Gepatomegaliya – the syndrome which is characterized by increase in the sizes of a liver. Viral hepatitises, infectious , an alcoholic disease, cirrhosis, pathology of accumulation (hemochromatosis), Badda-Kiari's syndrome (thrombosis of hepatic veins), fatty dystrophy, oncological, cardiovascular and other diseases can be the cause. The main manifestations – feeling of weight, morbidity in the right podreberye, signs of a sdavleniye of the next bodies, dispepsichesky violations. Diagnostics is based on results of hepatic tests, ultrasonography of abdominal organs, MSKT, punktsionny biopsy of a liver and other methods. Treatment is defined by the syndrome reason.
Gepatomegaliya – the pathological syndrome consisting in true increase in a liver (the size on the right sredneklyuchichny line exceeds 12 cm or the left share is palpated in epigastralny area). Normal the liver of a soft consistence, is easily probed under a costal arch. At various diseases the sizes of body can increase considerably, the structure to become more dense. Gepatomegaliya can be caused by dystrophic changes of hepatic cells (at gepatoza), limfomakrofagalny infiltration (in case of acute or chronic hepatitis), formation of knots and a fibrozirovaniye (at cirrhosis), stagnation of blood (at damage of veins of a liver, a konstriktivny perikardit, heart failure) or focal changes (at abscesses, tumors, cysts). This syndrome often is the leader defining a clinical picture. Gepatomegaliya – not an independent disease, but a symptom of a certain pathology.
Increase in the sizes of a liver can meet at many diseases. One of the most widespread etiologichesky factors – diseases of the vascular course of body. More often the gepatomegaliya develops at defeat vorotny and hepatic veins owing to a tromboobrazovaniye, Badda-Kiari's syndrome, is much more rare – at damage of a hepatic artery.
Group of the reasons, the second for the importance, are infectious and virus defeats which consequence damage of a parenchyma of a liver, vorotny vein and bilious channels can be (at viral hepatitises, an infectious mononukleoz, amoebic abscess, purulent thrombophlebitis of a vorotny vein, a nonspecific holangit owing to a holedokholitiaz). Gepatomegaliya is a characteristic sign of neoplastic process (oncological pathology). Primary tumoral injury of a liver meets quite seldom, metastatic defeat develops more often; from benign tumors adenomas and gemangioma of a liver can come to light.
Gepatomegaliya also arises at degenerate defeats of tissue of liver (, steatogepatit not alcoholic genesis, secondary changes at pathology of cardiovascular system), an amiloidoza, effect of hepatotoxic substances (alcohol, medicines, some synthetic and natural connections). More rare congenital pathology, autoimmune, endocrine diseases (diabetes, endokrinopatiya is the reason of a gepatomegaliya at pregnancy) and traumatic damage of hepatic fabric (a liver injury).
Classification of a gepatomegaliya
Most often gastroenterologists use etiologichesky classification of this syndrome. Depending on the diseases which caused increase in a liver distinguish gepatomegaliya owing to violation of blood circulation, frustration of a metabolism, primary diseases of a liver, infiltrative processes in body, some hematologic diseases and local defeats.
Also at verification of the diagnosis anatomo-morphological classification of gepatomegaliya is considered: defeat of a parenchyma, bilious channels, connecting fabric or vascular network. For carrying out the differential diagnosis reflect in classification whether this symptom is combined with a splenomegaliya (increase in a spleen), jaundice or ascites.
Depending on extent of increase in body allocate a gepatomegaliya moderate (the minor change of the sizes and structure which is not keeping within norm indicators), expressed (increase by 10 cm from norm) and diffusion (more than for 10 centimeters). A separate form is the partial gepatomegaliya when the liver increases unevenly - only its part or one share.
Symptoms of increase in the sizes of a liver are defined by the main disease. The moderate gepatomegaliya developing at sharp viral infections and violations of food at children can not be shown in any way. At achievement by a liver of the considerable sizes the discomfort in the right podreberye, the painful feelings amplifying at the movements is possible. Rashes, dispepsichesky complaints (nausea, violation of a chair, a meteorizm), an unpleasant smell from a mouth are characteristic also skin itch.
In case of a gepatomegaliya against the background of viral hepatitis consolidation of a parenchyma of a liver is defined that easily comes to light even at a palpation. Increase in a liver is followed by yellowness a skler and integuments, intoxication phenomena. At timely effective treatment the syndrome can regress. Gepatomegaliya at cirrhosis arises owing to injury of hepatocytes and formation on their place of connecting fabric. Considerable consolidation of body, constant pain in the right podreberye, an earthy shade of skin, tendency to bleedings is characteristic.
Increase in a liver owing to primary neoplastic defeat arises quite seldom, at the same time the leading symptoms are: gepatosplenomegaliya, pain, dispepsichesky frustration, jaundice, hypostases and ascites. At secondary (metastatic) defeat symptoms of a gepatomegaliya are usually less expressed, than signs of primary tumoral growth. In case of good-quality formations of a liver increase in body usually is the first and leading sign. At achievement by formation of the considerable sizes perhaps asymmetric increase in a stomach, signs of a sdavleniye of the next bodies.
Feature of a gepatomegaliya at degenerate changes (a fatty disease of a liver) is the poor symptomatology, rare development of severe defeat. Usually this disease is a diagnostic find at the address of the patient for other reasons. At an amiloidoza the liver can reach the essential sizes, its structure dense, a smooth edge, morbidities at a palpation is not present.
Gepatomegaliya at diseases of heart develops in case of right ventricular insufficiency; the syndrome quickly progresses that leads to stretching of the capsule of body and the expressed pain. The sizes of a liver are changeable and at successful treatment of the main disease decrease.
In case of toxic injury of hepatocytes increase in a liver can be the only sign, the skler and skin, moderate change of laboratory indicators is less often combined with an itch, yellowness. At traumatic damage of hepatic fabric the gepatomegaliya against the background of a serious general condition of the patient is followed by symptoms of intra belly bleeding and hemorrhagic shock. Arterial hypotension and tachycardia, a hypoxia progress; at a palpation the liver is sharply painful.
Diagnostics of a gepatomegaliya
Definition of increase in the sizes of a liver is possible – the palpation and percussion, and also ultrasonography of abdominal organs is for this purpose carried out. Establishment of the reasons of this syndrome is necessary.
Differential diagnostics of a gepatomegaliya in gastroenterology begins with an exception of a virus etiology. The anamnesis is studied in detail (whether there were blood transfusion or its components, a hemodialysis and other adverse epidemiological factors). In laboratory analyses at viral hepatitises increase in activity of aminotransferases, and mainly to ALT is defined. A reliable method of diagnostics is detection of specific immunoglobulins and genetic material of the activator by the polymerase chain reaction (PCR). For assessment of degree of histologic activity the punktsionny biopsy is carried out.
For the purpose of an exception of the autoimmune nature of a gepatomegaliya the level of circulating is defined autoantitet. More often this pathology develops at women up to 25 years and in the post-menopausal period and can be followed by such signs as pains in joints (artralgiya), also fever glomerulonefrit.
The Tsirrotichesky etiology of a gepatomegaliya is confirmed by anamnestichesky instructions on alcohol intake or diseases of a liver, the increased level of gamma globulins in blood, activity of alkaline phosphatase and aminotransferases, the low level of a prothrombin and albumine in serum. At ultrasonography of abdominal organs diffusion heterogeneity of a parenchyma of a liver, and also increase in diameter of portal and splenic veins comes to light.
Diagnostics of the vascular reasons of a gepatomegaliya (obstruction of hepatic veins) is based on results of ultrasonic doppler sonography, lower kavagrafiya, punktsionny biopsy of a liver and radio isotope scanning. For an exception of tumoral defeat MSKT of abdominal organs is carried out.
Treatment of a gepatomegaliya
The main directions of treatment of a gepatomegaliya depend on its reason. Therapy includes the dietary food (table No. 6) meaning frequent meals, refusal of fat, fried dishes, excess of simple carbohydrates and sufficient intake of vitamins, protein and minerals.
For the purpose of protection and restoration of functioning of hepatic cells gepatoprotektor (essentsialny phospholipids, phytogenesis medicines, vitamins and amino acids) are appointed. At acute hepatitises dezintoksikatsionny and specific antiviral therapy is also carried out. At chronic hepatitises interferona and immunomodulators are used.
The cardiogenic gepatomegaliya well regresses at purpose of the treatment eliminating heart failure on a big circle of blood circulation. In case of thrombosis of a vorotny vein of the leader thrombolytic and antikoagulyantny therapy is, at sharp thrombosis transplantation of a liver is shown. At abscess antibacterial or anti-parasitic therapy, a puncture of a cavity and external drainage is carried out. In treatment of an amiloidoz Prednisolonum and colchicine are applied.
Gepatomegaliya of a neoplastic etiology demands carrying out chemotherapy, beam methods or surgical removal of a tumor (depending on type of primary center). At good-quality new growths expeditious treatment is necessary at achievement by a gepatomegaliya of the considerable sizes and violation of work of nearby bodies.
Forecast and prevention of a gepatomegaliya
The forecast is defined by the reason of a syndrome and a damage rate of hepatocytes, reversibility of process. Predictively gepatomegaliya at cirrhosis, toxic damage, primary neoplastic process are adverse. Moderate increase in body at the general diseases, including viral infections, a tranzitorny gepatomegaliya at children are characterized by quickly regressing current. Prevention consists in the prevention of diseases which can become the reason of increase in a liver.