Liver enlargement

　　1. Etiology

　　Many diseases can cause liver enlargement, summarized as follows.

　　1. Enlarged liver due to infection

　　(1) Viral infections: Hepatitis A, B, C, D, and E, Infectious mononucleosis, Yellow fever, Rubella, Cytomegalovirus, Herpes simplex virus, Coxsackievirus, Adenovirus, Herpes zoster virus, Measles virus, etc.

　　(2) Chlamydial infections: Psittacosis, etc.

　　(3) Rickettsial infections: Typhus, Q fever, etc.

　　(4) Bacterial infections: Acute obstructive suppurative cholangitis, Chronic cholangitis, Primary biliary cirrhosis, Bacterial liver abscess, Liver tuberculosis.

　　(5) Spirochetal infections: Leptospirosis, Relapsing fever, Syphilis of the liver, Lyme disease, etc.

　　(6) Fungal infections: Actinomycosis, Blastomycosis, Coccidioidomycosis, Cryptococcosis, Histoplasmosis, Candidiasis, Aspergillosis, Mucorosis, etc.

　　(7) Protozoan infections: Amoebic liver abscess, Kala-azar, Malaria, Toxoplasmosis, Trypanosomiasis, Trichomoniasis, etc.

　　(8) WORM INFECTIONS: Schistosomiasis, Clonorchiasis, Biliary ascariasis, Ascariasis liver abscess, Echinococcosis, Opisthorchiasis, Fascioliasis, Anoplostoma hepaticum, Capillaria, Strongyloides, Paragonimiasis, etc.

　　2. Non-infectious liver enlargement

　　(1) Toxic: can be caused by carbon tetrachloride, chloroform, ethanol, phenol, naphthalene, benzene, acetaminophen, sodium valproate, heavy metals, phosphorus, arsenic, isothiocyanate compounds, trinitrotoluene, monoamine oxidase inhibitors, paraaminosalicylic acid, pyrazinamide, ethionamide, azathioprine, methotrexate, cyclohexylhexane, amiodarone, aminophen quinoline, thorium oxide, polyvinyl chloride, aflatoxin, mushrooms, isoniazid, phencyclidine, rifampicin, tetracycline, diclofenac, chlorpromazine, methandienone, oral contraceptives, ketoconazole, methyldopa, phenytoin sodium, phenobarbital, furazolidone, sulfonamides, thioureas, phenethylbiguanide, and so on.

　　(2) Congestive: congestive heart failure, tricuspid stenosis or insufficiency, myocarditis or cardiomyopathy, congenital heart disease, restrictive pericarditis, cardiac tamponade, and hepatic vein obstruction, and so on.

　　(3) Bile stasis: intrahepatic bile stasis, extrahepatic bile stasis, common bile duct stones, cholangiocarcinoma, pancreatic head cancer, ampullary cancer, and so on.

　　(4) Metabolic disorders: fatty liver, Relye syndrome, acute fatty liver of pregnancy, liver amyloidosis, liver copper storage disease, tyrosine metabolism disorder, hemochromatosis, porphyria, glycogen storage disease, lipoid histiocytosis, familial splenic anemia, cholesterol ester storage disease, ganglioside disease, mucopolysaccharidosis, galactosemia, hereditary fructose intolerance, cystic fibrosis, alpha-1 antitrypsin deficiency, tyrosine metabolism disorder, and so on.

　　(5) Liver cirrhosis: portal cirrhosis, schistosomal cirrhosis, post-necrotic cirrhosis, primary biliary cirrhosis, secondary biliary cirrhosis, and cardiogenic cirrhosis, and so on.

　　(6) Tumors and cysts: primary liver cancer, secondary liver cancer, liver blastoma, carcinoid, liver mixed tumor, liver adenoma, cystadenoma, liver angiosarcoma, liver vascular endothelioma, cavernous liver hemangioma, adult polycystic liver disease, non-parasitic liver cysts, and so on.

　　(7) Others: such as granulomatous liver disease, sarcoidosis, autoimmune hepatitis, liver hematoma, various blood diseases, multiple myeloma, bone marrow fibrosis, AIDS, and so on.

　　Second, pathogenesis

　　1. Infections caused by various pathogenic microorganisms and toxic hepatitis, due to inflammation, there is vascular congestion, tissue edema, infiltration of inflammatory cells, and exudation of other inflammatory substances, or due to the degeneration and swelling of liver cells, or due to the stimulation of the liver reticuloendothelial system, resulting in the proliferation of a large amount of cells, causing liver enlargement. Among various infections, viral hepatitis is the most common.

　　2. Congestion in cases of congestive heart failure, cardiac tamponade, restrictive pericarditis, pericardial effusion, and obstruction of the hepatic venous return causes the liver to swell due to congestion, appearing purple with blunted edges.

　　3. Bile stasis in primary biliary cirrhosis, pancreatic head cancer, and obstruction of the intrahepatic and extrahepatic bile ducts leads to bile stasis, causing liver enlargement.

　　4. In cases of poisoning by certain drugs and hepatotoxins, and various systemic infections, pathogens can directly invade the liver, and can also cause toxic hepatitis through factors such as sepsis, high fever, malnutrition, and hypoxia, leading to liver cell necrosis, the formation of microcystic fat deposition, hepatitis-like injury, liver fibrosis, hepatic vein obstruction, and cholangitis, resulting in liver enlargement.

　　5, Metabolic abnormalities Fatty liver, amyloidosis, and other diseases when fats, glycogen, lipids, amyloid substances, copper, or iron are deposited in the liver, causing it to swell.

　　6, Tumors and cysts Hepatocellular carcinoma, sarcoma, benign tumors, and various cysts infiltrating liver cells cause them to swell.

　　7, Other immune injuries, connective tissue diseases, blood diseases, etc., can all cause liver enlargement.

　　1, Rupture and bleeding of liver tumors can cause severe pain in the upper abdomen, as well as hemorrhagic and shock symptoms; when pedunculated tumors growing outside the liver twist.

　　2, Tumor necrosis can occur, resulting in severe abdominal pain, fever, and weakness.

　　3, There are also individual cases where due to the large size of the tumor, an arteriovenous fistula is formed, resulting in increased return blood volume and increased cardiac burden, leading to heart failure and endangering the patient's life.

　　4, Liver cirrhosis: Diffuse liver damage formed by the long-term or repeated action of one or more etiologies. In China, most cases are post-hepatitis cirrhosis, and a small number are alcoholic cirrhosis and schistosomal cirrhosis. Pathologically, there is extensive necrosis of liver cells, nodular regeneration of residual liver cells, proliferation of connective tissue, and formation of fibrous septa, leading to destruction of the lobular structure and formation of pseudo-lobules.

　　Tooth infection symptoms are pain localized to a tooth and caused by sweet or cold, often indicating caries approaching the pulp containing nerves. Such pain often disappears quickly. Patients should avoid stimuli that cause pain, use milder analgesics, and should seek medical attention as soon as possible.

　　Persistent toothache that worsens with heat or cold and occasionally relieves with cold often indicates irreversible pulp damage. This condition often leads to inflammation of the periapical tissue, and periapical infection often accompanied by swelling of the adjacent soft tissue, which often occurs in untreated pulpitis. Diagnosis can be made by palpation or percussion with a tongue depressor. If all the maxillary posterior teeth on one side are sensitive to percussion, sinusitis of the maxillary sinus should be suspected.

　　Emerging or impacted wisdom teeth, especially the third molar, can cause pain and inflammation of adjacent soft tissue (pericoronitis), and acute perioral swelling is rare due to periodontal abscess, infected cysts, arthritis, allergies, sialadenitis or infection, and peritonsillar infection.

　　One, Lesion range

　　1, Diffuse enlargementDue to generalized liver lesions, it is seen in various hepatitis, fatty liver, amyloidosis of the liver, liver congestion, liver cirrhosis, hepatocellular carcinoma, metastatic carcinoma, cholangiocellular carcinoma, etc.

　　2, Localized enlargement:Due to intrapulmonary space-occupying lesions, it is seen in liver abscess, liver cyst, liver tumor, liver echinococcosis, etc.

　　Two, Liver hardness

　　Normal individuals with weak physique can feel the edge of the liver and it is soft. Moderate hardness of the liver is seen in hepatitis, liver abscess, schistosomiasis, fatty liver, malaria, and other conditions. The liver texture is hard in liver cirrhosis, advanced schistosomiasis, congestive cirrhosis, malignant tumors, leukemia, amyloidosis of the liver, and syphilis of the liver, etc.

　　Three, the edge and surface of the liver

　　The edge of chronic hepatitis and congestive liver is relatively钝, the surface is still smooth, the edge of liver cirrhosis is sharp, and the surface is nodular.

　　1. Tenderness in acute hepatitis:Acute hepatic congestion, acute cholangitis or biliary colic attack, marked tenderness is evident, and tenderness is more severe during bacterial or amebic liver abscess, mainly localized tenderness. Liver cancer usually has no significant tenderness, and tenderness is mild during chronic hepatitis. Liver cirrhosis, fatty liver, amyloidosis of the liver, and syphilis of the liver generally have no tenderness.

　　2. Jaundice:Common in viral hepatitis, biliary cirrhosis, extrahepatic biliary tract obstruction.

　　3. Weight loss:Liver cancer and liver cirrhosis can be accompanied by significant weight loss.

　　4. Ascites:Seen in liver cancer, liver cirrhosis, acute, subacute fulminant hepatitis, circulatory disorders, etc.

　　5. Spider nevi and liver palms:Seen in chronic liver parenchymal lesions.

　　6. Petechiae: Abnormal coagulation function of the gums is common in severe liver disease, long-term obstructive jaundice, blood diseases, leptospirosis, etc.

　　1. According to traditional Chinese medicine, the decline of physique, drinking, food retention, depression, overeating of greasy and sweet foods, etc., may cause changes in the liver.

　　2. Vegetables are commonly used in people's lives, rich in nutrients, beneficial, and can be eaten regularly. Vegetables are not only rich in vitamins but also contain a large amount of fiber, lignin, organic acids, inorganic salts, and other substances, which are essential nutrients for the recovery process of liver patients.

　　One, blood examination:

　　An increase in white blood cells may occur during bacterial infection or amebic liver abscess, while a decrease in white blood cells may occur during viral infection or hypersplenism. After esophageal variceal rupture, a decrease in red blood cells and hemoglobin may occur due to hypersplenism or folic acid deficiency. Liver cirrhosis, severe hepatitis, long-term obstructive jaundice may cause liver protein synthesis disorder or disseminated intravascular coagulation leading to abnormal coagulation mechanism. Viral diseases can be diagnosed by increased serum antibody titer or positive virus isolation. Diseases such as leptospirosis, syphilis, fungal disease, schistosomiasis, echinococcosis, etc., can be detected by specific antibodies in serum. Diseases such as echinococcosis, schistosomiasis, tuberculosis, etc., can be tested by intradermal tests.

　　Two, fecal examination:

　　Eggs or cysts can be found in the feces.

　　Three, duodenal drainage:

　　Helpful in diagnosing liver enlargement caused by biliary tract infection, pathogenic bacteria can be found in the drainage fluid.

　　Four, liver function tests:

　　1. Test of protein metabolism:

　　①Plasma proteins: Albumin and prealbumin can be used as an indicator for the prognosis of chronic liver disease; an increase in α1-globulin in liver disease usually indicates a mild condition, while a decrease often suggests a severe condition, and liver cancer shows a significant increase; an increase in β-globulin is often accompanied by an increase in lipids and lipoproteins; γ-globulin is normal or slightly elevated during acute hepatitis, and significantly elevated during liver cirrhosis; in liver disease, the increase of alpha-fetoprotein reflects the regeneration of liver cells and is related to the activity of the disease. A positive alpha-fetoprotein is not unique to liver cancer, and increased serum alpha-fetoprotein can also be seen in viral hepatitis, liver cirrhosis, teratoma, gastric cancer, pancreatic cancer, colorectal cancer, pregnancy, and other conditions.

　　② Serum turbidity test: The cerebroside cholesterol flocculation test (CCFE) is an index for diagnosing acute hepatitis and the prognosis of hepatitis. Many other diseases can also show positive and false-positive reactions. The zinc sulfate turbidity test (ZnTT) can differentiate hepatitis and liver cirrhosis, judge the diagnosis and prognosis of chronic hepatitis and liver cirrhosis. The thymol turbidity test (TTT) is not a special liver function test, it can only reflect the degenerative change of liver cells, but the false-positive rate is high.

　　Some of the above tests have been eliminated, but understanding this knowledge still has certain practical significance.

　　③ Ammonia tolerance test: This test has certain diagnostic value for judging whether there is a collateral circulation in patients with liver cirrhosis, but there is a risk of causing hepatic encephalopathy.

　　2, Tests of class:Insulin resistance test is one of the characteristics of glucose metabolism disorders in chronic liver disease; hypoxia of liver cells can block the metabolism of galactose in the liver, which is a special factor of liver disease.

　　3, Lipid metabolism tests:Serum phospholipid determination is significant for differentiating hepatocellular and obstructive jaundice.

　　4, Enzymatic tests:It is an indispensable biochemical examination method in clinical liver disease, which is of great significance for the discovery of liver and biliary diseases, elucidating the nature of the disease process, and defining the intracellular localization of the lesion.

　　① Enzymes mainly used for diagnosing liver parenchymal damage:

　　A, Transaminases mainly include glutamic-oxaloacetic transaminase (GOT), alanine aminotransferase (GPT), and GOT isoenzymes.

　　B, Adenosine deaminase (ADA), its advantage is the diagnosis of acute hepatitis during recovery, assist in diagnosing chronic liver disease, and differentiate hepatocellular jaundice from obstructive jaundice.

　　C, Glutamate dehydrogenase (GDH), can reflect the activity and severity of liver disease.

　　D, Amylase, serum amylase levels increase during acute liver cell necrosis, often parallel to the increase in aminotransferases.

　　② Enzymes mainly used for diagnosing cholestasis:

　　A, Alkaline phosphatase (ALP), used for differentiating jaundice, diagnosing intrapulmonary space-occupying lesions and biliary lesions without jaundice.

　　B, Gamma-glutamyl transferase (GGT), can screen for liver and biliary diseases, assist in diagnosing liver cancer, differentiate obstructive jaundice from hepatocellular jaundice, diagnose acute hepatitis during recovery, judge the activity and prognosis of chronic liver disease, and diagnose alcoholic liver damage.

　　③ Enzymes used for diagnosing liver fibrosis:

　　A, Monoamine oxidase (MAO), the activity of this enzyme can also be altered by other diseases and some extrahepatic diseases.

　　B, N-acetyl-β-glucosaminidase helps reflect the activity of fibrosis.

　　C, Prolyl hydroxylase (PHO), whose activity is parallel to progressive fibrosis.

　　④ Enzymes mainly used for diagnosing liver tumors:

　　A, 5'-nucleotidase, which binds to AFP and is one of the effective methods for diagnosing liver cancer in clinical practice.

　　B. Alpha-1 antitrypsin (ACT), which can be used as one of the diagnostic methods for liver cirrhosis, especially liver cancer.

　　5. Test of bilirubin and bile acid metabolism: The determination of serum bilirubin can understand the presence of jaundice, the degree of jaundice, and the evolution process, reflect the degree of liver cell damage, and judge the prognosis. The qualitative test of urinary bilirubin can detect liver damage early, identify early extrahepatic biliary obstruction, and differentiate jaundice. Serum bile acid can sensitively detect mild liver damage early and can differentiate hepatitis, liver cirrhosis, and intrahepatic or extrahepatic bile stasis with normal liver cell function.

　　6. Test of pigment excretion:The sodium bromosulfophthalein (BSP) excretion test can reflect the amount of liver blood flow and the state of liver cell function. This test is a sensitive indicator for discovering and judging the degree of liver disease. Indocyanine green (ICG) excretion test is the best and most practical dye for testing liver function, safer than BSP, and better than BSP test when applied in chronic liver disease.

　　7. Test of hormone metabolism:Under the condition of excluding endocrine diseases or other related factors, the determination of serum, urine hormones, or other metabolic products can reflect the functional state of the liver. The level of T3 in serum decreases during liver disease, and the corresponding reverse T3 increases.

　　8. Test of vitamin metabolism:Abnormalities can occur in vitamin metabolism and a series of related in vivo biochemical reactions during liver disease. Detecting the state of vitamin metabolism in the body not only has guiding significance for the nutritional treatment of liver disease patients but also helps to understand and recognize the pathogenesis of various clinical manifestations during liver disease. In some cases, it can also be used to judge liver function and assist in diagnosis. The absorption of vitamin E is reduced, and the plasma concentration is decreased during liver disease and obstructive jaundice, but it is not proportional to the severity of liver disease. The determination of blood transketolase can reflect the state of vitamin B1 metabolism in the body.

　　9. Test of drug conversion function:The drug conversion function is consistent with the change of liver synthesis function. For those with decreased plasma albumin, prolonged prothrombin time, and ineffective vitamin K injection, the drug conversion function is also reduced, and its sensitivity is higher than that of plasma protein, bilirubin, and prothrombin time determination. It is similar to sodium bromosulfophthalein excretion and galactose clearance test, but not as good as GPT and indocyanine green excretion test. For patients with mild liver damage, the drug conversion function test is still within the normal range, while moderate or severe liver damage shows a decrease, which is helpful for judging the prognosis of liver disease at this time.

　　Fifth, ultrasound examination

　　Ultrasound can be used in the diagnosis of liver and biliary diseases to measure the position, size, shape, and observe the changes of liver veins, portal veins, and their branches; determine the nature, location, and extent of liver and biliary diseases, confirm clinical impression diagnosis, and solve special problems; it can be used to guide percutaneous transhepatic biliary drainage and liver biopsy under ultrasound guidance; to treat and follow up patients with diagnosed liver and biliary diseases; further verify the results of radionuclide examination, determine the nature and depth of the lesions, the relationship between liver and biliary diseases and adjacent organs, and the diagnostic significance of B-ultrasound for intrapulmonary space-occupying lesions, which can be detected if the diameter exceeds 1cm.

　　Six, X-ray examination

　　1, Chest X-ray:It can determine the position, shape, and movement of the right diaphragm.

　　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 bile ductography:It has diagnostic value for gallbladder lesions or biliary obstruction, but is not suitable for patients with jaundice. At this time, percutaneous transhepatic cholangiography must be performed to clarify whether there is a calculus or tumor obstruction. Its clarity of biliary tract lesions is better than that of endoscopic retrograde cholangiopancreatography, and better than that of excretion contrast, but it is contraindicated when the prothrombin time is significantly prolonged. The effect of duodenal fiberoptic endoscopy for retrograde cholangiography is similar to that of percutaneous puncture.

　　Seven, CT and MRI

　　For the diagnosis of liver cirrhosis, fatty liver, and liver adenoma, MRI is not as good as CT, but for liver cysts and liver hemangiomas, MRI is superior to CT.

　　Eight, Radioisotope scanning

　　It can dynamically observe the radioactive concentration and passage in the liver, bile duct, and gallbladder, and can display the size, location, and shape of the liver, mainly used for diagnosing intrahepatic space-occupying lesions. The blood pool filling has a diagnostic significance for hemangiomas, and it can also assist in distinguishing between intrahepatic bile stasis or extrahepatic obstructive jaundice, which is superior to X-ray hepatobiliary contrast imaging.

　　Nine, Laparoscopic examination

　　It is helpful for the diagnosis and differential diagnosis of various liver diseases, used for confirming hepatitis, hepatitis stage, hepatitis complications; the cause, nature, and degree of liver cirrhosis; the nature, location, and degree of tumor; deciding whether to perform laparotomy, and whether the tumor can be resected; it also has certain help in distinguishing extrahepatic obstruction and intrahepatic bile stasis.

　　Ten, Liver angiography

　　There are methods such as splenic portal venography, hepatic venography, hepatic artery angiography, and umbilical vein portal venography. Splenic portal venography can understand the condition of portal vein system obstruction and measure portal vein pressure, hepatic venography can understand the condition of hepatic venous obstruction, hepatic artery angiography can help in estimating the possibility and extent of liver tumor resection, and MRI can replace some invasive vascular造影 examinations.

　　Eleven, Liver blood flow imaging

　　It is a non-invasive method for examining liver and vascular function, which reflects the liver's blood circulation status by measuring the impedance changes of liver tissue to high-frequency current, and is used to judge the liver function and pathological changes, diagnose and understand the evolution of the disease, prognosis, and outcome. Although the liver blood flow imaging has no specificity for the cause, it is significant in reflecting the degree of liver lesions, and it has certain value in the diagnosis and localization of liver cancer, as well as in the judgment of chronic hepatitis, liver cirrhosis, early portal hypertension, and cardiac liver congestion.

　　Twelfth, Liver Biopsy with Needle Aspiration

　　Its indications are unexplained liver enlargement, which provides reliable scientific evidence for clear diagnosis, judgment of efficacy and prognosis, and understanding the evolution process of various liver diseases. It is contraindicated in severe jaundice, ascites, or coagulation disorders.

　　It is recommended to eat more of the following foods:

　　1. Fungi:Ganoderma lucidum, black fungus, white fungus, mushrooms;

　　2. Leafy Vegetables:Celery, chrysanthemum, amaranth, Chinese cabbage, leek, cauliflower, mustard, spinach, etc.;

　　3. Root and Tuber Vegetables:Bamboo shoots, asparagus, radish, carrot, water chestnut, horsehoof;

　　4. Nuts:Chrysanthemum, hemp, sesame, peas, broad beans, mung beans, corn, buckwheat, watermelon seeds, sunflower seeds, lotus seed heart;

　　5. Aquatic Products:Kelp, nori, green vegetables, seaweed, oysters, shrimp skin, silver fish;

　　6. Animal Products:Milk (skim), pork gallbladder, cow gallstone, honey, vinegar, soy products;

　　7. Fruits:Apples, watermelons, fresh plums, lemons.

　　It is necessary to avoid smoking and drinking, avoid staying up late, avoid overwork, and avoid too much emotional fluctuation in daily life.

　　 1、Treatment

　　There are many causes of liver enlargement, and in most cases, liver enlargement is an important sign of a disease. Therefore, when encountering patients with liver enlargement, one should actively seek the exact cause of liver enlargement and should not rely on the application of certain liver-protecting drugs to restore the liver to normal. If liver enlargement is caused by a single large abscess or cyst, treatment such as abscess or cyst puncture and fluid aspiration can be performed. After aspiration of the pus, antibiotics or metronidazole solution can be injected into the abscess cavity. After aspiration of the fluid from the cyst, a hardening agent such as absolute alcohol or aluminum solution can be injected into the cyst cavity to prevent the cyst wall from continuously渗出液体 into the cavity.

　　2. Prognosis

　　Currently, there is no relevant information