syndrome may regress. Hepatomegaly in cirrhosis of the liver occurs due to damage to hepatocytes and the formation of connective tissue in their place. Significant compaction of the organ, constant pain in the right hypochondrium, earthy skin tone, and a tendency to bleeding are characteristic.
Enlargement of the liver due to a primary neoplastic lesion is quite rare, with the leading symptoms being: hepatosplenomegaly, pain, dyspeptic disorders, jaundice, edema, and ascites. With a secondary (metastatic) lesion, the symptoms of hepatomegaly are usually less pronounced than the signs of primary tumor growth. In the case of benign liver tumors, an increase in the organ is usually the first and leading sign. When the formation reaches a significant size, an asymmetric increase in the abdomen is possible, signs of compression of neighboring organs.
A feature of hepatomegaly in degenerative changes (fatty liver disease) is poor symptoms, a rare development of a severe lesion. Usually, this disease is a diagnostic finding when the patient contacts for other reasons. With amyloidosis, the liver can reach a significant size, its structure is dense, the edge is even, there is no pain on palpation.
Hepatomegaly in heart disease develops in the case of right ventricular failure; the syndrome progresses rapidly, which leads to stretching of the organ capsule and severe pain. The size of the liver is variable and, with successful treatment of the underlying disease, decreases.

Diagnostics

Determining an increase in the size of the liver is not difficult - for this purpose, palpation and percussion are performed, as well as ultrasound of the abdominal organs. It is necessary to establish the causes of this syndrome.

Differential Diagnosis

Differential diagnosis of hepatomegaly in gastroenterology begins with the exclusion of viral etiology. The anamnesis is studied in detail (whether there were transfusions of blood or its components, hemodialysis and other adverse epidemiological factors). In laboratory tests for viral hepatitis, an increase in the activity of aminotransferases is determined, predominantly ALT. A reliable diagnostic method is the detection of specific immunoglobulins and the genetic material of the pathogen by polymerase chain reaction (PCR). To assess the degree of histological activity, a puncture biopsy is performed.
In order to exclude the autoimmune nature of hepatomegaly, the level of circulating autoantibodies is determined. More often, this pathology develops in women under 25 and in the postmenopausal period and may be accompanied by symptoms such as joint pain (arthralgia), glomerulonephritis, and fever.
The cirrhotic etiology of hepatomegaly is confirmed by anamnestic indications of alcohol use or liver disease, elevated blood levels of gamma globulins, alkaline phosphatase and aminotransferase activity, and low serum prothrombin and albumin levels. Ultrasound of the abdominal organs reveals diffuse heterogeneity of the liver parenchyma, as well as an increase in the diameter of the portal and splenic veins.
Diagnosis of vascular causes of hepatomegaly (obstruction of the hepatic veins) is based on the results of Doppler ultrasound, lower cavography, puncture liver biopsy, and radioisotope scanning. To exclude a tumor lesion, MSCT of the abdominal organs is performed.

Hepatomegaly is a pathological increase in the size of the liver (pathological or physiological), which is a sign of various abnormalities. This disease can also be observed in an isolated form. This is due to organic pathology or the presence of systemic changes in the body.

ICD-10 code

Hepatomegaly and splenomegaly (enlargement of the spleen) are coded R16 and include three subcategories:

• R16.0- hepatomegaly, not indicated in other rubrics,
• R16.1- splenomegaly, not prescribed in other parts,
• R16.2- Hepatomegaly and splenomegaly.

Causes

Enlargement of the liver is an indicator of damage, the nature and stage of which depend on the size of the organ. Pathology can form against the background of cardiovascular abnormalities, metabolic disorders.

With the latter, in 90% of cases, the development of the disease is observed, which can be both moderate and severe. The disease in this situation develops due to the excessive accumulation of metabolic products.

Often the problem develops:

• Due to ailments of the vascular bed of the organ, for example, with lesions of the portal and hepatic veins due to thrombosis, lesions of the hepatic artery.
• Against the background of infectious and viral lesions, which may result in damage to the parenchyma, portal vein and bile ducts.

Hepatomegaly also occurs during degenerative processes in tissues, congenital pathologies and traumatic injuries. It is also found during pregnancy, in the third trimester. Since an increase in the size of the uterus provokes a displacement of the liver up and to the right.

The parenchyma in this case becomes more full-blooded. There is a decrease in the motor function of the diaphragm, the excretion of bile is difficult.

An enlarged liver is often observed in a newborn child. In the absence of other pathologies, the manifestations disappear quickly. The process slows down if there are infectious diseases or obstruction of the bile ducts.

Symptoms

Symptoms depend on which deviation is dominant. Most often, the patient complains of pain on palpation, yellowness of the skin and a feeling that there is a foreign body in the right side. At the initial stage, an asymptomatic course of the liver is noted.

Depending on the disease, different symptoms can be observed:

Hepatomegaly syndrome

This syndrome indicates the presence of an increase in individual zones or the entire organ. There can be many reasons for this. An increase indicates signs of other diseases.

There are several factors contributing to the development of the disease:

• alcohol abuse,
• increasing doses of drugs
• infectious diseases,
• improper nutrition.

There are several main symptoms that are present in hepatomegaly syndrome. These include pain in the right side when changing body position, skin rashes, accumulation of fluid in the peritoneum, icteric skin.

Left lobe of the liver

This pathology is rare. An increase in the left lobe can occur due to the vital activity of pathogens or infections of other internal organs.

This part of the liver is located very close to the pancreas, so changes in the organ can lead to an increase in the volume of the left lobe.

The patient is undergoing various diagnostic measures to identify abnormalities not only in the liver, but also in the functioning of other organs and systems.

Due to the right share

Changes in this area appear more often. The increase may be natural, since the right lobe carries a high functional load. In this case, any toxins or lack of the required amount nutrients affect the right lobe of the organ.

However, negative factors not always become the cause for the appearance of disturbances only in the work of the liver, but also in the whole organism. If hepatomegaly of the right lobe is detected, then a comprehensive treatment of the entire organ is carried out.

diffuse form

They talk about it if the size of the organ in an adult is increased by 13 cm. Each lobe of the organ has separate nerve fibers. The tissues are “impregnated” with nerve capillaries. Each part has its own ducts and a separate main artery.

If diffuse deviations are detected, then the failure may affect the functioning of any of the elements. This leads to the fact that it is difficult to make an accurate diagnosis, as well as determine the cause of the changes.

diffuse changes

They can occur against the background of streptococcal infections. This causes the development of pain radiating to the shoulder blade.

Chills are often present. In this case, treatment with conservative methods does not bring the desired result. Only surgical treatment is effective.

If the changes are caused by intoxication, then the pain can be not only from the location of the liver, but also from the joints. The cause of the development of diffuse changes can also be the use of drugs, the abuse of fatty foods.

Daily exposure to toxins leads to impaired liver function, as well as changes in structure and size.

Partial

With this form, an uneven increase in the organ occurs. Often this type is observed with moderate hepatomegaly. Since the homogeneity of tissues is disturbed, the formation of tumors, or various ones, is possible.

If only the left or right lobe is enlarged, then we can talk about this form. At the doctor's appointment, this pathology is detected quite easily by the method, since the edges of the affected area become uneven and bumpy.

Disease on the background of fatty hepatosis

Liver cells can change into fat cells. A simple explanation is the accumulation of a large amount of fat. The problem is formed due to the regular use of harmful and fatty foods, alcohol and drug abuse.

Toxic substances, when they enter the liver, change their structure. An excess amount is deposited in the organ, which leads to an enlarged liver.

If no action is taken, then such phenomena can lead to cirrhosis.

First, the first fat cells mature. They gradually accumulate, grow. Connective fibers begin to form between them. This pathology may be a manifestation diabetes caused by disturbances in the functioning of the digestive system.

Pathology in children: causes and signs

Subjective signs of the disease are detected by palpation. There may be swelling of the abdominal circumference, pain, heaviness, loss of appetite, increased fatigue and tearfulness.

Almost always the skin is stained in yellow light, the nature and color of the stool changes, a vascular network appears.

Pathology affects children of all ages. The development of the disorder can be triggered by disruptions in diet, autoimmune reactions and other factors. If we take children aged 5-7 years, then the usual age-related changes become the reason for the increase in the organ.

In the fetus

The liver in the fetus can be seen as early as 11-14 weeks. During this period, the body is determined in the form of a crescent formation. An increase in the size of the liver is detected simply, since at first the diagnostician draws attention to the large size of the fetal abdomen.

Sometimes the pathology is combined with an increase in the size of the spleen. Hepatomegaly is more often detected in the second trimester of pregnancy.

The tactics of pregnancy management depends on the reasons that led to the deviation. Isolated vit deviation is extremely rare. More often this happens under the influence of:

1. Metabolic disorders.
2. Congestive heart failure.
3. Liver formations.
4. intrauterine infections.

Hepatolegalia is diagnosed in 10% of children with Down syndrome. In this case, it is the result of transient abnormal myelopoiesis.

In newborns

The cause may be a primary lesion, such as biliary cirrhosis or fibrosis.

Often appears against the background of inflammatory processes. Provoking factors are hepatitis, liver abscesses. Possible difficulty in the flow of blood and bile, pathology of metabolism.

Doctors note that an enlarged liver in a newborn can also occur with emphysema. The expansion of their boundaries leads to the expulsion of the body. This is clearly visible on the x-ray. But there are no changes in the organ itself, therefore this form of the disease is called false.

Regardless of the cause of the development of the pathology, yellowness of the skin and mucous membranes, increased lethargy and refusal to feed, an increase, bulging of the abdomen, the appearance of a vascular network, discoloration of the stool appear. All of these symptoms require immediate medical attention.

Neonatologist, gastroenterologist and hepatologist deal with issues related to this form of the disease.

During pregnancy

As already noted, the disease usually develops in the second half of pregnancy, when there is an intensive growth of the uterus. Sometimes at this time there is such a disease as intrahepatic cholestasis.

It can also lead to an increase in the size of organs. The cause may be viral hepatitis, abscess and toxoplasmosis. All these factors can adversely affect the development of the fetus, so it is mandatory to consult a doctor.

If a pregnant woman has an isolated type of disease, then a feeling of fullness in two sides at once, a feeling of heaviness in the hypochondrium may appear. In other forms, there is a rapid increase in the liver and slow growth of the spleen, pain on palpation.

Forms of development

There are several forms of development:

• unexpressed,
• moderate,
• expressed.

Unexpressed

This type has no symptoms, therefore it is detected only with the help of ultrasound. The enlargement of the liver in this case is no more than 20 mm.

The only thing that patients can complain about is increased fatigue, weakness even in the absence of physical exertion. Over time, unpleasant sensations of heaviness and discomfort may appear. Possible heartburn and bad smell from mouth.

Moderate

It is diagnosed with small diffuse changes.

Doctors use this term to describe abnormalities in the structure and size of an organ that are not normal.

A moderate increase often occurs in people who eat without following the rules, abuse alcohol. Such a problem can be seen with the use of CT or ultrasound.

Expressed

This form indicates the presence of pathological abnormalities. It is observed with hepoblastoses, and with massive damage to tissues by malignant cells. This provokes the appearance of foci.

With serious pathologies, the organ can reach enormous sizes, occupying most of the abdominal cavity, disrupting the work of other internal organs.

Why is the disease dangerous?

If we talk about pregnancy, then the disease is dangerous in any form. complications can be different:

• miscarriage,
• development of intrauterine anomalies,
• physical or mental retardation of the fetus in development,
• fatal outcome.

In children, with appropriate treatment, there is a chance of eliminating the syndrome. But in the absence of exposure in the baby's body, irreversible processes begin to occur that affect other systems.

In adults, an irreversible increase in the organ can occur against the background of:

• cirrhosis,
• carcinomas,
• disturbances in blood pressure in the portal vein,
• benign tumors,

Diagnostics

Determining the enlargement of the liver thanks to modern technology is not difficult. For this, palpation and percussion are performed.

Medical therapy

Most often assigned:

• Hepatoprotectors. They make it possible to protect the liver from the damaging effects of other drugs. The uniqueness of the drugs lies in the fact that they restore the normal functioning of the body.
• Diuretics. These are diuretics that help purify the blood, reduce the burden on the liver.
• Osmotic pressure regulators. They reduce swelling and reduce pain.
• Vitamin preparations. Aimed at increasing the efficiency of natural recovery processes.

Folk remedies

Alternative therapy methods can be used as an addition to drug therapy. To reduce the enlargement of the liver, a decoction is made from the same amount of sage herb and motherwort.

It is necessary to add the same amount of crushed and dried roots of dandelion, peony and chicory. Then it is necessary to boil, quickly reduce the heat and cook with a slight boil. It is better to keep the finished infusion in a thermos for 30 minutes.

Other methods of treatment are also effective:

• Drink honey solution in the morning and before going to bed. To prepare it, take 200 ml of warm boiled water, 2 small spoons of honey, the same amount of lemon juice.
• Eat ½ half a beetroot. In the morning, you can make a salad based on olive oil from it.
• Drink sauerkraut brine. It is necessary to drink half a glass, mixed in the same proportion with tomato juice.

Diet food

The specialist takes into account the form of the disease, the degree of liver damage, as well as the individual characteristics of the patient's body.

The use of alcohol, smoking, as well as the use of highly salted and fried foods are completely excluded. there should be 6 times a day in small portions. It is desirable that the breaks are equal between each meal.

Allowed products include:

• vegetable oils,
• fish meals,
• vegetables,
• fruit,
• bran bread.

Some products have healing properties. Pumpkin is a source of magnesium, therefore, restores the structure of the liver, apples contain substances involved in the synthesis and filtration of microelements. Cauliflower and broccoli cleanse the body of carcinogens, reduce the risk of developing cirrhosis of the liver.

Forecast

The prognosis depends on the cause of the syndrome and the degree of cell damage. An unfavorable outcome can be with cirrhosis, toxic damage, primary non-plastic process.

Doctors note that a moderate increase in the body with general ailments, viral infections, as well as transient hepatomegaly, are distinguished by their rapidly regressing course.

In most situations, the prognosis for life is favorable, but depends on early detection of the cause of liver enlargement.

Prevention

Avoiding many liver problems is quite simple. To do this, you need to eat fresh fruits and vegetables every day. Food is taken in small portions.

Prevention often comes down to following the rules of a healthy lifestyle. All doctors say that our body suffers especially from the intake of alcoholic beverages.

It is easy to prevent the appearance of a disease in a child if you constantly monitor the health of the child. If there are signs of diseases of other organs, you should immediately consult a doctor. As a preventive measure, use only fresh and organic products on the children's menu.

In conclusion, we note that hepatomegaly is a sign of problems not only with the organ, but with the whole organism. Regular medical examinations, ultrasound examinations can detect an enlarged liver in the early stages. Thanks to this, it is possible to start treatment in a timely manner, to return the size of the organ to normal.

Hepatomegaly (ICD code - 10 R16, R16.2, R16.0) is the process of liver enlargement. Indicates multiple diseases. Signs of hepatomegaly are bright or mild. There is moderate hepatomegaly, severe hepatomegaly.

The reasons for the development of fatty and diffuse changes are different. This may be organ obesity or ordinary poisoning with poisons. Timely ultrasound examination, treatment and diet will help to get rid of the pathology forever.

The liver is the filter of the human body. It is in this organ that the processes of decay of non-toxic and toxic elements take place, which are subsequently excreted with urine and feces. In medicine, there is no separate concept that diffuse changes are an independent pathology.

Enlargement of the liver, pancreas or spleen (ICD code - 10 R16, R16.2, R16.0) is a syndrome indicating that the state of the parenchyma and tissues of other organs is unsatisfactory.

Pathology is determined by ultrasound examination and palpation.

Causes of diffuse changes in the parenchyma:

The above pathologies cause damage, swelling of the parenchyma.

Changes can develop against the background of non-alcoholic and alcoholic fatty degeneration, accumulation of fatty elements in the parenchyma, blockage of the gallbladder channels. It develops both in adults and in children, including newborns.

Signs of diffuse changes

A diffuse change, which entails the growth and enlargement of the organ, is very well felt on palpation. Another ghost of change is pain on palpation. Such symptoms indicate that immediate treatment of the liver should be carried out. But first of all, you need to find out for what reasons the organ enlargement syndrome has developed. When the symptoms are studied, analyzes of the ultrasound examination of the liver, ultrasound of the pancreas, the doctor will be able to prescribe treatment.

Diffuse changes can develop at different ages. But there are factors that can provoke such a condition.

The risk group includes people:

1. Alcohol abusers. Ethanol has a detrimental effect on the liver. It provokes the development of cirrhosis, fatty hepatosis and cancer.
2. Uncontrolledly taking medications for a long time, narcotic drugs, dietary supplements, vitamins.
3. With weak immunity. Viral infections lead to changes in the liver.
4. Malnourished and overweight. Eating fatty, spicy or salty food items causes liver enlargement.

Symptoms of the pathological process directly depend on the pathology that provoked hepatomegaly.

What are the symptoms, besides organ enlargement and pain, may be observed:

• pain and colic in the right hypochondrium, especially at the entrance or if a person abruptly gets up from a chair, sofa;
• the skin becomes yellow, the sclera of the eyes acquire the same shade;
• skin rashes, itching;
• diarrhea and constipation;
• a feeling of heartburn, an unpleasant odor from the oral cavity;
• feeling of nausea, often ending in vomiting;
• hepatic asterisks in certain areas of the skin (with the development of fatty hepatosis);
• sensation of accumulation of fluid in the abdomen.

Hepatomegaly can also develop against the background of extrahepatic pathologies. For example, in case of metabolic disorders. Disturbed glycogen catabolism leads to the fact that the substance accumulates in the liver. As a result, there is a slow increase. In addition to the hepatic parenchyma, the kidneys, spleen, and pancreas increase in size. They provoke diffuse processes of the organ and cardiovascular pathologies.

With a weak contractility, a violation of blood flow develops. As a result, swelling and growth of the organ develops. Therefore, in order to determine real reasons an ultrasound should be done.

Enlargement of the liver and spleen

Moderate hepatomegaly and splenomegaly (ICD code - 10 R16, R16.2, R16.0) are two pathologies that occur, in most cases, simultaneously. Splenomegaly is an enlargement of the spleen.

It develops for the following reasons:

The liver and spleen suffer due to the fact that the functionality of the two organs is closely related. Moreover, the growth of the spleen occurs more often in children, in most cases in newborns. Irregularities in ultrasound diagnostics are determined.

Hepatomegaly in children

In newborns and children under 10 years of age, the development of moderate (age-related) hepatomegaly is most often observed. ICD code R16, R16.2, R16.0. That is, an increase in the liver by 10-20 mm is considered an acceptable norm. If a child under 10 years old or in newborns exceeds the allowable size, while there are symptoms of liver damage, you should immediately visit a doctor.

What signs, besides an increase, may indicate developing pathologies in children:

• pain in the right side, even at rest;
• nausea and vomiting;
• yellowing of the sclera and skin;
• bad breath;
• drowsiness and fatigue.

Causes of organ enlargement in children

The signs are the following:

1. If there is inflammation caused by congenital infections. Hepatomegaly develops against the background of rubella, toxoplasmosis, herpes, liver abscess, obstruction, intoxication, hepatitis A, B, C.
2. In violation of metabolic processes, when a pregnant woman does not eat properly.
3. If genetic disorders are present. These include excessive content of porphins in the body; hereditary enzyme defects; violation of protein metabolism, metabolic diseases of the connective tissue.
4. In the presence of a benign increase in the parenchyma, for example, with hepatitis, hypervitaminosis, blood poisoning.
5. With diagnosed congenital fibrosis, multicystosis, cirrhosis.
6. The causes of organ growth in newborns and children under 10 years of age are infiltrative lesions. This can occur with malignant neoplasms, leukemia, lymphoma, metastases, histiocytosis.

Another reason for diffuse changes in the liver of children under 10 years old is impaired outflow of blood and secretion, which is produced by the gallbladder. It develops with blockage of the bile ducts, stenosis or thrombosis of blood vessels, heart failure, cirrhosis.

Sometimes children develop moderate diffuse hepatomegaly as the body's response to an infection. But this condition is not a pathology. He does not need to be treated.

You can correct the size of the liver, pancreas by eliminating the cause. Diet in childhood is also important. Symptoms of diffuse changes in children are the same as in adults. Children under 10 years old become capricious, they lose their appetite, stool disorders are observed.

In this case, you should immediately contact the appropriate specialist. Treatment of diffuse changes in the liver, spleen and pancreas is carried out by pediatricians, infectious disease specialists, gastroenterologists, and hepatologists.

Echosigns, ultrasound examination can accurately identify the degree of increase: unexpressed, moderate and pronounced.

Treatment in children

Age-related physiological moderate enlargement of the liver, pancreas in children does not need to be treated. In this case, it is enough to pass an ultrasound examination.

Treatment is prescribed only if there is a pathological process that provoked a change in the size of the liver.

As mentioned above, a prerequisite not only for children, but also for adults is a diet. Everyone is excluded harmful products nutrition. The diet is saturated with vegetables and fruits.

Treatment in adults

Treatment is based on the results of the tests, ultrasound examination and visual examination. An ultrasound will show how much the organ has grown. The main goal of therapy is to eliminate the cause of the enlarged liver.

Antiviral and hepatoprotective treatment of viral hepatitis leads to complete recovery. The parenchyma is restored. Hepatomegaly is absent.

If cirrhosis is diagnosed, then, in most cases, it cannot be cured. Because healthy cells are replaced by connective tissue. And this process, unfortunately, is irreversible.

Each disease, accompanied by an increase in the liver or pancreas, requires individual specific treatment, which can only be prescribed based on the results of ultrasound. Sometimes one ultrasound examination is not enough and an MRI is required. But basically, all patients with hepatomegaly are prescribed hepatoprotective treatment. The drugs will help to quickly restore the affected cells.

Some of the most common recovery medications include:

1. Gepabene.
2. FanDetox.
3. Liv 52.
4. Heptral.
5. Karsil.
6. Essentiale forte.
7. Ovesol.
8. Phosphogliv.
9. Ursofalk.

It is advisable to undergo an ultrasound examination throughout the year.

Many diseases are accompanied by an increase in the size and mass of the liver. Hepatomegaly (literally "large liver") - is an integral part of various pathologies, since the organ is involved in all biochemical processes of the body.

Hepatomegaly of the liver is not a disease, but a symptom of a primary or secondary lesion. It is revealed by certain objective signs. Therefore, we immediately warn those who are interested in what this diagnosis means: you should not look for it in the classification of diseases as a separate nosology, it is taken into account in the “Symptoms and Syndromes” section.

Criteria for determining hepatomegaly

We are already so accustomed to the most objective assessment of the size of the liver according to the results of ultrasound or computed tomography that we forget that the attending physician is the first to determine the signs of hepatomegaly using the ancient methods of palpation and percussion.

Normally, when examining an adult, percussion, the diameter of the organ along the right mid-clavicular line should not exceed 12 cm. The lower edge of the right lobe can be palpated in incomplete people, it is soft, glides over the doctor's fingertips.

In relation to the right costal arch, a protrusion of 1–2 cm is allowed. This is typical for people with an asthenic physique. The left lobe of the liver is not palpable. It is located in the upper part of the epigastrium behind the stomach. If in this zone it is possible to determine a dense formation, then hepatomegaly can be suspected.

To be sure of an increase in the liver, the doctor needs to exclude the prolapse of the organ in chronic bronchitis, severe pneumosclerosis. For the right lobe of the liver, an unclear compaction can be taken with a tumor of the kidney, intestines, an increase in the gallbladder.

In addition to size, the doctor pays attention to the shape and density of the edge (sharp, rounded, "stony", "bumpy", soft), the presence of pain on palpation.

What causes pathology?

The causes of hepatomegaly are very diverse. They are associated both with diseases of the liver itself, and with other pathologies. The most common organ enlargement is caused by the following liver diseases:

• viral and non-viral hepatitis;
• hepatosis (fatty hepatosis is a common pathology in obese people), alcoholic and non-alcoholic fatty degeneration;
• tumors (adenoma, hemangioma, carcinoma, cancer metastases from other organs, focal hyperplasia);
• formed cysts;
• amyloidosis;
• liver fermentopathy (with a deficiency of lysosomal lipase, hepatomegaly appears in 87% of cases);
• Gaucher disease, which caused the accumulation of fat;
• cirrhosis with irreversible fibrotic disorders with necrosis of hepatocytes;
• thrombosis of the hepatic veins, blockage of the bile ducts with inflammation of the bladder.

Hepatomegaly is caused by chronic infections and intoxications. The liver ensures the neutralization of toxic substances, poisons, some pathogens “settle” directly inside the organ: with malaria, echinococcosis, granulomatous hepatitis develops with tuberculosis, sarcoidosis, cytomegalovirus damage, mononucleosis, septic pericarditis.

With decompensation of cardiac activity, venous blood of the inferior vena cava system is retained in the liver, the organ swells, a long process causes compression of hepatocytes and their necrosis, followed by replacement with fibrous tissue, and cardiac cirrhosis of the liver is formed.

Since the liver suffers from a pathology associated with metabolic disorders, hepatomegaly is detected with hemochromatosis (iron deposition in cells), Wilson-Konovalov disease (copper particles are found in hepatocytes).

Decompensation of cardiac activity caused by insufficiency of the right ventricular type contributes to overflow and increased pressure in the inferior vena cava and its basin. The congestive type of hepatomegaly is observed:

• with the consequences of acute myocardial infarction;
• myocardial dystrophy;
• cardiomyopathies;
• heart defects.

Hepatomegaly is most pronounced in malignant tumors of the lymphatic system (leukemia, leukemia). In this case, foci of additional extramedullary hematopoiesis are formed in the liver or the tissue is impregnated with lymphoblastic cells. The liver reaches an enormous size, occupies most of the abdominal cavity, its weight reaches 20 kg.

How does hepatomegaly syndrome manifest itself?

On examination, the doctor reveals signs of hepatomegaly and interprets them in favor of a particular diagnosis. For example,

• The "stony" consistency of the edge of the liver, the tuberosity of the surface indicate the likelihood of cirrhosis or a tumor (new cells grow faster, so tubercles form);
• soreness on palpation is more typical for hepatitis (inflammation), moderate edge sensitivity is observed with steatosis;
• a rapid increase in the organ is typical for the development of cardiac decompensation, while the capsule is stretched, which is accompanied by pain;
• the course of liver abscess, echinococcal cyst differs in severe pain.

With a significant increase in the liver, the patient experiences the following symptoms of hepatomegaly:

• heaviness, arching pains constant under the ribs on the right or in the epigastrium with irradiation to the side, the right side of the abdomen, aggravated by movement;
• an increase in the volume of the abdomen due to the accumulation of fluid in the abdominal cavity (ascites);
• itchy skin rashes;
• yellowing of the sclera and skin;
• nausea, heartburn;
• violation of the stool (alternating diarrhea and constipation);
• small angiomas on the skin of the face, chest, abdomen in the form of "spiders" or vascular "asterisks".

Jaundice is one of the possible symptoms of pathology

Specific symptoms depend on the cause of hepatomegaly. With hepatitis in a patient, the liver increases evenly, a seal appears, which is felt along the lower edge. Palpation is painful. There is yellowness of the skin, signs of general intoxication and inflammation (fever, weakness, headaches, dizziness).

Treatment of hepatomegaly caused by viral hepatitis requires antiviral agents, immunostimulants. With good efficiency, the liver returns to normal size. Cirrhosis differs from hepatitis by the mechanism of destruction of the liver tissue. Due to diffuse changes in the liver with areas of necrosis, there is a replacement of working hepatocytes with scar tissue.

Impaired functions are accompanied by a tendency to bleeding, the skin takes on an earthy tint, and ascites grows due to portal hypertension. Around the navel, an expanded venous ring appears with outgoing vessels in the form of a “jellyfish head”.

With metabolic disorders characteristic of metabolic diseases, fermentopathy, along with hepatomegaly, they detect:

• damage to the kidneys and spleen (glycogenosis);
• copper deposition and a colored ring around the iris, hand tremor (Wilson-Konovalov disease);
• yellow-brown spots on the body and xanthelasmas on the eyelids, the relationship of clinical manifestations with the period of fasting (pigmented hepatosis with Gilbert's syndrome);
• cough with hemoptysis (hemochromatosis).

In the patient, signs of heart disease come first: shortness of breath, swelling in the legs, ascites, palpitations and arrhythmia, pain like angina pectoris, cyanosis of the feet, hands, lips, in children - the nasolabial triangle.

Can hepatomegaly develop in only one lobe of the liver?

The liver consists of two lobes, each has its own innervation, blood supply, bile ducts (central artery, vein, bile duct). Isolated hepatomegaly of the right lobe of the liver is observed more often than the left. Functionally, the right lobe is loaded more, it performs 60% of the work of the organ, therefore, any violations primarily affect it.

The left lobe is rarely affected, it is closer to the pancreas, so pancreatic disorders can cause an increase in the proportion

The examination usually reveals damage to the gallbladder and ducts, spleen.

With an uneven increase in the organ, one speaks of partial hepatomegaly. The lower edge of the liver rarely changes, so ultrasound is necessary to detect. A characteristic echo feature is a change in the homogeneity of the tissue structure. Usually found in tumors, cysts, abscess.

How is the enlargement of the liver and spleen combined?

Enlargement of the spleen (splenomegaly) may accompany hepatomegaly. It is noticed that these two signs of pathology support each other. A simultaneous increase is expressed in the hepatolienal syndrome. It is more typical for children, as it is aggravated by the peculiarities of the anatomy and physiology of a growing organism.

It is provoked by hereditary diseases, infections, congenital anomalies. The syndrome is observed:

• with vascular diseases of the arteries and veins of the liver, spleen (vasculitis, thrombosis);
• chronic focal and diffuse pathology of the liver;
• hemochromatosis;
• Gaucher disease;
• hepatocerebral dystrophy.

The main task of diagnosis is to identify the common cause that caused hepatomegaly and splenomegaly.

Organs have a pronounced functional relationship

Types of hepatomegaly according to the conclusion of ultrasound

After the ultrasound, the specialist doctor gives a conclusion using the accepted terms. Hepatomegaly is considered "unexpressed" if the size of the organ exceeds the normal size by 1-2 cm. It is usually detected incidentally, since it does not cause any symptoms (rarely, mild weakness, heartburn, bad breath, diarrhea or constipation are mentioned during targeted questioning).

It is important for the early appointment of treatment, the prevention of further progression. The term "moderate hepatomegaly" is used if, in addition to an increase in size, there are small diffuse changes. They occur with alcoholism, unbalanced nutrition.

Hepatomegaly is called “expressed” if the size of the liver is estimated to be huge, a clear pathology is visible, and the functions of neighboring organs are disrupted. The structure of the tissue is changed due to denser foci.

Sometimes the changes are reversible. It is observed in blood diseases, tumors. Rapid negative dynamics of liver growth is possible with fatty hepatosis, cardiovascular diseases.

How does hepatomegaly progress in pregnant women?

Doctors note that liver problems during pregnancy occur in the third trimester. An enlarged uterus displaces the liver up to the right. The movements of the diaphragm are limited, this makes it difficult to remove bile, the liver overflows with blood.

The functioning of the liver is influenced by hormones, which is manifested by yellowish spots on the face of a woman, "asterisks" on the skin. In the blood of a pregnant woman, an increase in fatty acids, cholesterol, triglycerides is found.

Pathological hepatomegaly can be caused by:

• toxicosis with prolonged vomiting, observed in 2% of pregnant women from the fourth to the tenth week, stops by the twentieth week, dehydration, electrolyte disturbances can occur due to vomiting, the woman's weight decreases;
• intrahepatic stagnation of bile, found in every fifth pregnant woman, the cause is associated with a hereditary predisposition.

Hepatomegaly may occur during pregnancy due to exacerbation of existing chronic diseases (cardiac decompensation, fatty hepatosis, diabetes mellitus, neoplasms, leukemia, hepatitis)

When does hepatomegaly occur in children?

Hepatomegaly in the fetus is manifested by an enlarged abdomen, which is detected by ultrasound during pregnancy. Already at this stage, doctors are trying to determine the cause, the course of pregnancy and the health of the unborn baby depend on it.

The most frequent are:

• intrauterine infection with viruses and bacteria (toxoplasma, cytomegalovirus, Coxsackie, causative agents of chickenpox, rubella, syphilis, HIV), small hyperechoic inclusions are detected in the enlarged fetal liver;
• Rh-conflict, when the mother's blood is Rh-negative, and the fetus takes on the father's Rh;
• various tumor-like formations (hemangioma, hepatoblastoma, adenoma are detected in the fetus);
• increased hemolysis of red blood cells;
• malformation of the heart with insufficiency;
• genetic manifestations of impaired metabolism;
• congenital anomalies.

Isolated fetal hepatomegaly rarely develops, more often it is accompanied by an enlarged spleen and other defects. The most successful period for detection is the II-III trimesters. By a complete examination, it is necessary to exclude Down's syndrome.

In newborns and infants up to a year, a slight increase in the liver is considered the norm. If, on palpation, the lower edge protrudes from the hypochondrium by more than 2 cm, the condition refers to pathology and needs to be clarified.

Hepatomegaly syndrome may accompany a violation of the diet, complicate vaccination, indicate autoimmune processes in the child's body

Of the pathological causes more often found:

• infectious diseases, any viral infections;
• heart defects with right ventricular failure - pay attention to the baby's heavy breathing, cyanosis of the face and limbs, tachycardia;
• diseases respiratory system- the child has severe shortness of breath, wheezing in the lungs;
• bile duct cysts with blockage of the bile ducts, inflammation - accompanied by high fever, pain on palpation in the hypochondrium on the right;
• Debre's syndrome, Gierke's disease - the accumulation of glycogen in the liver tissue contributes to the early development of fatty hepatosis, accompanied by convulsions, the content of lactic acid is increased in the blood, acetoacetic acid is excreted in the urine;
• impaired lipid metabolism - expressed by constant diarrhea, vomiting, yellow spots on the skin;
• Mauriac's syndrome - complicates the course of diabetes, fat accumulates in the child's liver;
• tumors (hepatoblastoma, hemangioma) benign and malignant are rare.

In a small child with hepatomegaly, all the classic symptoms appear. They are hard to bear. With an increase in the abdomen, the umbilical ring does not overgrow, a hernial ring is formed, through which the navel and intestinal loops bulge. Jaundice persists.

HIV-infected newborns sometimes differ from healthy children only in hepatomegaly. From an early age, frequent viral infections of the respiratory tract, parotitis, dermatitis occur, lymph nodes increase, and the oral cavity is affected by fungi. Any infection can lead to sepsis, meningitis, anemia.

Echinococcosis affects older children. The main reason is contact with dogs. At the age of 5–7 years, a moderate enlargement of the liver is observed, which is considered a physiological phenomenon and does not require intervention.

There may be metabolic changes in diabetes mellitus, Wilson-Konovalov disease, porphyria, liver damage caused by hemolysis, lymphoma, leukemia, hemangioma-type tumors, carcinomas with metastases.

In the presence of respiratory diseases, false hepatomegaly should be distinguished, it appears due to the expulsion of the liver from under the ribs by increased airiness of the lungs

How is the diagnosis carried out?

The above reasons for the increase in the size of the liver indicate the difficulty of finding the underlying disease, the importance of differential diagnosis. This means that, in addition to detecting hepatomegaly, all possible types research: blood and urine tests, general, bilirubin, sugar, protein, liver function checks on biochemical tests for basic enzymes.

Assign control over the blood coagulation system, enzyme immunoassay for viral and bacterial infections. The doctor establishes the estimated growth of the organ by percussion and palpation.

Hardware methods are much more accurate and objective: ultrasound, computed tomography and magnetic resonance imaging, radiography is less informative, scanning with preliminary administration of hepatotropic radioactive substances gives a complete picture of cell damage, it is possible to calculate the proportion of the remaining intact tissue.

Modern equipment makes it possible to detect not only changes in size, but also to accurately contrast the boundaries, tissue structure, and the nature of the changes (focal, diffuse). Finally, the morphological changes can be judged by the study of the biopsy.

The most accessible to the population method is ultrasound, it is based on the principle of recording the reflection of a wave from a dense organ

Ultrasound allows you to compare the structure of the liver in all areas, to identify more dense foci, the size of the lobes. Echoscopic observation can be represented as a visual examination on the screen without recording. It is more important when observing a contracting organ (heart). The liver is examined using echographic criteria, images are printed in different projections.

Features of treatment

In the treatment of hepatomegaly, it is very important to know whether it is caused by liver pathology or provoked by concomitant diseases. This determines the prognosis and effectiveness of therapy. In inflammatory processes, it is possible, with the help of strong means, to return the organ to a healthy state.

How to treat hepatomegaly in a particular case, the doctor decides after a full examination and finding out the cause. The treatment regimen depends on the primary disease. It can be:

• antibacterial, antiviral agents, corticosteroids for inflammation of the liver;
• cardiac glycosides and coronary lytics in cardiac pathology;
• cytostatics and radiation therapy for leukemia, tumors;
• hepatoprotectors;
• vitamins;
• choleretic agents.

If it happens active growth connective lymphoid tissue, tumor cells, then complete replacement of dead hepatocytes is impossible, therapy consists in stopping the progression of pathology

Be sure the patient is prescribed a diet according to table number 5. All foods that irritate the liver are excluded from the diet: animal fats, light carbohydrates. With cardiac decompensation, salt is sharply limited. It is forbidden to eat fried and smoked meat, fish products, canned food, sweets.

Everything is cooked only boiled or steamed, you can bake in the oven. Patients are recommended a sufficient amount of protein and vitamins from dairy products, fruits, vegetables.

The detection of even a slight hepatomegaly should alert a person and force him to find out the cause. Treatment of the liver depends on the degree of damage, the underlying pathology. The diet will have to be followed for almost a lifetime.

Hepatomegaly is an enlargement of the liver, which is a sign of various diseases. Consider the main causes of hepatomegaly, types, methods of diagnosis and treatment.

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

ICD-10 code

R16 Hepatomegaly and splenomegaly, not elsewhere classified

Causes of hepatomegaly

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

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

Consider the main causes of hepatomegaly:

• Hepatitis A, B, C, toxic hepatitis.
• Infectious diseases: malaria,
• Alcoholic intoxication of the liver.
• Non-alcoholic and alcoholic fatty degeneration of the liver.
• Cancer metastases to the liver from other organs and cysts filled with fluid.
• Gaucher disease, glycogenosis.
• Fibrotic changes in the liver.
• Obstruction of the bile ducts and blockage of the hepatic veins.
• Pericarditis.
• Malignant tumors of the lymphatic system.
• Benign liver tumors: adenoma, hemangioma.
• Accumulation of an abnormal protein in the liver is known as amyloidosis.
• Metabolic disorders.
• Wilson's disease, that is, the deposition of copper in the liver.

Symptoms of 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), then it can be detected by palpation and even by the outlines of the abdomen. On palpation, the patient feels pain.

Consider the symptoms characteristic of hepatomegaly:

• Painful sensations and a feeling of heaviness in the right side, especially when changing positions.
• Skin rashes, itching.
• Accumulation of fluid in the abdominal cavity, ascites.
• Yellowness of the skin (most often occurs with hepatitis).
• Violation of the stool (diarrhea or constipation) and an increase in the abdomen.
• Heartburn and bad breath.
• Nausea.
• The appearance of "liver stars" on the skin.

If hepatomegaly occurs against the background of hepatitis, then the patient has a uniform increase and compaction of the parenchyma. Because of this, the lower edge of the liver can be palpated under the costal arch. Attempts to probe the liver cause pain and discomfort. With an exacerbation of hepatitis, the pain becomes permanent. Hepatitis causes yellowness of the skin and symptoms of intoxication (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 bleeding tendency, 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, both hereditary and acquired. Due to the violation of glycogen catabolism, it begins to accumulate in the liver, which leads to its slow increase. 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, an increase in the organ develops according to the type of cirrhosis. But changes occur not only in the liver, but also in the lungs. The patient suffers from a violent cough with bloody sputum.

Diseases of the cardiovascular system can provoke an increase in the liver. Due to insufficient contractility, chronic cardiovascular insufficiency develops, which leads to the development of chronic hypoxia. As a result, a stagnant liver develops. Prolonged 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 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 enlargement of the spleen.

The cause of diffuse changes in hepatomegaly may be in long-term use medicines or eating fatty foods. Daily exposure to toxins on the body leads to impaired 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.

Ultrasound is performed to diagnose diffuse enlargement of the liver. If a slight increase in the organ and a uniform compaction of the parenchyma are detected, the patient is checked for hepatitis. More details about the degree of violations in the work of the liver and the severity of liver failure are judged by the results of a biochemical blood test. If there are changes in the contours of the organ, a bumpy and uneven structure, then this may indicate cirrhosis.

The main treatment for hepatomegaly with diffuse changes is diet. The patient is made up of a diet that involves the rejection of fatty, spicy and sweet foods, as well as alcohol and other bad habits. Methods can be used to cleanse the liver traditional medicine and, of course, medications. But the most important thing is to determine the cause of the pathology in a timely manner and begin immediate treatment and a complex effect on the symptoms of the disease.

Partial hepatomegaly

Partial hepatomegaly is not a uniform increase in the liver, that is, 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 increase in the organ. In rare cases, there is an uneven change in the lower edge of the liver. On palpation, this pathology is felt uneven and bumpy.

Partial hepatomegaly can be diagnosed by ultrasound. The disease has a characteristic echo sign: a violation of the homogeneity 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

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 hepatolienal syndrome, that is, a combination of pathologies and a change in the size of the spleen and liver.

The involvement of the spleen in the pathological process is explained by the close functional connection of the organs. Hepatolienal syndrome is more common in patients 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, 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 damage to the spleen.

Hepatomegaly against the background of fatty hepatosis

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

Left untreated, fatty liver 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 the liver tissue.
• At the second stage, the number of fat cells increases, and connective tissue begins to grow between the cells.
• At the last stage, pronounced strips of connective tissue appear, which subsequently lead to fibrosis and severe 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, consider them:

• Diseases that cause lipid metabolism disorders: type 2 diabetes mellitus, obesity, hypertriglyceridemia and others.
• Toxic effect 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 the systematic use of alcohol.
• Digestive disorders and related diseases. The liver takes an active part in the process of digestion, but if there is a violation of the absorption of fats or the excretion of bile acids, this leads to serious pathologies.
• Diseases of the endocrine system. Fatty hepatosis occurs when excessive production of hormones of the adrenal cortex and with a lack of thyroid hormone.
• Malnutrition causes lipid disorders, which leads to hepatomegaly and fatty liver. Irregular meals, limited amount of protein, 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 exposure, 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 condition of the skin worsens, a decrease in visual acuity is possible. Pronounced symptoms of the disease occur at the last stage of fatty hepatosis.

, , , ,

Hepatomegaly in children

Hepatomegaly in children can occur at any age, both in newborns and in adolescents or children school age. Dietary disorders, autoimmune processes in the body and other factors can cause pathologies of the liver and spleen. For example, in children 5-7 years old, an increase in the liver is age-related, so hepatomegaly is moderate. Such a physiological phenomenon does not require medical intervention and treatment. But if this happens in older children, then the reason may be in violations of the body or diseases.

The danger is not just an enlarged liver, 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 combined with an enlarged liver is a reason to seek immediate medical attention. Your doctor will order tests to confirm or rule out liver damage.

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

For examination, the child is percussion of the abdominal circumference and palpation. Particular attention is drawn to the pronounced venous vascular network in the abdomen, 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.

For reliable confirmation of liver damage, an ultrasound examination is performed. Such a diagnosis is fully justified in the absence of external manifestations of hepatomegaly. Ultrasound allows you to recognize different forms of the disease, to detect violations in the structure of the organ. According to the results of the examination, a suitable 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 liver of the embryo is larger than normal. Such a pathology is easily diagnosed, since an increase in the organ leads to an increase in the abdomen, which cannot be overlooked during an ultrasound scan of a pregnant woman. The primary task of the doctor is to determine the causes that caused the pathology in the unborn child. It is on this that the tactics of treatment and prognosis depend.

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

• Intrauterine infections - the negative effects of toxoplasmosis, cytomegalovirus, chicken pox, rubella, Coxsackie virus, syphilis and even Rh conflict can lead to liver enlargement.
• Various hepatic formations.
• Metabolic disorders.
• Heart failure.
• Hemolysis.
• Syndrome of Datsna, Beckwith - Wiedemann, Zellweger.

If hepatomegaly occurs against the background of intrauterine infection, then this 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, it can be hemangioma, hepatoblastoma, adenoma, mesenchymal hamartoma and others.

Quite often, an increase in 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 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 has an unexpressed character, 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 an organ or organism. Hepatomegaly syndrome may be associated with eating disorders, autoimmune processes, or a condition after vaccination.

The main causes of pathology lie in inflammatory and degenerative processes in the liver parenchyma. Hepatomegaly in newborns can also be a physiological phenomenon. Consider the main causes of liver enlargement in infants:

• Infectious diseases - almost all viral infections in babies cause thickening and enlargement of the liver.
• Diseases of the cardiovascular and respiratory system - pathology can develop due to right ventricular failure.
• Blockage of the bile ducts and cysts of the bile duct - this disease is very rare, but also causes enlargement of the liver. 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 fever and pain in the right hypochondrium.
• Debre's syndrome - pathology occurs in children who develop poorly. Due to the developmental delay in the liver, glycogen and fat accumulate, 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. Pathology causes nodular enlargement of the organ. The main cause of echinococcosis is contact with animals, especially dogs.
• Woringer's syndrome - hepatomegaly occurs in children with autonomic symptoms and abnormal body weight.
• Mauriac's syndrome is a complication of diabetes that causes the accumulation of fat in the baby's liver.
• Liver tumors - hepatoblastomas and isolated tumors of the organ are extremely rare, but can metastasize and affect both one and both lobes of the liver.
• Gierke's disease is a glycogen storage disease. In addition to enlargement of the liver, it causes convulsions, increased levels of lactic acid in the blood, and excretion of acetoacetic acid in the urine.

Despite such a variety of causes and factors that cause hepatomegaly in newborns, there are common symptoms that may indicate a disease, consider them:

• Jaundice of the skin - persistent jaundice appears with many liver diseases. Particular attention should be paid to the color of the child's feces. If the baby has colorless stools, you should immediately seek medical help.
• Vascular asterisks in the abdomen.
• Nausea, mouth, poor appetite.
• Lethargy, increased fatigue.
• Swelling of the navel - this happens only with severe diseases of the liver and abdominal cavity. The child's abdomen is greatly enlarged 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 acts as an early symptom of HIV infection. In such children, the spleen enlarges, infections of the upper respiratory tract, dermatitis, parotitis, and swollen lymph nodes appear. If the disease is in a moderate course, then the baby may suffer from prolonged oral candidiasis, hepatitis, diarrhea, fever, anemia, meningitis or sepsis.

Hepatomegaly during pregnancy

Occurs quite often. As a rule, liver problems occur in the last trimester. Due to the increase in the uterus, the liver shifts upward 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 the excretion of bile. In addition, during pregnancy, there are a number of changes that must be taken into account when examining the organ. For example, the appearance of spider veins on the skin, an increased content 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.

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

• Organ lesions associated with pregnancy (occur only in pregnant women).
• Intrahepatic cholestasis of pregnancy is a disease that is diagnosed in 20% of women. Pathology is based hereditary predisposition to an incorrect cholestatic response to estrogens and progesterones produced during the gestation period.
• Liver damage due to manifestations of toxicosis (with excessive vomiting). A similar phenomenon occurs in 2% of pregnant women and develops between 4 and 10 weeks of gestation, stops by the 20th week of pregnancy. Excessive vomiting leads to dehydration, protein catabolism, electrolyte disturbances, and weight loss.

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

Forms

Hepatomegaly is included in the international classification of diseases of the 10th revision. That is, a single regulatory document used to record morbidity, causes of death and reasons for the population to seek medical help.

Unexpressed hepatomegaly

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

Typical symptoms of unexpressed hepatomegaly are weakness, fatigue that occurs without physical and other stress. In the abdominal cavity, unpleasant sensations of heaviness and discomfort appear, heartburn, bad breath, skin itching and dyspepsia are possible. When the above symptoms appear, it is necessary to undergo a complete examination, since palpation is ineffective. The patient is prescribed an ultrasound examination, the results of which can assess the condition and size of the liver. In addition to ultrasound, computed tomography of the abdominal cavity can be prescribed, which provides more complete and reliable information about the state of the organ.

If a change in the liver is found, then 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, then the doctor prescribes drugs to strengthen the shell of the liver cells: Karsil, Ursosan, Essentiale-forte and others.

Moderate hepatomegaly

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

A moderate enlargement of the liver occurs with prolonged alcohol abuse and an unbalanced diet. As a rule, this diagnosis can be seen after an ultrasound or CT scan of the abdomen. Without proper treatment and a healthy lifestyle, the pathology progresses and becomes pronounced.

Severe hepatomegaly

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

With severe 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. A rapid increase in the liver is possible with fatty infiltration and cardiovascular diseases.

Diagnosis of hepatomegaly

The doctor examines the patient, performs palpation and percussion of the liver. Particular attention is paid to the collection of anamnesis of the disease. The patient should tell the doctor if there is any pain in the abdomen, the presence of vomiting and nausea, an unusual color of the stool, yellowing of the skin, a feeling of excessive heaviness or a lump in the abdomen. To prescribe a further examination, the doctor will find out if the patient is taking any medications, how much alcohol is consumed and about nutrition.

The symptoms characteristic of hepatomegaly give every reason for a detailed examination of the body. As a rule, patients are prescribed:

• Biochemical analysis of blood (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 the abdominal organs.
• Radiography.
• Liver function tests, including blood clotting tests.

In some cases, to clarify the processes in the liver, a biopsy is performed. 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 scans as focal lesions. The enlarged liver is characterized by the presence of zones with a reduced accumulation of radionuclides. During the examination, the doctor reveals topographic changes in the position, size of the organ, changes in the structure of the hepatic segments.

Ultrasound examination can reveal any focal lesions of the liver. Diagnostics makes it possible to determine the degree of hepatomegaly, the condition of the spleen and other internal organs. More extensive information to study the causes of liver enlargement is obtained using echohepatography.

Echo signs of hepatomegaly

They play an important role in determining the diseases that caused an enlarged liver.

Echo signs of hepatomegaly allow you to accurately determine the degree of pathology: unexpressed, moderate and pronounced enlargement of the liver.

Differential Diagnosis

Differential diagnosis of hepatomegaly is necessary in order to accurately determine the cause of liver damage and separate it from other diseases with similar symptoms. Particular attention is paid to the size of the shares of the body. So, an increase in the edge of the right lobe without differential diagnosis can be mistaken for neoplasms of the colon, gallbladder or kidney. One more milestone diagnosis is to distinguish hepatomegaly from hepatoptosis and hepatosis. To accurately determine the causes of liver enlargement, palpation is performed in different positions and an ultrasound examination.

• 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 you to establish the phase of virus replication and identify its presence.
• Hepatomegaly is one of the first symptoms of liver cirrhosis, so this disease is also important to differentiate. Cirrhosis causes portal hypertension, functional failure and hardening of the liver.
• Portal hypertension is accompanied by circulatory disorders, which causes an increase in the organ. To recognize this disease, gastroscopy is performed, which reveals the expansion of the veins of the stomach and esophagus, a biopsy is possible.
• An increase in the liver and pain in the right hypochondrium is also characteristic of obstruction of the hepatic veins, which leads to impaired outflow of blood from the organ (Budd-Chiari syndrome). The patient complains about elevated temperature, weakness and ascites. For diagnosis, Doppler ultrasound is performed with an assessment of blood flow. The main symptom of this disease is hepatomegaly with a complete violation of liver function. It is mandatory to perform a puncture biopsy.
• It is extremely important to recognize storage diseases (amyloidosis, fatty liver, hepatocerebral dystrophy, hemochromatosis), which at the initial stage give one single 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 needle biopsy data.
• When diagnosing diseases of the cardiovascular system that cause hepatomegaly, it is necessary to remember the possible pericarditis in the right ventricle. As a rule, in this case there was a history of trauma in the region of the heart or tuberculosis. The first signs of the disease cause pain in the right hypochondrium, an increase in the left lobe of the liver, shortness of breath, and high blood pressure.

Treatment of hepatomegaly

Treatment of hepatomegaly depends entirely on the results of the diagnosis and on the etiological component of the pathology. Treatment should be aimed at eliminating the causes of liver damage and combating painful symptoms. It is obligatory to follow a special diet, a sparing regimen 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. Appointment of betaine, pentoxifylline, rosuvastatin, orlistat, ursodeoxycholic acid and atorvastatin for non-alcoholic steatohepatitis. [

If the patient has an enlarged liver against the background of compensated cirrhosis, then it is recommended to limit physical activity, follow a diet with enough vitamins and protein, and completely stop drinking alcohol. Active viral cirrhosis B and C causes viral replication, so the treatment is carried out with medications. ,

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

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. Consider the basic rules of nutrition for hepatomegaly:

• You need to eat at least 6 times a day, that is, three main meals and three snacks. Food is recommended to be taken fractionally, in small portions.
• It is necessary to completely abandon fatty and fried foods. Dishes are best steamed, boiled or baked. It is allowed to consume no more than 70 g of fat per day, while it is better to replace animal fats with vegetable ones.
• From the diet you need to completely exclude bakery products, sugar and any sweets.
• It is forbidden to eat fatty meat and fish, lard, smoked, spicy, canned or salty foods.
• The diet should include stewed and boiled vegetables, cereals, steamed or baked fish, poultry meat. It is recommended to consume more seasonal vegetables and fruits.

Diet for hepatomegaly

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

Allowed products:

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

Nutrition for hepatomegaly requires dinner no later than seven o'clock in the evening. It is strictly forbidden to overeat, 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 meat, lamb.
• Cheese with a high percentage of fat.
• Pickled and fried foods.
• Hot spices, sauces, vinegar.
• Beans and onions.
• Tomato juice.
• White refined sugar and any confectionery.
• Chocolate.
• Canned food.
• Bakery products.

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

Prevention

Prevention of hepatomegaly depends on the underlying disease that caused the liver enlargement. To prevent hepatomegaly, dietary healthy eating, give up bad habits (alcohol, smoking) and control weight. With extreme caution and only after medical permission, you can take medications, as they can also cause toxic liver damage.

Any diseases that caused 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, death occurs from complications of the underlying disease that caused hepatomegaly. These can be intraperitoneal bleeding, severe infectious diseases, violations of the antitoxic function of the liver, and more.

Hepatomegaly is a sign of problems with the liver and the body. Regular medical examinations and ultrasound examinations can detect an enlarged liver in the early stages. Thanks to this, it is possible to start timely treatment of the underlying disease and return the size of the organ and its functional abilities to normal.