Hepatomegaly: diffuse liver changes. The structure of the internal organs of man

For normal life of a person, all organs are important, since each of them performs its specific function. When one breaks down, the work of the rest, and the whole organism as a whole, is disrupted. So, problems with the liver cause worsening of the digestive tract, blood and excretory systems, which inevitably leads to a decrease in immunity and many other health problems. How does the human liver work and what are the pathological changes in it?

The structure of the internal organs of man

Before talking about the liver, we will consider how our internal organs are arranged, and what relationship exists between them. In the human body, several systems function: circulatory, respiratory, musculoskeletal, digestive, excretory, nervous, sexual. Each of them has a complex structure. Since we are talking about the liver, we will disassemble the organs associated with it and located in its immediate vicinity. So, our liver is a gland located immediately below the diaphragm on the right side of the body, in the abdominal cavity. Its lower edge touches the esophagus, stomach, gallbladder and duodenum. Also, its segments come into contact with the right kidney and adrenal gland. The pancreas lies directly behind the stomach. The gallbladder has common hepatic and bile ducts with the organ under consideration. In addition, the nerve fibers, blood and lymph vessels are suitable for the liver.

The structure of the liver

Hepatomegaly (diffuse changes in the liver) occurs when its size in an adult exceeds 12-13 cm. This organ consists of their right and left lobes, and according to the Claude Quino system is divided into 8 segments. Each individual segment (lobule) has its own blood supply, bile excretion and a network of nerve fibers. The tissue of the lobules (parenchyma) form elongated cells (hepatic beams). The parenchyma is permeated with bile capillaries and blood vessels. In the center of each liver segment there is one central vein, and between them - arteries, bile ducts and other veins. In the lower part of the organ under consideration there are two longitudinal grooves and one transverse groove. This is the so-called gate of the liver. They connect all the bile ducts, forming one common, continuing into the duodenum. Hepatic veins form one - the portal. Blood comes from it and from the arteries to this important organ. Diffuse changes can affect each of the above elements.

Liver function

One of the main functions of our liver is the neutralization of poisons, toxins, all kinds of foreign and superfluous substances. This gland takes part in all kinds of metabolism in the human body, in digestion, blood formation, in the production of many vitamins and hormones. It is a kind of storage of blood and microelements. Constantly being in a strained working mode, the liver is exposed to the risk of various pathological processes occurring in it. One of them - hepatomegaly, diffuse liver changes, characterized by its increase. It is determined by palpation, by ultrasound and computed tomography. The last two types of studies allow to accurately distinguish the increase in the liver from a similar pathology of neighboring organs (right kidney, gallbladder, intestine).

Causes of the disease

The concept diffuse means changes in the entire body, and not only in any part of it, as in focal pathologies. When does hepatomegaly develop? Diffuse liver changes are observed in the following diseases:

• cirrhosis of the liver;
• heart failure;
• Benign and malignant (cancer) tumors;
• Hemangioma;
• Parasitic and nonparasitic cysts;
• Helminthiases;
• Abscesses;
• Tuberculosis, syphilis and other infectious lesions;
• Intoxication of the body;
• dehydration;
• Metastases from neighboring organs;
• Toxic and infectious hepatitis;
• adenoma;
• carcinoma;
• Hyperplasia.

In some cases, there is moderate hepatomegaly, which is a concomitant symptom of the common cold, some infectious diseases, malnutrition.

Symptoms

Symptoms of diffuse liver changes at the initial stages of this pathology are not significant. The patient may feel some discomfort in the right hypochondrium, which is strengthened after taking fatty and spicy food, alcohol. However, there are patients who do not feel anything at all until the disease that caused hepatomegaly goes into acute forms, and there is not a significant increase in the liver. Symptoms depend on the underlying disease. To the general it is possible to carry:

• Pains in the right side, especially sharp with mechanical squeezing;
• Nausea, sometimes vomiting;
• heartburn;
• Decreased appetite;
• Icteric color of the skin;
• Unpleasant odor from the mouth;
• Sometimes there is a rash, accompanied by itching;
• General deterioration of the condition.

Specific signs of hepatomegaly

Staphylococcal, streptococcal and pneumococcal infections can cause abscesses (suppuration) in the largest human gland and, as a consequence, enlarge the liver. Symptoms are the following: severe chills, tachycardia, excessive sweating, aching pains on the right side of the body, giving even to the scapula and arm. The treatment in this case is only surgical. With another common disease - liver cancer, which takes more than a million lives each year - hepatomegaly, plus the above signs, is accompanied by a sharp slimming, weakness, bowel dysfunction, flatulence. Cirrhosis of the liver (the main cause is alcoholism) and the associated hepatomegaly are characterized by pain in the right upper quadrant, in the joints, portal hypertension, enlarged spleen. In hepatitis, an increase in the liver is also accompanied by pain in the right side, which is significantly enhanced with physical exertion (for example, with fast walking), nausea, general weakness.

Diagnostics

If the patient complains of pain in the right hypochondrium, the doctor first of all will make a palpation and, probably, will diagnose hepatomegaly. Diffuse liver changes can be detected (or disproved) by additional tests. In principle, palpation can only determine the boundaries of the enlarged organ, the degree of soreness and, to some extent, the density of the parenchyma. And to clarify the diagnosis, ultrasound, CT, MRI and a number of samples are prescribed. These include:

• Determination of bilirubin and total protein in the blood;
• Determination of stercobilin in feces;
• Samples with a load of bile extract substances (bromosulfophthalein, galactose);
• Radioisotope studies;
• Liver biopsy.

Bilirubin is determined in a free and bound state. A healthy person has only a free (0.4-1 mg / dl). Deviations from the norm are observed with jaundice, tumors and occlusions of the hepatic tubules, some types of cirrhosis. With the help of samples, it is determined how protein processes in the liver proceed. Bromsulfoftaleinovaya sample allows you to determine whether there is a violation of the excretory (excretory) function in the gland. In healthy individuals, less than 5% of the dye remains within 45 minutes after the dye has been injected into the bloodstream. The introduction of galactose makes it possible to trace how carbohydrate metabolism occurs. A biopsy is performed in the laboratory under suspicion of hepatitis in the latent stage, cirrhosis, cancer, fibrosis and other diseases. It is contraindicated in abscess, ascites, prolonged mechanical jaundice, hemorrhagic syndrome. The study by radioisotopes (introduction of Bengal rose into the blood) is performed with many liver diseases. In healthy individuals, the blood is half-cleared from the paint in 8 minutes.

Pathologies of the pancreas

The liver is closely related to another gland, the pancreas. The pathology of one inevitably leads to disruption of the work of another, so during the diagnosis, these two organs are checked at the same time. Diffuse changes in the pancreas (the liver is not affected) can be detected only through ultrasound. Palpation is not determined. Ultrasound examination shows the dimensions, density and uniformity of tissues, as well as echogenicity (sound reflection) of this important organ, which takes an active part in digestion and glucose assimilation (insulin secretion). Diffusive changes are observed in pancreatitis, fibrosis and in connection with age. Having found out on ultrasound changes, the patient can send for additional examinations (blood donation, endoscopy of the duodenum).

Treatment

If there are diffuse changes in the pancreas, but the patient has no complaints, therapy is not required. Also, moderate hepatomegaly is not treated. As a rule, this condition passes on its own after the normalization of nutrition and the disappearance of concomitant diseases. With liver hepatomegaly, the compulsory treatment of the underlying ailment causing pathology is begun. Along with this, the patient is placed on a strict diet, excluding from the menu all fried, spicy, salty, fatty and alcoholic. Traditional medicine recommends drinking infusions of dog rose, aronia, some mineral water, use low-fat cottage cheese with honey. The patient is recommended a sparing regimen, physical activities are prohibited.