hepatic aneurysm
Introduction
Introduction to hepatic aneurysms Hepatic aneurysm is a rare vascular lesion that is divided into extrahepatic or intrahepatic; its size can vary from needle tip to grapefruit. Intrahepatic type often breaks into the bile duct to cause biliary bleeding, and the extrahepatic rupture causes bloody abdomen. Hepatic aneurysms are not easily found when there is no rupture, so most of them are diagnosed after rupture. Typical clinical manifestations of rupture causing massive bleeding of the biliary tract include gastrointestinal bleeding, upper abdominal pain, and obstructive jaundice, but only about one-third of the patients with this triad. By 1980, more than 300 foreign literatures were collected. By 1985, 2 cases of extrahepatic aneurysms had been reported in China. Intrahepatic aneurysms have not been reported. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: upper gastrointestinal bleeding, hemorrhagic shock
Cause
Cause of hepatic aneurysm
Trauma (35%) :
Common causes are trauma, biliary tract infection, nodular polyarteritis, arteriosclerosis, cholelithiasis, erosion of the arterial wall, etc., due to trauma, infection, mostly pseudoaneurysm; vascular wall degeneration or congenital developmental defects It may also be the cause of the disease.
Pathogenesis:
Hepatic aneurysms usually have a saclike shape with a diameter ranging from 2 to 10 cm. Most hepatic aneurysms are located outside the liver. Liver aneurysms are rare. Pseudoaneurysms caused by bacterial infections are common. Hepatic aneurysms compress the common bile duct. , hepatic duct and cystic duct, can cause intrahepatic bile duct biliary necrosis, extrahepatic biliary obstruction, liver infarction, etc., the wall is mostly non-specific inflammatory changes, 25% have arteriosclerosis or calcification, granulation tissue, thrombus and Bleeding.
Prevention
Hepatic aneurysm prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Hepatic aneurysm complications Complications upper gastrointestinal bleeding hemorrhagic shock
Hepatic aneurysm rupture is the most serious and most common complication. After rupture, it often causes acute upper gastrointestinal bleeding with biliary tract; if hepatic aneurysm rupture is connected with portal vein, portal hypertension can occur, and a few can also break into the abdominal cavity. Causes blood abdomen and hemorrhagic shock.
Symptom
Hepatic aneurysm symptoms Common symptoms Dull pain, abdominal pain, black stool, jaundice, systolic murmur
80% of patients may have colic or dull pain in the right upper quadrant or right quarter rib. More than half of them may have hematemesis or melena. Those with jaundice before hemorrhage may be tumors broken into the bile duct and biliary tract caused by aneurysm. Bleeding, if the amount is large, mostly manifested as hematemesis, its color is bright red; and the amount of bleeding caused by biliary tumors is generally small, mostly manifested as black stools, about half of cases of hepatic aneurysms break into the abdominal cavity, often in a colic After that, abdominal ablation occurred, and he died in the future. About 60% of the cases had jaundice, which was caused by hepatic aneurysm compression of the common bile duct, hepatic duct or complicated stones. In the early stage of the disease, the depth of jaundice often fluctuated, once hemorrhage After the tumor shrinks, the jaundice subsides, which is of great value to the diagnosis. In a few cases, if the upper abdomen twitches and pulsatile mass or tremor, and can also smell systolic murmur, it is also meaningful for diagnosis, about 1/3 Cases may have fever, mostly associated with biliary infection or inflammation of the hepatic artery itself.
Examine
Hepatic aneurysm examination
Blood and biochemical tests generally have no special significance. When accompanied by biliary infection, there may be leukocytosis.
Upper gastrointestinal X-ray angiography may have signs of gastric pylorus or duodenum being pushed and displaced. Establishing a diagnosis must rely on selective celiac angiography. The abdominal plain film sometimes shows calcification of the eggshell-like aneurysm wall. Radionuclide liver scans can distinguish between liver tissue and aneurysm.
Diagnosis
Diagnosis and diagnosis of hepatic aneurysms
diagnosis
According to the characteristic manifestations of abdominal pain, gastrointestinal bleeding, jaundice and pulsatile mass in the right upper quadrant, combined with the analysis of medical history, the diagnosis was established by selective hepatic angiography or celiac angiography.
Differential diagnosis:
Upper gastrointestinal bleeding caused by traumatic hepatic artery-biliary fistula, duodenal ulcer, biliary tract tumor, and portal hypertension should be considered in differential diagnosis.
