Symptom >> Internal Medicine >> Gastroenterology

Large and hard liver

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Large and hard liver is a symptom of a common medical condition, especially liver cancer, acute glomerulonephritis, and typical signs of cirrhosis. Liver large and hard related diseases: pediatric hepatoblastoma, multiple myeloma in the elderly, acute hepatitis B dengue hemorrhagic fever, pediatric hepatolenticular degeneration, pediatric hepatitis B virus-associated nephritis, pediatric cirrhosis, glycogen storage Pathogenic liver cancer dystrophic cirrhosis, hepatitis B drug cirrhosis, cardiogenic cirrhosis, biliary cirrhosis.

Cause

Cause

This symptom can be caused by a variety of diseases, such as liver cancer, acute glomerulonephritis, cirrhosis, acute glomerulonephritis and the like.

Causes of acute glomerulonephritis:

The vast majority of the disease is glomerulonephritis after acute streptococcal infection. In the 1982 national pediatric urinary system disease hospitalized children survey, acute nephritis in the anti-"O" increased accounted for 61.2%. After hemolytic streptococcal infection, the incidence of nephritis is generally 0 to 20%. The incidence of nephritis after acute pharyngitis (12 serotype-based infection) is about 10% to 15%, and about 1% to 2% of pyoderma and nephritis after scarlet fever.

Respiratory and skin infections are major pre-infections. However, the proportions vary according to the natural and social conditions such as geographical climate, season, social and economic living standards and health habits. According to domestic data, respiratory infection or tonsillitis is the most common in all regions, accounting for 51%, followed by pyoderma or skin infections, accounting for 25.8%. In the northern group, the sensation or tonsillitis was significantly higher than that in the southern group, while the skin infection in the southern group was higher than that in the northern group. In addition to beta-hemolytic streptococcus, other bacteria such as Streptococcus mutans, Streptococcus pneumoniae, Staphylococcus aureus, wound medicine teaches to collect and organize cold bacteria, influenza bacilli, etc.; viruses such as Coxsackie B4, ECH0 virus type 9, measles virus, mumps virus, hepatitis B virus, cytomegalovirus, Epstein-Barr virus, influenza virus, etc.; and Plasmodium, Mycoplasma pneumoniae, Candida albicans, Filaria, hookworm, Schistosomiasis, Toxoplasma gondii, Treponema pallidum, leptospira, etc. can also cause acute nephritis.

Causes of cirrhosis:

1 viral hepatitis;

2 alcoholism;

3 cholestasis;

4 circulation disorders;

5 poison or drug;

6 metabolic disorders;

7 nutritional disorders;

8 immune disorders;

9 schistosomiasis.

Liver cirrhosis caused by viral hepatitis in China is more common. Foreign countries are more likely to be caused by alcoholism.

Examine

an examination

Related inspection

Liver function test liver palpation functional liver volume determination liver and gallbladder percussion liver area peritoneal friction

Diagnosis of liver cirrhosis:

There are related medical history such as viral hepatitis or drinking, there are clinical manifestations of liver dysfunction and portal hypertension, liver texture is hard and nodular; liver function tests often have positive findings, and liver biopsy see pseudolobule formation.

Examination and diagnosis of benign stenosis of extrahepatic bile duct:

1. Jaundice occurs after upper abdominal surgery, which can be progressive or intermittent, and can be light or heavy. Often accompanied by cholangitis.

2. Those with longer course of disease, the liver is large and hard, and may have splenomegaly, spleen hyperfunction and portal hypertension.

3. Serum bilirubin and AKP increased, white globulin ratio inverted and other liver function damage performance. Blood culture can be positive in severe cholangitis.

4. "T" tube retrograde angiography, venous cholangiography, PTC, ERCP and other examinations can show the stenosis and morphology. Feasible biliary drainage, with contrast angiography to help diagnose.

Diagnosis

Differential diagnosis

Differential diagnosis of large and hard liver:

1. Identification of diseases characterized by large liver

Such as chronic hepatitis, primary liver cancer, hepatic parasitic diseases, metabolic diseases involving the liver and blood diseases.

2. Identification of diseases that cause ascites and bloating

Tuberculous peritonitis, constrictive pericarditis, chronic glomerulonephritis, intra-abdominal tumors, giant ovarian cysts, etc.

3. Identification of complications with cirrhosis

(1) Upper gastrointestinal bleeding

Should be associated with peptic ulcer, erosion hemorrhagic gastritis, gastric cancer and so on.

(2) Hepatic encephalopathy

Should be identified with hypoglycemia, uremia, diabetic ketoacidosis.

(3) Hepatorenal syndrome

Should be differentiated from chronic glomerulonephritis, acute tubular necrosis.

4, other pathogens infected with glomerulonephritis: a variety of pathogens can cause acute nephritis, such as bacteria, viruses, protozoa, etc., can be distinguished from the primary infection and their clinical characteristics.

5, IgA nephropathy: hematuria as the main symptom, manifested as recurrent episodes of hematuria, more than 24 to 48 hours after upper respiratory tract infection, hematuria, edema, hypertension, serum complement C3 normal, clear medical teaching Collecting and diagnosing a diagnosis requires kidney biopsy.

6, acute exacerbation of chronic nephritis: most children with malnutrition, anemia, growth and development lag, pre-infection period is only 1 to 2 days, renal function continues to be abnormal, urine specific gravity is low and fixed can be differentiated from acute nephritis.

7, idiopathic nephrotic syndrome: 2% to 5% of children with acute nephritis clinical manifestations of nephrotic syndrome must be identified. If the child has acute onset, there is clear evidence of streptococcal infection, serum complement C3 can be restored to normal, renal biopsy pathology for capillary proliferative nephritis can contribute to the diagnosis of acute nephritis.

8, secondary nephritis should also be differentiated from allergic purpuric nephritis, systemic lupus erythematosus and hepatitis B virus-associated nephritis.

Diagnosis of cirrhosis:

There are related medical history such as viral hepatitis or drinking; there are clinical manifestations of liver dysfunction and portal hypertension; liver texture is hard and nodular; liver function tests often have positive findings; liver biopsy see pseudolobule formation.

Diagnosis of benign biliary stricture: