hepatomegaly
Introduction
Introduction Hepatomegaly can be a clinically important sign that can be caused by many diseases. The normal liver size is 25 cm long and 15 cm in diameter and 15 cm in diameter. The liver can often be touched, the edges are sharp and soft, and there is no tenderness. Sometimes the liver that is touched under the rib is not due to hepatomegaly but because the liver position is moved down. This can be seen in the loosening of the abdominal wall of the women, singing or playing the athletes, distributing the emphysema, having a large amount of fluid in the chest, and sputum. In patients with lower abscesses, sometimes gallbladder enlargement, transverse colon tumor, pancreatic cyst, gastric cancer, right renal ptosis, right renal hydronephrosis, right pheochromocytoma, pheochromocytoma, etc. can also be mistaken for hepatomegaly, but the respiratory mobility is not as good as the large edge of the liver. The liver is clear, so it should be combined with medical history, liver position and texture.
Cause
Cause
(1) Viral infection
A, B, C, D and viral hepatitis, infectious mononucleosis, yellow fever, rubella, cytomegalovirus, simple sore virus, Coxsackie virus, adenovirus, band Malaria, measles and other infections.
(two) bacterial infection
Acute obstructive suppurative cholangitis, chronic cholangitis, primary sclerosing cholangitis, bacterial liver abscess, liver tuberculosis.
(3) Fungal infections
Actinomycosis, blastomycosis, sphagnum mycosis, cryptococcosis, histoplasmosis, dysbacteriosis, aspergillosis, mucormycosis, etc.
Examine
an examination
Related inspection
Ultrasound diagnosis of liver, gallbladder and spleen by liver disease
(a) the extent of the lesion
1, diffuse enlargement
Due to widespread liver disease, it is found in various hepatitis, liver, amyloidosis, hepatic sputum, liver cirrhosis, hepatocellular carcinoma, metastatic cancer, and cholangiocarcinoma.
2, limited swelling
Due to intrahepatic space-occupying lesions, it is found in liver abscesses, hepatic cysts, liver tumors, and liver hydatid.
(two) liver hardness
Normally thin and healthy people can touch the edge of the liver and are soft. The liver is moderately hard in hepatitis, liver abscess, schistosomiasis, fatty liver, malaria, etc. The liver has a hard texture and is found in cirrhosis, advanced schistosomiasis, congestive cirrhosis, malignant tumors, leukemia, hepatic amyloidosis, and syphilis.
(c) the edge and surface of the liver
The edges of chronic hepatitis and congested liver are blunt, the surface is still smooth, the edge of cirrhosis is sharp, and the surface is nodular.
Diagnosis
Differential diagnosis
Identification:
1. Viral hepatitis A
The incubation period of hepatitis A virus is mostly 15-40 days. From 9 days before the onset to 17 days after the onset, HAV can be detected from the feces. SGPT often reaches a peak of more than 500 units in the first week, SGPT>SGOT, AKP liter. High SGPT/AKP7, serum anti-HAV-IGM positive, double serum anti-HAV total antibody titer 4 times in acute phase and recovery phase, HAV-RNA was detected in serum or feces. Clinically, it is divided into acute jaundice, acute jaundice and fulminant.
2. Forming viral hepatitis
The prevalence of viral hepatitis E is very wide. In some areas, viral hepatitis can account for 50% of clinical viral hepatitis. It can be popular all year round, but it is more common in autumn and winter, often after rain or after flood. Water pollution has caused epidemics. Detoxification can still be detected within 2 weeks after the onset of HEV in the feces from 1 to 4 days before the onset of the disease. About half of the patients had fever and joint pain at the onset of illness. Astragalus, cholestasis and clay-like forms are more common than viral hepatitis A, and the symptoms are generally heavier than those of viral hepatitis A.
3. Infectious mononucleosis
The disease often has hepatomegaly and abnormal liver function, but fever is higher than hepatitis and lasts for a long time. It often has pharyngeal pain, congestion and endocrine secretions, lymph nodes in the neck and other parts are often swollen, splenomegaly and tenderness. More obvious.
