Contents 1 Pinyin 2 English reference 3 Overview 4 Disease name 5 English name 6 Alias ??for hepatomegaly 7 Classification 8 ICD number 9 Cause 9.1 Infectious hepatomegaly 9.2 Non-infectious hepatomegaly 10 Pathogenesis 10.1 Infection 10.2 Congestion 10.3 Cholestasis 10.4 Poisoning 10.5 Metabolic abnormalities 10.6 Tumors and cysts 10.7 Others 11 Clinical manifestations of hepatomegaly 11.1 Range of lesions 11.2 Hardness of the liver 11.3 Edge and surface of the liver 11.4 Tenderness 11.5 Jaundice 11.6 Weight loss 11.7 Ascites 11.8 Spider nevus and liver palms 11.9 , Abnormal coagulation function 12 Laboratory tests 12.1 Blood test 12.2 Stool test 12.3 Duodenal drainage 12.4 Liver function test 12.4.1 Protein metabolism test 12.4.2 Carbohydrate test 12.4.3 Lipid metabolism test 12.4.4 Enzymology Test 12.4.5 Test of bilirubin and bile acid metabolism 12.4.6 Pigment excretion test 12.4.7 Hormone metabolism test 12.4.8 Vitamin metabolism test 12.4.9 Test of drug conversion function 13 Auxiliary examination 13.1 Ultrasound examination 13.2 X-ray examination 13.3 CT and MRI 13.4 Radionuclide scan 13.5 Laparoscopy 13.6 Hepatic angiography 13.7 Liver blood flow diagram 13.8 Liver biopsy 14 Diagnosis 15 Differential diagnosis 15.1 Viral hepatitis 15.2 Toxic hepatitis 15.3 Liver abscess 15.4 Primary disease Sexual or metastatic liver cancer 15.5 Liver cyst 16 Treatment of hepatomegaly 17 Related drugs 18 Related examinations attached: 1 Acupoints for treating hepatomegaly 1 Pinyin
gān dà 2 English reference
hepatomegalia < /p>
Hepatomegaly 3 Overview
Hepatomegaly can be caused by many diseases and is an important clinical sign.
The normal size of the liver is 25cm long diameter x 15cm upper and lower diameter x 16cm front and rear diameter. The average liver weight of Chinese adult men is 1342g and that of women is 1234g, accounting for about 1/50 of the body weight. The livers of fetuses and newborns are relatively larger than those of adults, accounting for about 1/20 of the body weight. The upper limit of the normal liver is consistent with the diaphragmatic fornix, starting from the 7th rib at the right midaxillary line, to the right midclavicular line level with the 5th rib, then to the left to the anterior midline and then crossing the junction of the sternum body and the xiphoid process to the left midclavicular line. Slightly medial to the 5th intercostal space, the lower limit of the liver is consistent with the anterior edge of the liver, starting from the 11th rib at the right midaxillary line, along the lower edge of the right costal arch to the tip of the 9th costal cartilage, leaving the costal arch, diagonally to the upper left Below the xiphoid process of Fangda, it extends about 3cm below the xiphoid process in the anterior midline.
The position of the liver is related to gender, age, and body shape. It can change to a certain extent with breathing, visceral activity, and vaginal movements. When standing and inhaling, Descends, rises in the supine position and during exhalation, and the difference in rise and fall during calm breathing is about 3cm. For children under 5 years old, drinking more water, after meals, at night, after exercise, and people living at plateau for more than 2 months, 1 below the costal margin ~2cm, the liver can often be palpated, with sharp edges, soft texture, and no tenderness. Sometimes the liver palpated under the ribs is not due to enlargement of the liver, but due to the downward movement of the liver. This can be seen in multiparous women with loose abdominal walls, excessive diaphragm movement in singers or performers, emphysema, large amounts of effusion in the right pleural cavity, Subdiaphragmatic abscess. Sometimes gallbladder enlargement, transverse colon tumors, pancreatic cysts, gastric cancer, right nephroptosis, right hydronephrosis, right renal cyst, pheochromocytoma, etc. can also be mistaken for hepatomegaly, but the respiratory movement is not as large as the liver, and the edge is not as good as the liver. Therefore, pathological hepatomegaly should be determined based on the medical history, the location, shape, texture, respiratory mobility, tenderness and other examination results of the liver.
4 Disease name
Hepatomegaly 5 English name
hepatomegaly 6 Alias ??for hepatomegaly
Hepatauxe; hepatomegalia; megalohepatia; hepatomegaly 7 Classification
Gastroenterology> Digestive System Symptomology 8 ICD Number
R16.0 9 Causes
There are many diseases that cause hepatomegaly, which are summarized as follows. 9.1 Infectious hepatomegaly
(1) Viral infections: viral hepatitis A, B, C, D and E, infectious mononucleosis, yellow fever, rubella , cytomegalovirus, herpes simplex virus, coxsackie virus, adenovirus, herpes zoster virus, measles virus and other infections.
(2) Chlamydial infection: such as psittacosis, etc.
(3) Rickettsia infections: typhus, Q fever, etc.
(4) Bacterial infection: acute obstructive suppurative cholangitis, chronic cholangitis, primary sclerosing cholangitis, bacterial liver abscess, liver tuberculosis.
(5) Spirochetal infections: leptospirosis, relapsing fever, hepatic syphilis, Lyme disease, etc.
(6) Fungal infections: actinomycosis, blastomycosis, coccidioidomycosis, cryptococcosis, histoplasmosis, candidiasis, aspergillosis, mucormycosis, etc.
(7) Protozoal infections: amoebic liver abscess, kala-azar, malaria, toxoplasmosis, trypanosomiasis, piroplasmosis, etc.
(8) Helminthic infections: schistosomiasis, clonorchiasis, biliary ascariasis, roundworm liver abscess, echinococcosis, opisthorchiasis, hepatic fascioliasis, toxoplasmosis Ascariasis, capillariasis, strongyloidiasis, paragonimiasis, etc. 9.2 Non-infectious hepatomegaly
(1) Toxicity: can be caused by carbon tetrachloride, chloroform, ethanol, phenol, naphthalene, benzene, acetaminophen, sodium valproate, heavy metals, phosphorus, arsenic , isothiocyanate compounds, trinitrotoluene, monoamine oxidase inhibitors, p-aminosalicylates, pyrazinamide, ethionamide, azathioprine, methotrexate, dicyclohexanide Tridine, amiodarone, amioquinoline, thorium oxide, polyvinyl chloride, aflatoxin, toadstool, isoniazid, cinchofen, phenylbutazone, rifampicin, tetracycline, diacetyl tincture, chlorpromazine , methyltestosterone, oral contraceptives, ketoconazole, methyldopa, phenytoin, phenobarbital, furazuidine, sulfa drugs, thioureas, phenformin, etc.
(2) Congestion: congestive heart failure, tricuspid stenosis or insufficiency, myocarditis or cardiomyopathy, congenital heart disease, constrictive pericarditis, cardiac tamponade, hepatic vein obstruction, etc.
(3) Bile stasis: intrahepatic cholestasis, extrahepatic cholestasis, common bile duct stones, bile duct cancer, pancreatic head cancer, ampullary cancer, etc.
(4) Metabolic disorders: fatty liver, Relye syndrome, acute fatty liver of pregnancy, hepatic amyloidosis, hepatolenticular degeneration, hemochromatosis, porphyria, excess hepatic glycogen syndrome, lipoid histiocytosis, familial spleen anemia, cholesterol ester storage disease, gangliosidosis, mucopolysaccharidosis, galactosemia, hereditary fructose intolerance, cystic fibrosis, α1 resistance Trypsin deficiency, tyrosine metabolism disorders, etc.
(5) Liver cirrhosis: portal venous, schistosomiasis, postnecrotic, primary biliary, secondary biliary, cardiogenic cirrhosis, etc.
(6) Tumors and cysts: primary liver cancer, secondary liver cancer, hepatoblastoma, carcinoid, liver mixed tumor, hepatic adenoma, cystadenoma, hepatic angiosarcoma, hepatic vasculature Endothelioma, hepatic cavernous hemangioma, adult polycystic liver disease, non-parasitic liver cysts, etc.
(7) Others: such as granulomatous liver disease, sarcoidosis, autoimmune hepatitis, liver hematoma, various blood diseases, multiple myeloma, myelofibrosis, AIDS, etc. 10 Pathogenesis 10.1 Infection
In various pathogenic microbial and toxic hepatitis, vascular congestion, tissue edema, inflammatory cell infiltration and exudation of other inflammatory substances may occur due to inflammation, or due to liver cell Degeneration, swelling, or massive hyperplasia due to damage to the liver's reticuloendothelial system, causing hepatomegaly. Among various infections, viral hepatitis is the most common. 10.2 Congestion
In congestive heart failure, cardiac tamponade, constrictive pericarditis, pericardial effusion and obstruction of hepatic venous return, the liver becomes enlarged due to congestion, with a purple appearance and blunt edges. 10.3 Cholestasis
In primary biliary cirrhosis, pancreatic head cancer, and intrahepatic and extrahepatic bile duct obstruction, cholestasis results, leading to hepatomegaly. 10.4 Poisoning
With certain drugs, hepatotoxins, and various systemic infections, the pathogens can not only directly invade the liver, but also cause poisoning through toxemia, high fever, malnutrition, hypoxia and other factors. Hepatitis causes liver cell necrosis, resulting in microcystic fat deposition, hepatitis-like damage, liver fibrosis, hepatic vein obstruction, capillary bile duct cholestasis, etc., resulting in hepatomegaly.
10.5 Metabolic abnormalities
In diseases such as fatty liver and hepatic amyloidosis, fat, glycogen, lipids, amyloid, copper or iron are deposited in the liver, causing it to swell. 10.6 Tumors and Cysts
Liver cancer, sarcoma, benign tumors and various cysts infiltrate liver cells and cause them to enlarge. 10.7 Others
Immune damage, connective tissue diseases, blood diseases, etc. can all cause hepatomegaly. 11 Clinical manifestations of hepatomegaly 11.1 Range of lesions
(1) Diffuse enlargement: due to general liver lesions, seen in various hepatitis, fatty liver, hepatic amyloidosis, liver congestion, and cirrhosis , hepatocellular carcinoma, metastatic carcinoma, cholangiocarcinoma.
(2) Localized swelling: caused by space-occupying lesions in the liver, seen in liver abscesses, liver cysts, liver tumors, liver hydatid, etc. 11.2 Hardness of the liver
In normal and thin people, the edge of the liver can be palpated and is soft. Moderately hard liver is seen in hepatitis, liver abscess, schistosomiasis, fatty liver, malaria, etc. The liver is hard in texture and is found in cirrhosis, advanced schistosomiasis, congestion cirrhosis, malignant tumors, leukemia, hepatic amyloidosis, syphilitic liver, etc. 11.3 The edge and surface of the liver
The edge of the liver with chronic hepatitis and congestion is blunt and the surface is smooth. The edge of the liver with cirrhosis is sharp and the surface is nodular. 11.4 Tenderness
The tenderness is obvious in acute hepatitis, acute liver congestion, acute cholangitis or biliary colic. The tenderness is more severe in bacterial or amoebic liver abscess. It is mainly localized tenderness. It is often seen in liver cancer. There is no obvious tenderness, and the tenderness is mild in chronic hepatitis. There is generally no tenderness in liver cirrhosis, fatty liver, hepatic amyloidosis and syphilitic liver. 11.5 Jaundice
Viral hepatitis, biliary cirrhosis, and extrahepatic biliary obstruction are common. 11.6 Weight loss
Liver cancer and cirrhosis may be accompanied by significant weight loss. 11.7 Ascites
Liver cancer, cirrhosis, acute and subacute severe hepatitis, circulatory disorders, etc. can be seen. 11.8 Spider nevi and liver palms
Seen in chronic parenchymal liver lesions. 11.9 Hemorrhage and abnormal coagulation function
Purpura, gum bleeding, etc. and abnormal coagulation function are common in severe liver disease, long-term obstructive jaundice, blood diseases, leptospirosis, etc. 12 Laboratory tests 12.1 Blood tests
Leukocytes increase in bacterial infection or amoebic liver abscess, and decrease in leukocytes in viral infection or hypersplenism. After esophageal vein rupture, hypersplenism or folic acid deficiency, red blood cells and hemoglobin are reduced. In liver cirrhosis, severe hepatitis, and long-term obstructive jaundice, hepatic protein synthesis disorder or disseminated intravascular coagulation causes abnormal coagulation mechanism. Viral diseases can be diagnosed by increased serum antibody titers or positive virus isolation. Specific antibodies in serum can be detected for leptospirosis, syphilis, fungal diseases, trematodes, etc., and intradermal tests can be used for echinococcosis, trematodes, tuberculosis, etc. 12.2 Fecal examination
Eggs or trophozoites can be found in the feces. 12.3 Duodenal drainage
It is helpful in the diagnosis of hepatomegaly caused by biliary infection, and pathogenic bacteria can be found in the drainage fluid. 12.4 Liver function test 12.4.1 (1) Test of protein metabolism
①Plasma protein: albumin and prealbumin can be used as an indicator to judge the prognosis of chronic liver disease; if α1 globulin increases in liver disease, it reflects the severity of the disease. Mild, a decrease often indicates a serious condition, and a significant increase in liver cancer; an increase in β-globulin is often accompanied by an increase in lipids and lipoproteins; γ-globulin is normal or slightly elevated in acute hepatitis, and significantly elevated in cirrhosis; liver disease The increase in alpha-fetoprotein reflects liver cell regeneration and is related to the activity of the disease. Positive alpha-fetoprotein is not unique to liver cancer and can be found in serum of viral hepatitis, cirrhosis, teratoma, gastric cancer, pancreatic cancer, colon cancer, pregnancy, etc. Alpha-fetoprotein may also increase.
②Serum turbidity test: Cephalin cholesterol flocculation test (CCFE) is an indicator for the diagnosis of acute hepatitis and the prognosis of hepatitis. Many other diseases can also show positive and false positive reactions. Zinc sulfate turbidity test (znTT) can identify hepatitis and cirrhosis, and determine the diagnosis and prognosis of chronic hepatitis and cirrhosis. Thymol turbidity test (TTT) is not a special liver function test and can only reflect the degeneration of liver cells, but has a high false positive rate.
Although some of the above experiments have been eliminated, understanding this knowledge still has certain practical significance.
③Ammonia tolerance test: This test has certain diagnostic value in determining whether patients with liver cirrhosis have collateral circulation, but it has the risk of causing hepatic encephalopathy. 12.4.2 (2) Sugar test
Insulin resistance test is one of the characteristics of glucose metabolism disorder in chronic liver disease; hepatocyte hypoxia can block the metabolism of galactose in the liver, which is a characteristic of liver disease. special factors. 12.4.3 (3) Lipid metabolism test
Serum phospholipid measurement is meaningful for the identification of hepatocellular and obstructive jaundice.
12.4.4 (4) Enzymology test
It is an indispensable biochemical examination method in the clinical practice of liver diseases. It is of great significance for discovering hepatobiliary diseases, elucidating the nature of the disease process, and clarifying the intracellular location of the lesions.
①Enzymes mainly used for liver parenchymal damage:
A. Transaminases mainly include glutamine aminotransferase (GOT), glutamine aminotransferase (GPT), and GOT Isoenzymes.
B. Adenosine deaminase (ADA) has the advantage of diagnosing the recovery period of acute hepatitis, assisting in the diagnosis of chronic liver disease, and distinguishing hepatocellular jaundice and obstructive jaundice.
C. Glutamic acid dehydrogenase (GDH) can reflect the activity and severity of liver disease.
D. Amylase. Serum amylase increases during acute liver cell necrosis, often in parallel with the increase in aminotransferase.
②Enzymes mainly used to diagnose cholestasis:
A. Alergic phosphatase (ALP), used for the identification of jaundice, diagnosis of intrahepatic space-occupying lesions and asymptomatic Biliary lesions of jaundice.
B. γ-glutamyl transferase (GGT) can screen for hepatobiliary diseases, assist in the diagnosis of liver cancer, identify obstructive jaundice and hepatocellular jaundice, diagnose the recovery period of acute hepatitis, and diagnose the activity of chronic liver disease. Judgment of prognosis and diagnosis of alcoholic liver damage.
③Enzymes used to diagnose liver fibrosis:
A. Monoamine oxidase (MAO), other diseases and some extrahepatic diseases can also cause changes in the activity of this enzyme .
B. N-acetyl beta-glucosaminidase helps reflect fibrotic activity.
C. Prolyl hydroxylase (PHO), whose activity parallels progressive fibrosis.
④Enzymes mainly used to diagnose liver tumors:
A. 5’ nucleotide phosphodiesterase, this combination of AFP and clinical is one of the effective methods to diagnose liver cancer.
B.α1 antichymotrypsin (ACT) can be used as one of the diagnostic methods for liver cirrhosis, especially liver cancer. 12.4.5 (5) Test of bilirubin and bile acid metabolism
Serum bilirubin measurement can understand the presence or absence of jaundice, the degree and evolution of jaundice, reflect the degree of liver cell damage and judge the prognosis. Qualitative urine bilirubin test can detect liver damage early, identify early extrahepatic biliary obstruction and differentiate jaundice. Serum bile acids can sensitively detect mild liver damage at an early stage, and can differentiate hepatitis, cirrhosis, and intrahepatic or extrahepatic cholestasis in patients with normal liver cell function. 12.4.6 (6) Pigment excretion test
The sodium bromide sulfonphthalate (BSP) excretion test can reflect the amount of liver blood flow and the status of liver cell function. This test is used as a method to discover and judge the degree of liver disease. Sensitive indicators. The indocyanine green ICG excretion test is the best and most practical dye for testing liver function. It is safer than BSP and is superior to the BSP test when used in chronic liver diseases. 12.4.7 (7) Hormone metabolism test
Under the condition that endocrine disorders or other related factors are excluded, measuring hormones or other metabolites in serum and urine can reflect the functional status of the liver. In liver disease, serum T3 decreases and anti-T3 increases accordingly. 12.4.8 (8) Vitamin metabolism test
Vitamin metabolism and a series of related biochemical reactions in the body may be abnormal in liver disease. Testing the vitamin metabolism status in the body is not only useful for nutritional treatment of patients with liver disease. It has guiding significance and helps to understand and understand the mechanisms of various clinical manifestations of liver disease. In a few cases, it can also be used to judge liver function and assist diagnosis. In liver disease and obstructive jaundice, vitamin E absorption is reduced and plasma concentration is reduced, but not in proportion to the severity of liver disease. The measurement of blood transol ketonase can reflect the metabolic status of vitamin B1 in the body. 12.4.9 (9) Test of drug conversion function
The drug conversion function is consistent with the changes in liver synthesis function. If the plasma albumin is reduced and the prothrombin time is prolonged and vitamin K injection is ineffective, the drug The conversion function is also reduced, and its sensitivity is higher than that of plasma protein, bilirubin and prothrombin time measurement. It is similar to sulfobromphthalein sodium excretion and galactose clearance tests, but not as good as GPT and indocyanine green excretion tests. For patients with mild liver damage, the drug conversion function test is still within the normal range, while for patients with moderate or severe liver damage, the test is reduced, which is helpful for judging the prognosis of liver disease. 13 Auxiliary examinations 13.1 Ultrasound examination
In the diagnosis of hepatobiliary diseases, ultrasound can be used to measure the location, size, and shape of the liver, spleen, and gallbladder, and to observe changes in the hepatic vein, portal vein, and their branches; to determine the nature, site and scope, confirm clinical impression diagnosis and solve special problems; percutaneous transhepatic cholangiography and drainage, liver biopsy can be performed under the guidance of ultrasound exploration; treatment and follow-up observation of confirmed hepatobiliary diseases can be carried out; further Verify the results of radionuclide examination, determine the nature and depth of lesions, and the relationship between hepatobiliary diseases and surrounding organs. B-ultrasound examination is of great significance in the diagnosis of intrahepatic space-occupying lesions, and space-occupying lesions with a diameter of more than 1 cm can be detected. 13.2 X-ray examination
(1) Chest X-ray: The position, shape and movement of the right diaphragm can be determined.
(2) Gastrointestinal barium meal: It can detect esophageal varices and is helpful in detecting biliary obstruction caused by pancreatic head cancer or ampullary cancer.
(3) Cholecystography or cholangiography: It has diagnostic value for gallbladder lesions or bile duct obstruction, but is not suitable for patients with jaundice. At this time, percutaneous transhepatic cholangiography must be performed to determine whether there are stones or tumors. The imaging clarity of bile duct lesions is better than that of endoscopic retrograde cholangiopancreatography and excretory angiography in cases of severe obstruction, but it is contraindicated when prothrombin time is significantly prolonged. The effect of retrograde cholangiography using duodenal fiberscope is similar to that of percutaneous puncture. 13.3 CT and MRI
MRI is inferior to CT in diagnosing cirrhosis, fatty liver, and hepatic adenoma, but MRI is worse than CT in diagnosing liver cysts and hepatic hemangiomas. 13.4 Radionuclide scanning
It can dynamically observe the concentration and passage of radioactivity in the liver, bile duct, and gallbladder. It can display the size, location, and shape of the liver. It is mainly used to diagnose intrahepatic space-occupying lesions. Filling of the blood pool has diagnostic significance for hemangiomas and can also help differentiate between intrahepatic cholestasis and extrahepatic obstructive jaundice. It is superior to X-ray hepatobiliary angiography. 13.5 Laparoscopy
It is helpful in the diagnosis and differential diagnosis of various liver diseases. It is used to confirm the diagnosis of hepatitis, the stage of hepatitis, and the complications of hepatitis; the cause, nature, and extent of cirrhosis; and the nature of tumors. , location, and degree; determine whether laparotomy is necessary and whether the tumor can be resected; it is also helpful in identifying extrahepatic obstruction and intrahepatic cholestasis. 13.6 Hepatic angiography
There are methods such as splenic portal venography, hepatic venography, hepatic arteriography, and transumbilical vein portography. Splenic portal venography can understand the obstruction of the portal vein system and measure the portal vein pressure. Hepatic venography can understand the obstruction of the hepatic veins. Hepatic arteriography is helpful in estimating the possibility and scope of surgical resection of liver tumors. MRI can replace some invasive angiograms. 13.7 Liver blood flow diagram
It is a non-destructive method to check the function of liver and blood vessels. By measuring the impedance changes of liver tissue to high-frequency current, it can reflect the blood circulation status of the liver and It is used to judge liver function and pathological changes, diagnose and understand the evolution, prognosis and outcome of the disease. Although the liver blood flow diagram is not specific for the cause, it is meaningful for reflecting the degree of liver disease. It is useful for chronic hepatitis, liver cirrhosis and early portal diseases. It has certain value in the judgment of pulse hypertension, cardiogenic liver congestion, and the diagnosis and localization of liver cancer. Human body surface area calculator BMI index calculation and evaluation Female safe period calculator Pregnancy date calculator Normal weight gain during pregnancy Safety classification of medication during pregnancy (FDA) Five elements and eight characters Adult blood pressure evaluation Body temperature level evaluation Diabetes diet recommendations Common clinical biochemistry units Conversion to basal metabolic rate Calculate sodium supplementation calculator Iron supplementation calculator Commonly used Latin abbreviations for prescription Quick check Common symbols for pharmacokinetics Quick check Effective plasma osmolality calculator Ethanol intake calculator
Medical encyclopedia, calculate now! 13.8 Liver biopsy
Its indication is hepatomegaly of unknown cause, which provides reliable scientific basis for clear diagnosis, judgment of efficacy and prognosis, and understanding of the evolution of various liver diseases. It is contraindicated in severe jaundice, ascites, or coagulopathy. 14 Diagnosis
1. Medical history: Medical history can often provide clues to the diagnosis of liver disease. Pay attention to whether there is a history of contact with infectious diseases, a history of receiving blood products, and a history of traveling to endemic areas. This can help with infectious diseases. Diagnosis of parasitic diseases. A history of exposure to drugs or poisons can cause toxic hepatomegaly. Patients with cirrhosis often have a history of hepatitis, jaundice, and chronic alcoholism. Pain in the liver area is mostly caused by intrahepatic inflammation, acute liver congestion, and intrahepatic space-occupying lesions. It is mostly dull pain, but the pain of liver cancer can be quite severe. Fever often indicates hepatitis, liver abscess, biliary tract infection, liver cancer or other acute infectious diseases, blood diseases, connective tissue diseases, etc. Viral or drug-induced hepatitis is accompanied by anorexia.
2. Clinical manifestations.
3. Laboratory and other auxiliary examinations. 15 Differential diagnosis 15.1 Viral hepatitis
People with liver enlargement caused by viral hepatitis often have a history of close contact with patients with viral hepatitis, unclean diet, blood transfusion, or drug injection. Clinical manifestations include fatigue, loss of appetite, nausea, abdominal distension, liver pain, etc. Signs include liver enlargement, liver pain, jaundice, etc. Serum enzymatic activity is increased in liver function tests, and various types of hepatitis (A) can be detected in serological tests. , B, C, D, E, H, G) virus antigens or antibodies. 15.2 Toxic hepatitis
There is often a history of exposure to drugs or poisons before the onset of the disease, and symptoms such as liver enlargement, fever, rash, pain in the liver area, and jaundice appear later. Toxic hepatitis is also accompanied by symptoms of damage to other organ functions, with an increase in peripheral blood eosinophils. However, serum antigen or antibody tests for various types of viral hepatitis are mostly negative. Normal symptoms can return to normal after stopping taking the drug or stopping exposure to the poison, but the same symptoms will reappear when exposed to the drug or poison again.
15.3 Liver abscess
Liver abscess generally starts slowly. Due to obvious inflammation, chills and fever are common, followed by pain in the liver area, enlargement of the liver, smooth liver surface, tenderness, and percussion. There is often edema in the abdominal wall and an increase in peripheral blood white blood cell and neutrophil counts. Auxiliary examinations such as ultrasonic examination, radionuclide, and CT scan can assist in diagnosis, and diagnostic puncture examination can be performed when necessary. 15.4 Primary or metastatic liver cancer
Patients with primary liver cancer are mostly over 40 years old, more common in men, and have a slow onset. The clinical manifestations include weight loss, loss of appetite, pain in the liver area, fever, and jaundice. etc., the liver can be significantly enlarged, the texture is tough, and the nodules can be palpated. In patients with primary liver cancer, the serum alpha-fetoprotein value is often elevated, and serum AKP, γGT, and carcinoembryonic antigen may also be elevated. Abdominal B-ultrasound, CT, radionuclide, MRI and other auxiliary examinations can detect cancer lesions; in metastatic liver cancer, , B-ultrasound and other examinations often reveal multiple cancer foci of varying sizes in the liver parenchyma. 15.5 Liver cysts
Patients with liver cysts often have no obvious clinical symptoms or only have non-specific symptoms such as upper abdominal discomfort. Most of them are congenital, and a few are acquired. Ultrasound, CT, MRI and other examinations can detect liquid dark areas in the liver with clear edges, and strong echogenic light groups can be seen when calcification occurs. 16 Treatment of hepatomegaly
Since there are many causes of hepatomegaly, and in most cases hepatomegaly is an important sign of a certain disease. Therefore, patients with hepatomegaly should actively look for the cause of hepatomegaly. To determine the exact cause of the disease, actively treat the primary disease, rather than hoping that the liver will return to normal after applying certain liver-protecting drugs. If the liver enlargement is caused by a single huge abscess or cyst, the abscess or cyst can be treated by puncture and drainage. In the former, antibiotics or metronidazole solution can be injected into the abscess cavity after the pus is extracted. After the cyst is drained, it can be treated. Inject a sclerosing agent such as absolute alcohol or compound aluminum solution into the cyst cavity to prevent the cyst wall from continuously leaking liquid into the cavity.
17 Related Drugs
Acetaminophen, sodium valproate, oxygen, salicylic acid, pyrazinamide, ethionamide, azathioprine, methotrexate, amiodarone, isoflurane Niazid, phenylbutazone, rifampicin, tetracycline, chlorpromazine, methyltestosterone, testosterone, ketoconazole, methyldopa, phenytoin, phenobarbital, barbiturate, sulfa, phenformin, pancreatic acid Protease, folic acid, phospholipid, zinc sulfate, thymol, adenosine, glutamic acid, glucosamine, glucose, chymotrypsin, sodium sulfonium bromide, vitamin E, thrombin, metronidazole 18 related tests
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