Enlarged liver

Introduction Under normal circumstances, the liver is in the upper right side of the abdominal cavity, surrounded by ribs, and under the diaphragm of the diaphragm, usually under the right rib can not be touched. For example, when breathing calmly, 1.5 cm or more than 1.5 cm below the right rib can touch the liver, suggesting that the right lobe of the liver is swollen. In the middle of the upper abdomen, the liver should be within the upper third of the line between the xiphoid and the umbilical cord. If the indication is exceeded, the left lobe of the liver is swollen. This is a preliminary judgment of hepatomegaly. There are many causes of hepatomegaly, which can be caused by hepatitis, cirrhosis, portal hypertension or other organ generators.

Cause

Liver enlargement is very common. But it is not an independent disease, but a manifestation of many diseases.

1. Various infectious diseases, such as viral hepatitis, liver abscess, schistosomiasis, liver fluke, cysticercosis, malaria, sepsis, liver tuberculosis, etc.

2, tumors, such as primary or metastatic liver cancer, liver infiltration of leukemia or lymphoma, hepatic hemangioma.

3, poisoning, such as alcoholism, arsenic poisoning or chlorpromazine poisoning; biliary, such as common bile duct stones, pancreatic head cancer, capillary bile duct hepatitis.

4, blood stasis, such as congestive heart failure, constrictive pericarditis.

5, other such as connective tissue disease, diabetes, fatty liver, hepatic cyst, polycystic liver, hepatolenticular degeneration, etc., can lead to hepatomegaly.

an examination

Related inspection

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1 Check the abdomen when checking the liver, whether there is protuberance in the right upper abdomen, whether there is anger in the superficial vein, and the upper hepatic boundary of the peritoneal examination should exclude the liquid-chest or emphysema from causing the liver to move down;

2 degree of liver enlargement: mild hepatomegaly is less than 3cm under the rib, moderate hepatomegaly is more than 3cm below the rib to the umbilicus, severe hepatomegaly is more than the umbilical level, and most severe hepatomegaly has entered the pelvis, and Cross the middle line;

3 pay attention to liver hardness, liver texture is more common in viral hepatitis, toxic hepatitis, bacterial infection, congestive heart failure, liver texture is more common in liver cirrhosis and liver cancer;

4 pay attention to the liver with no nodules, masses, post-necrosis cirrhosis or biliary cirrhosis, liver cancer patients may touch the same size nodules, congenital cysts and biliary dilatation, echinococcosis can touch cystic mass and fluctuations ;

5 The liver and gallbladder area have no tenderness and abdominal muscle rigidity;

6 positive for jugular venous return is common in hepatomegaly caused by congestive heart failure. At the same time, attention should be paid to the swelling of the whole body lymph nodes and spleen, as well as related symptoms (thinness, jaundice, ascites, edema, etc.). There is no mass in the rib angle of the posterior wall of the abdomen.

Differential diagnosis

When clinically determining whether the liver is swollen, care should be taken to help determine the upper and lower margins of the liver through percussion. If necessary, a B-ultrasound can be performed to determine whether there is hepatomegaly. In clinical practice, the abdominal wall tissue or the adjacent tissue of the liver is often mistaken for a swollen liver due to lack of experience, and should be differentiated from the following:

1. Abdominal rectus muscles of the abdominal muscles and subcutaneous fat nodules of obese people may be considered as the lower edge of the liver. The distinguishing point is that the tendons and fat nodules that are touched above do not move up and down with the breath.

2, gallbladder enlargement: the rib F of the patient with obstructive jaundice just touches the gallbladder with a spherical saclike sense. If the gallbladder has adhesion to the surrounding omentum and duodenum, the boundary is unclear and easy to be confused. Further examination such as B-ultrasound, gallbladder angiography, CT or MRI to distinguish.

3, right transverse colon: physical weight loss and abdominal wall relaxation, if the transverse colon flatulence or constipation, often easy to be confused with the lower edge of the liver, pay attention to the above factors and then palpation to identify.

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