The liver is one of the largest and most important functional organs of the human body. So it is a large digestive gland, as it produces bile, necessary for digestion, and performs the following functions:
- function of hematopoiesis;
- synthesis of
- metabolic proteins.
The liver is in some way an indispensable organ, it is very important for a poet to know the signs of liver disease so that they can be identified and taken as soon as possible to treat this pathology!
- Complaints of the patient
- External signs of liver disease
- Signs obtained with palpation and percussion of the liver
- Laboratory test data
What are the clinical symptoms that indicate the pathology of this organ?
Complaints of the patient
First and foremost, complaints of patients are signaled about liver disease. So patients suffering from hepatic pathology will complain about:
pain and feeling of heaviness in the right hypochondrium - pain syndrome. For example, with cirrhosis and hepatitis, it is blunt or bursting, increases after eating. Gallstone disease is accompanied by a sharp, paroxysmal pain, which radiates into the collarbone, scapula. Dyskinetic disorders are accompanied by spastic or burgeoning pain;
- decreased appetite, bitter taste in the mouth, nausea and vomiting - hepatic dyspepsia syndrome occurs in all pathological conditions of the hepatobiliary system;
- abdominal enlargement - abdominal syndrome is a pathognomonic sign of cirrhosis and portal hypertension.
- yellowing of the skin and eye sclera - icteric syndrome occurs with all liver diseases, but has its own characteristics, which are caused by the type of jaundice.
- appearance of bruising and bleeding gums - hemorrhagic syndrome, which develops due to a violation of the protein-forming function of the liver, is characteristic of cirrhosis, hepatitis.
- general weakness, irritability, sleep disturbance, decreased ability to work - asthenoneurotic syndrome is common to all liver diseases.
- strong weight loss - a cachectic syndrome is one of the characteristic signs of oncological pathology of the liver. If this syndrome arises, surgical treatment of liver cancer should be carried out immediately to prevent the development of stage 4 with extensive metastasis!
- increase or decrease in temperature - hypo - or hyperthermia syndrome - is a sign, primarily inflammatory processes in the liver and bile ducts.
External signs of liver disease
During an external examination, it is possible to detect very specific signs that will help in the differential diagnosis of underlying liver diseases.
The most frequent sign is jaundice, so when hemolytic jaundice, the color of the skin and the sclera of the eyes will have a lemon color, with parenchymal jaundice the orange-red color predominates, while the mechanical color is accompanied by the appearance of a yellow skin with a greenish tinge.
The second sign is the so-called "hepatic signs":
vascular sprouts - telangiectasia up to 1 cm in size, arising from hepatitis and cirrhosis;
xanthomas - cholesterol deposits under the epidermis of the skin on the eyelids, in the corners of the eyes;
xantelasm is an oblong form of elevation on the skin of a brownish color;
"hepatic" palms with flushing of the skin in the area of the thumb.
Hemorrhagic syndrome will be manifested by petechial rash, a large number of ecchymoses, bruises on the skin.
Cirrhosis of the liver is manifested by a combination of specific signs such as ascites or "frog stomach", "jellyfish head" - varicose veins of the abdomen, parchment for a set of strong thinning and atrophy, "bald" abdomen - baldness of the abdominal region in men.
Liver cancer during examination will be determined by abdominal asymmetry due to the presence of a tumor process in the liver.
In liver failure, in addition to the above symptoms, there is such a characteristic sign as a "liver odor" from the mouth, reminiscent of the smell of meat with signs of decay.
Signs obtained by palpation and percussion of the liver
In hepatitis during palpation, a thick and dense liver texture is determined. About cirrhosis will testify to the pointed, rather dense and painful edge of the organ, which is significantly enlarged in size. Hepatoses, amyloidosis can be differentiated during palpation of the liver by such signs as a tauto-elastic consistency, painlessness and roundness of the edge.
Laboratory test data
To determine the type of liver pathology, it is mandatory and extremely important to conduct functional tests that will help to reveal some additional and very specific signs of hepatobiliary system damage:
test with galactose load, which consists in taking40 grams of galactose in 200ml of water on an empty stomach with the subsequent determination of its level in the urine. With parenchymal lesions of the liver this carbohydrate does not recycle, it appears in the urine, and in the blood there is an increased sugar content.
- protein samples( thymol, sulemic), which also indicate the presence of parenchymal liver damage. They are based on the appearance of sediment in the blood plasma after the addition of electrolytes to it, which is associated with developed disproteinemia, increased content of globulins, and a decrease in albumins;
- Quinck-Pytel assay helps to determine the degree of disruption of the detoxifying function of the liver by the level of the isolated hippuric acid. A decrease in this indicator indicates cirrhosis or liver hepatosis;
- determination of the level of AST( aspartic transaminase), ALT( alanine transaminase), lactate dehydrogenase, gamma-glutamyltranspeptidase, alkaline phosphatase. So the increase in activity of alkaline phosphatase is observed with cholestasis, but the increase of AST, ALT speaks about the cytolysis of hepatocytes and the development of cirrhosis;
- determination of trace elements, for example, iron, the level of which increases with hepatitis, or copper, increasing this element indicates a mechanical jaundice;
- definition of pigmented metabolism, that is, the calculation of the level of bilirubin( direct, indirect, general) is very highly informative in determining the type of jaundice. For example, hepatic jaundice is accompanied by an increase in total bilirubin due to its direct fraction, the appearance of urobilin in the urine, and stercobilin in the stool is small. Mechanical jaundice is characterized by a complete absence of urobilin, stercobilin and an increase in total bilirubin due to a direct fraction. But superhepatic jaundice is accompanied by the growth of indirect bilirubin, a high content of urobilin in the urine and stercobilin in the feces.
These are the main signs of liver disease that help to recognize it at the initial stages, to prevent the development of such severe conditions as cirrhosis and hepatosis of the liver. And early diagnosis is very important, since the treatment of liver hepatosis and cirrhosis is very difficult and has low effectiveness!