For normal human life, all organs are important without exception, since each of them performs its specific function. When one fails, the work of the rest, and the whole organism as a whole, is disrupted. So, liver problems cause deterioration of the digestive tract, circulatory 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, what kind of connection exists between them. Several systems function in the human body: circulatory, respiratory, musculoskeletal, digestive, excretory, nervous, reproductive. Each of them has a complex structure. Since we are talking about the liver, we will analyze the organs associated with it and located in close proximity to it. So, our liver is a gland located immediately below the diaphragm on the right side of the body, in the abdominal cavity. The lower edge of it touches the esophagus, stomach, gall bladder and duodenum. Also, its segments are in 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, nerve fibers, blood and lymph vessels approach the liver.
Liver structure
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 it is divided into 8 segments. Each individual segment (lobule) has its own blood supply, bile excretion and a network of nerve fibers. The lobule tissue (parenchyma) is formed by elongated cells (hepatic beams). The parenchyma is penetrated by bile capillaries and blood vessels. In the center of each hepatic segment passes one central vein, and between them - arteries, bile ducts and other veins. In the lower part of the body under consideration there are two longitudinal grooves and one transverse. These are the so-called liver gates. They connect all the bile ducts, forming one common, continuing into the duodenum. The hepatic veins form one - the portal. From this and from the arteries, blood flows into this important organ. Diffuse changes can affect each of the above elements.
Liver work
One of the main functions of our liver is the neutralization of poisons, toxins, all kinds of foreign and excess substances. This gland takes part in all types of metabolism occurring in the human body, in digestion, blood formation, in the production of many vitamins and hormones. It is a kind of repository of blood and trace elements. Constantly in a busy operating mode, the liver is at risk of various pathological processes in it. One of them is hepatomegaly, diffuse changes in the liver, characterized by its increase. It is determined by palpation, by ultrasound and computed tomography. The last two types of studies make it possible to accurately distinguish liver enlargement from a similar pathology of neighboring organs (right kidney, gall bladder, intestine).
Causes of the disease
The concept of diffuse means changes in the entire organ, and not just in any part of it, as in focal pathologies. When does hepatomegaly develop? Diffuse changes in the liver are observed with the following diseases:
- cirrhosis of the liver;
- heart failure;
- benign and malignant (cancer) tumors;
- hemangioma;
- parasitic and non-parasitic 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 a cold, some infectious diseases, malnutrition.
Symptoms
Signs of diffuse changes in the liver at the initial stages of this pathology appear slightly. The patient may feel some discomfort in the right hypochondrium, worse after taking fatty and spicy food, alcohol. However, there are patients who do not feel anything at all until the disease that caused hepatomegaly passes into acute forms and a significant enlargement of the liver occurs. Symptoms depend on the underlying disease. Common ones include:
- pains in the right side, especially sharp with mechanical squeezing;
- nausea, in some cases, turning into vomiting;
- heartburn;
- decreased appetite;
- icteric color of the skin;
- bad breath from the oral cavity;
- sometimes a rash appears, accompanied by itching;
- general deterioration.
Specific signs of hepatomegaly
Staphylococcal, streptococcal and pneumococcal infections can cause abscesses (suppuration) in the largest human gland and, as a result, an increase in the liver. Symptoms are as follows: severe chills, tachycardia, excessive sweating, aching pains on the right side of the body, giving even to the shoulder blade and arm. The treatment in this case is only surgical. With another common disease - liver cancer, which takes more than a million human lives every year - hepatomegaly, plus the above symptoms, is accompanied by sharp weight loss, weakness, intestinal dysfunction, flatulence. Cirrhosis of the liver (the main cause is alcoholism) and the accompanying hepatomegaly are characterized by pain in the right hypochondrium, joints, portal hypertension, enlarged spleen. In hepatitis, an enlargement of the liver is also accompanied by pains in the right side, significantly aggravated by physical exertion (for example, when walking fast), nausea, general weakness.
Diagnostics
If a patient complains of pain in the right hypochondrium, the doctor will first palpate and possibly diagnose hepatomegaly. Diffuse changes in the liver can be detected (or refuted) using additional tests. In principle, palpation can only determine the boundaries of the enlarged organ, the degree of pain 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 substances (bromosulfophthalein, galactose);
- radioisotope studies;
- liver biopsy.
Bilirubin is determined in a free and bound state. A healthy person has only free (0.4-1 mg / dl). Deviations from the norm are observed with jaundice, tumors and blockages of the liver tubules, some types of cirrhosis. With the help of samples, it is determined how protein-metabolic processes proceed in the liver. Bromosulfophthalein test allows you to establish whether there are violations of the excretory (excretory) function in the gland. In healthy individuals, less than 5% remains within 45 minutes after the dye is introduced into the blood. The introduction of galactose makes it possible to trace how carbohydrate metabolism occurs. A biopsy is performed in a laboratory setting with suspected latent hepatitis, cirrhosis, cancer, fibrosis and other diseases. It is contraindicated in case of abscess, ascites, prolonged obstructive jaundice, hemorrhagic syndrome. A study of radioisotopes (the introduction of a Bengal rose in the blood ) is performed for many liver diseases. In healthy individuals, the blood is half cleared of paint in 8 minutes.
Pathology of the pancreas
The liver is closely connected with another gland - the pancreas. The pathology of one inevitably leads to disruption of the other, therefore, during diagnosis, these two organs are checked simultaneously. Diffuse changes in the pancreas (the liver is not affected) can be detected only by ultrasound. Palpation is not determined. Ultrasound examination shows the size, density and uniformity of tissues, as well as echogenicity (sound reflection) of this important organ that is actively involved in the digestion and absorption of glucose (insulin secretion). Diffuse changes are observed with pancreatitis, fibrosis and in connection with age. Having found changes on ultrasound, the patient can be referred for additional examinations (blood donation, endoscopy of the duodenum).
Treatment
If diffuse changes are found in the pancreas, but the patient has no complaints, therapy is not required. Mild hepatomegaly is also not treated. As a rule, this condition resolves on its own after normalization of nutrition and the disappearance of concomitant diseases. With hepatomegaly of the liver, it is mandatory to begin treatment of the underlying disease that caused the pathology. Along with this, the patient is put on a strict diet that excludes from the menu all fried, spicy, salty, fatty and alcohol. Traditional medicine recommends drinking infusions of rose hips, aronia, some mineral waters, and consume low-fat cottage cheese with honey. A gentle regimen is recommended for a sick person, physical activity is prohibited.