The liver is located under the diaphragm must, hiding behind the ribs, on the banks of the corresponding intercostal space Thursday (on the road between the clavicle pull down) and lower shore usually not palpable, or just palpable in the left part of the upper lobe position. In adults, the average height of liver per pull down the road between the clavicle is 10-11cm.
Gan to the increased height of the liver or liver broader limits. Hepatomegaly can be:
On the shores of the liver beyond intercostal V and emerge from the shore below the right costal margin – hepatomegaly both directions. It is possible only to one-dimensional liver as:
Bo is still in the same location on the shore but under low.
Shore below the right costal margin, but not beyond the shore on the pass intercostal V.
So want to determine hepatomegaly need to determine the limits of the shore and on-shore below:
How to check liver
How to determine the shore on liver
There are two ways – using x-ray and type:
Type the liver: Type the opaque areas of the liver to find and identify on the shores of the liver.
The patient supine, legs contraction. Physicians sitting right type from top to bottom, front chest and armpits.
Using x-ray: For the case when typing is difficult to determine as thick chest, liver shed behind, right pleural effusion, this time to use x-rays to shore on the liver.
Identify the shore below the liver
Combining touch and type, but mainly touch, even typing it less valuable. When should gently touch, pressure both palms on the abdomen, according to note touching the patient’s breathing. If a hard belly, or the sickness (up feeling abdominal skin) can ice until soft and then examined.
There are many methods to touch, depending on the nature of each type of hepatomegaly, we have different methods:
The patient supine, the physician uses his hands close to the abdominal wall prior to palpation. This is the method most often used.
The patient supine, the physician hand under elevated waist hole, hand palpation above. Often used this method when the liver is poured out behind miserable.
The patient supine left hand physicians, four finger holes under the waist, while the thumb open up to embrace the front right upper quadrant, right hand touching the front. This method is applied to determine the distribution of the right lobe of liver and liver shed behind.
To determine the shore edge of the liver when the liver is not to much, we use mechanical methods: Physicians sit above the hook to the liver with both hands, right upper quadrant.
Check with the patient recumbent posture on the left, is often used to examine the right lobe of the liver posture shed behind. There are two methods:
Physicians sitting behind as the liver, the left hand pressed into holes waist, right side abdominal palpation.
Physicians tr6en sitting behind the liver area, with both hands, hook into the right upper quadrant.
Some of the special position of the liver
In normal range, depending on the position and posture of the lower shore of the liver that can change the liver.
The liver is angling along the costal margin, so the banks of the lower right lobe of the liver palpable equivocal costal margin.
The liver is poured out behind, as will shore up, knock will see limited height shorter than normal liver and the liver to the shore below is not palpable.
The liver is poured forward, down the shore below the liver, so normal liver palpable equivocal shore costal margin.
Do not just rely on the shore below the liver palpable or not to conclude or not to hepatomegaly.
Some tests are particularly liver examination
Liver vibration test: The patient supine, the physician left hand placed on the liver, mild hand tightly in his left hand, a positive test measures the pain, sometimes severe, frequent in patients liver abscess .
Test is pressed interstitial slopes: Physicians finger print on the front rib interstitial liver. If the tests are positive pain, common in liver abscess.
Find feedback liver jugular vein: See the cardiovascular examination.
The characteristics of liver
While we need to determine liver visit the following characteristics:
Coast liver:
Coast liver how much costal margin (in cm): The best way is to redraw the image of the liver on paper for reference tracking.
Coast rounded or sharp.
Coast smooth or rough with protruding mound.
Face shape and liver:
To have or not have.
Surface smooth or bumpy, lumpy.
Density and pain:
Gan rigid or soft.
Type in more or less opaque.
Pain or not? The vibration test liver, alternating ribs, liver vein feedback neck positive or not ?.
Differential diagnosis
may be mistaken hepatomegaly with:
Gan is
Coast down below the liver, but also on the banks of the liver and low, respectively, so the height of the liver remains unchanged.
Gan to them, do not change the density and painless.
Could push up the liver.
Usually due to liver sa emphysema, pleural effusion right diaphragmatic paralysis due to either congenital.
Gastric tumors
It is easily confused with the left lobe of the liver is the largest.
Gastric tumors have the following characteristics:
Little or no moves with respiration.
Type in often.
The function expression: Nausea, vomiting blood, pyloric rules.
X-ray image.
Right corner of colon tumors: Rarely, hard to mistake the liver because:
Often there is no obstruction syndrome sale.
The tumor is not attached to the liver cell and not breathing rhythm.
Mesenteric lymph nodes
Usually a lumpy clusters in agriculture, not related to the liver, do not you move or breathe.
Elsewhere in the abdominal lymph nodes also.
U kidney or kidney u have to (fluid, pus, polycystic).
In the following, it is difficult to determine the boundaries.
There are touches of the following signs and floating kidney.
Type in (because in the back of the intestine).
U myositis or right upper quadrant abdominal wall
Location agriculture.
Run along the path of muscle fibers (large straight, diagonal great little dog).
When the patient on the abdomen near the tumor more clearly.
Right corner of colon tumors
Rarely, hard to mistake the liver because:
Often there is no obstruction syndrome sale.
The tumor is not attached to the liver cell and not breathing rhythm.
Visits to a liver disease
To diagnose the cause enlargement of the liver, in addition to identifying the characteristics of the liver, should be examined in a systematic way the parts related to the liver and body while incorporating the preclinical exploration.
Check out some of the symptoms of liver disease
Cholestasis syndrome or obstructive Jaundice and mucosa, discolored feces, urine yellow.
Syndrome static pressure amch door: ascites, collateral circulation, digestive tract bleeding.
Liver Syndrome: digestive disorders, bleeding under the skin ….
The function expression: Nausea, vomiting blood, pyloric rules.
Liver x-ray, door systems, chassis duodenum …
Biopsy of the liver, lymph nodes, bone marrow …
Laparoscope and surgical exploration.
Cause
Some signs relating to classify the cause. Favorable classification is based on clinical signs associated with hepatomegaly to divide: Gan to a lot of different reasons cause, we can rely on a number of characteristics of the liver or the presence of .
Gan to merely
Gan to do amip:
Liver enlargement is often uneven.
The density of soft, smooth surface.
Pain: Signs vibration liver, ribs alternating press (+).
Signs of infection.
Prehistoric often dysentery (sometimes not).
Gan to heart failure:
Gan to them.
The density of soft, smooth surface.
Click ie, hepatic response jugular vein.
There are other signs of heart failure: dyspnea, edema, high blood pressure veins.
Gan to coordinate with splenomegaly
Banti’s syndrome:
Splenomegaly and hypersplenism, portal venous pressure. Gan to combine with
nature:
To little and all.
No pain.
Cirrhosis to:
Before going to the atrophy of the liver, liver fibrosis stage with a big but.
To them.
Make or solid.
Splenomegaly, ascites, collateral circulation.
Benh Hanot:
Hepatomegaly, splenomegaly, yellow intermittent growing.
To them.
Make and painless.
Liver enlargement in a number of infectious diseases:
Typhoid, malaria, sepsis … hepatomegaly here is secondary, mainly signs signs of primary disease, soft and slightly painful.
Hepatomegaly in combination with splenomegaly and lymphadenopathy
A number of diseases associated retinal endothelial system or blood system can cause liver, spleen or lymph nodes to: Leukemia acute and chronic multiple births, lymphosacom Hodgkin.
Features of the liver are:
To little and all.
Soft smooth and painless.
For ease of use in clinical practice, the following is a summary table comparing symptoms causes the liver to some the most common:
|
Cause |
Coast and face |
Pain |
Jaundice |
Density |
Infections |
Cachet |
|
Amoebic liver abscess |
Smooth surface irregularities. |
++ |
– |
Soft |
++ |
History of dysentery. Specific effects of emetin. |
|
Abscess grams biliary |
Surface are smooth. |
+++ |
+++ |
Soft |
+++ |
Prehistoric more episodes of pain, fever, jaundice. Full bacterial infections, depression. |
|
Gan to heart failure |
Surface are smooth. |
+ (News) |
– |
Soft |
– |
Feedback liver TMC (+). Signs of liver failure. |
|
Primary liver cancer |
Irregular lumpy. |
– |
– Or + |
Hard |
– |
Gan to fast. Systemic collapse. |
|
Cirrhosis to |
To them, sharp and smooth shore. |
– |
– |
Hard |
– |
TMC hypertension. Signs of liver failure. |
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