The liver is one of the main organs of the human body. Diagnosis of diseases that negatively affect the work of this body is a serious and responsible event, which involves a set of different studies.
Diagnosis of diseases
The basis of all studies is a special tapping of the area where the organ is located, to determine the boundaries of the liver and its location. This is exactly the type of procedure that is used by specialists during initial examinations.
With a deeper diagnosis, laboratory tests are prescribed. This type of diagnosis helps to detect pathological changes in the organ. Additionally, if in doubt, experts prescribe liver tests using ultrasound.
What does terminology mean?
Percussion is one of the main techniques where, by tapping, the external state of the organ is quite clearly defined. When diagnosing with this method, sound experts determine the size of the liver. During percussion, parenchymal organs make sounds that absorb rattling, making it blunt. The opposite is hollow areas where the sound is felt louder. The beginning of the organ is the sites that, during the examination, make dull sounds.
Research Methods
Experts use two main research methods:
- Direct. A specialist examines the borders of the liver with his fingers. To determine the studied area located directly above the abdominal cavity.
- Mediated. A pessimeter is superimposed on the right place. For this purpose, a metal strip is most often used. If the device is missing, it is allowed to stick the phalanges of the fingers.
A more informative way to diagnose is indirect tapping. For children and adults, the research methodology is not uniform. The reason for the difference is the weight of the organ relative to the patient’s weight: in children this figure reaches 7% of the difference, in adults 3%. Primary diagnosis is prescribed at the onset of primary school age. In an earlier return, the borders of the liver in children are practically not felt, and its size may vary by individual characteristics.
The essence of the methodology
The liver belongs to the category of parenchymal organs, with a location in the right hypochondrium. Primary diagnosis is required to study the size of the organ. By tapping in certain areas, lines are defined in the areas of which a dull echo is heard. These places indicate the boundaries of the body, and there are three in total:
- Passing in the middle. Conditionally drawn line goes vertically, crossing the middle of the clavicle.
- Front The line runs vertically with respect to the front edge of the axillary groove.
- Periosternal. The conditional passage of the line takes place in the place where the sternum and the mid-clavicular zone border.
Comparing the length, using the reference points and the distance that is between them, the normal liver boundaries are compared. Additionally, using more complex studies, the location of the liver is calculated relative to the location of other organs.
How are dimensions determined?
A feature of determining the borders of the liver according to Kurlov is the measurement of sizes using the distance taken between several points. Kurlov used several points, placing them for the convenience of diagnosing along the edges of the organ. Examining the borders of the liver according to Kurlov, one should pay attention that when tapping, the organ responds with a dull, well-heard sound. For the convenience of research, scientists identified five key points:
- No. 1. The so-called upper point, since its location is the lower section of the 5th rib, on the line passing through the mid-clavicular section. A section of the border is determined by tapping, which is performed, starting from the top, smoothly moving down.
- No. 2. Point defining the lower border of the liver. The location of the point is the area just above the lower edge of the costal arch. It runs on the line of the mid-clavicular region. To detect it, percussion is used, in which tapping starts from the bottom, moving smoothly up.
- No. 3. The point is located on the same plane with point No. 1, horizontally to the midline. A feature of this mark is that due to the presence of the sternum, the point is difficult to find.
- No. 4. This mark belongs to the lower boundaries of the body. Normally, its location is underestimated in relation to the xiphoid process of the sternum.
- No. 5. The dot indicates the end of the sharp edge; it is tapped along the left costal arch.
All listed points are located at the edges. If you arbitrarily imagine an organ and connect all the points together, the size and location of its liver in the abdominal cavity are quite clearly defined. This is the basis of the method proposed by Kurlov, where for the calculation all distances between control points are measured. As mentioned earlier, the norms for calculating the border of the lobes of the liver for adults and children are different.
Norm limits for children
Until the age of eight, the child’s liver can vary in size due to the individual characteristics of the body. Only after the child is 8 years old, the parenchyma of the organ in structure begins to resemble a fully developed organ. The norms of young and older children are different, but still they are close to the parameters of adults:
- Size No. 1. The borders of the liver do not exceed 7 cm.
- Size No. 2. Normally, the limits are not more than 6 cm.
- Size No. 3. The maximum norm of the liver is 5 cm.
In babies whose age is less than 3 years, diagnosis with percussion will not give the necessary information due to the immaturity of the organ. The segmental structure is so poorly audible that it is almost impossible to detect. Another feature is the structure of the lower part of the liver. In this case, its lower edges protrude beyond the costal arch.
Adult Boundary Rate
In adult patients, at the initial stage, the points are determined, which are considered the main ones when performing measurements. The so-called control points help determine the size of the organ using a conditional join to calculate the distance. There are 3 sizes that are considered the norm in determining the size of an organ. In the first case, the distance taken between points No. 1 and No. 2 is used. In the second case, the distance between point No. 2 and point No. 3 is measured. In the third case, the length between point No. 3 and point No. 4 is calculated. The norm of organ size in adults is as follows way:
- No more than 10 cm.
- 7-8 cm.
- Up to 7 cm.
Despite the apparent primitiveness, the technique allows you to quite accurately determine the percussion borders of the liver, with their clear designation. If in the abdominal cavity at the time of diagnosis there is an increased gas content or fluid accumulation is observed, then it is likely that the size of the liver will be calculated incorrectly.
Palpation method
Palpation is another way by which you can determine the size of the liver. The main objective of this method is to touch, with the help of fingers alone, to correctly determine the boundaries of the body. With sufficient experience and knowledge, this will help to correctly calculate the size of the liver, to assess the sharpness of the angles, while simultaneously observing the patient's behavior and his reaction to pain.
A sharp reaction to pain that may appear in the patient at the time of pressing with fingers in the liver area will help determine the alleged areas of destruction of the organ tissue and foci, where inflammatory processes progress.
Palpation procedure
The procedure is carried out simultaneously in two directions - they process the area of the alleged boundaries of the organ vertically and horizontally. The procedure begins after the patient takes a slow but deep breath. During the filling of the lungs with air, the liver under the pressure of the diaphragm is heard and begins to protrude beyond the edges of the costal arch. This point can be used to study the lower boundaries of the liver, so they are most accessible for diagnosis. During the examination, the following indicators should be the norm of results:
- The lower edges should be moderately dense, rounded and even.
- Normally, the border of the liver should not go much beyond the edges of the costal arch, which is located on the right side. The maximum protrusion of the organs beyond the edges of the arc should not exceed 1 cm, but this is provided that the patient at this time took a breath.
- With exhaled air, the lower edges of the liver are not detectable by palpation.
- During the procedure, the patient should not experience pain or discomfort.
A prerequisite for the procedure is a deep, long breath of the patient. If, even without breathing in air, the patient feels the edges of the organ, and he feels pain and discomfort during palpation, this indicates that health is not very good.
The main causes of deviations
Kurlov’s liver border indices help determine the size and organ boundaries, which contributes to a deeper study in the study of pathological changes, if necessary. Each research is individual for each person, but if there are deviations from the norm, this is the reason for a more serious study of the problem.
Percussion helps to suggest the presence of organ diseases at an early stage, and the additional symptoms that are investigated in this case will help to begin timely treatment. The main causes of size deviations can be:
- Displacement of the upper bounds. You should pay attention to the state of the diaphragm. Often the body can deviate from the borders. Also, tumors that interfere with the normal functioning of the organ can become the cause of the displacement of the upper border of the liver. The negative effect of parasitic organisms in the form of helminths, which formed a cyst in the parenchyma. The development of abscesses in the area located under the capsule of the liver. Pleurisy.
- Offset lower bounds. Oversaturation of the alveoli with air (emphysema), which accumulates, affects the position of the diaphragm and organs located in the abdominal cavity. Pathology that affects the organs of the abdominal cavity shifts them down. Ascites, in which there is a displacement of organs down. Increased flatulence, when air constantly present in the digestive tract causes displacement of the borders of the liver.
Diseases that provoke liver abnormalities
Doctors also advise in such matters to pay attention to a number of diseases that can cause a displacement of borders and an increase in liver size:
- organ atrophy;
- decomposition cirrhosis;
- pneumothorax;
- chronic or acute hepatitis;
- stagnation of blood in the liver;
- congestive heart failure;
- inflammatory processes of varying severity.
The danger of liver disease
A feature of liver diseases is the difficulty of diagnosing them at an early stage. A feature of the hepatic parenchyma is the fact that there are no nerve endings in it. This is fraught with consequences, because with the initial destruction of the cells of the organ, the patient practically does not feel the changes taking place. It is percussion that is the main method for identifying ailments and other changes.
If you have become bothered by pain in the side, you need to see a doctor for a diagnosis. Remember: early and timely diagnosis of liver disease is the key to a quick and complete recovery of the patient.