Перечень заболеваний the liver, их симптомы иdiagnostics

Update: October 2018

The liver is an important human organ that is entrusted
quite difficult work in several directions.

  • First, the liver produces bile, which then
    going to the intrahepatic ducts, common bile and on
    some time accumulates in the gallbladder, after which
    is released into the duodenum. Bile helps break down fats.
    In addition, bile acids have a laxative effect and
    stimulate intestinal peristalsis.
  • Secondly, the liver is a laboratory in which it is neutralized.
    many poisons and toxic substances. Blood passing through the liver
    ammonia, phenols, acetone, ethanol, ketone bodies are purified. Here
    the part of vitamins and hormones collapses.
  • Third, the liver plays the role of a warehouse for vitamin B12, A and D,
    glycogen, iron, copper and cobalt.

Еще в the liver синтезируется холестерин и жирные кислоты (см.
обзор гепатопротекторов, лекарств для the liver). In this body can
deposited some amount of blood which if necessary
additionally released into the bloodstream.

Самой маленькой структурной единицей the liver является печеночная
wedge shaped like a prism and about 2 mm in size. Her make up
печеночные балки (ряд сдвоенных клеток the liver), между которыми
are intralobular bile ducts. In the center of the lobule
located vein and capillary. Between the segments are interlobular
vessels and bile ducts.

Today in the world about 200 million people suffer from
hepatic diseases that are among the ten most common
causes of death. Most often, the liver is affected by viruses and
toxic substances. The most popular outcome of chronic
hepatic pathologies – cirrhosis. А вот рак the liver встречается
relatively rare, with oncology metastases of other organs
поражают печень в 30 раз чаще, чем собственно рак the liver.

TOакие симптомы при заболевании the liver требуют наибольшего
attention, only the doctor can decide. Therefore, at the first
suspected hepatic impairment, it is worth referring to
a specialist.

Перечень болезней the liver

  • Гепатит: острое или хроническое воспаление the liver — вирусный,
    medicinal, toxic, due to lack of blood supply
    (ischemic).
  • Cirrhosis: алкогольный, билиарный, постнекротический, при
    hemochromatosis, rare species (against the background of Wilson-Konovalov disease,
    cystic fibrosis, galactosemia).
  • Новообразования the liver: печеночноклеточный рак, метастазы в
    liver, cysts (echinococcosis, polycystic), abscess.
  • Инфильтративные поражения the liver: амилоидоз, гликогенозы,
    жировая дистрофия the liver, лимфомы, гранулематоз (саркоидоз,
    tuberculosis).
  • Functional disorders with jaundice: Gilbert’s syndrome,
    pregnant cholestasis, Crigler-Nayar syndrome, syndrome
    Dubin-Johnson.
  • Damages of the intrahepatic bile ducts: blockage of the bile duct
    duct (stone, scar), inflammation of the bile flow
    (cholangitis).
  • Vascular pathology: congestive liver with heart
    недостаточности и кардиальный цирроз the liver, тромбоз печеночных
    veins, arteriovenous fistula.

Common signs of hepatic abnormalities

Asthenic manifestations

These are the first symptoms of liver disease. Weakness, lethargy,
fatigue, reduced performance, drowsiness – a consequence
нарушения обезвреживания в the liver продуктов азотистого обмена.

Боли в области the liver

Pains in the right hypochondrium and suburbs appear, as a rule, on
background inflammatory or stagnant swelling of the body, in which
its capsule is stretched, equipped with pain receptors. Than
the more tension, the more intense the pain. The nature of the pain – from aching
to blunt pressing constant (hepatitis, cirrhosis,
neoplasms):

  • Sometimes in the first place there is a feeling of spreading and heaviness in
    right upper quadrant (congestive heart failure due to
    circle, cardiac cirrhosis).
  • With cirrhosis of pain – an early sign that appears from the beginning
    diseases.
  • In neoplasms, they grow as the tumor grows or
    cysts.
  • Hepatitis accompanied by more pronounced and constant
    pain.
  • The greatest intensity and brightness of pain stabbing or pressing
    character acquire with lesions intrahepatic bile
    ducts.
  • With their low tone, bile pain syndrome
    provoked by alcohol intake, fatty or spicy foods,
    physical exertion.
  • Blockage of any of the ducts with a stone gives the clinic acute pain,
    which are called hepatic colic.

Dyspepsia

These are disorders in the gastrointestinal tract, they do not have
specific traits in hepatic pathologies and manifest
nausea, bitter taste in the mouth, appetite disturbances, episodes
vomiting, unstable stool. Read more about the causes and
symptoms of dyspepsia.

Jaundice

It is the staining of the skin, the white of the eyes and mucous membranes
(frenulum of tongue) in different shades of yellow. This is a manifestation
directly related to the violation of the transport of bile or exchange
bilirubin. The norm of the level of bilirubin in blood biochemistry: total from 8.5
up to 20.5 µmol per liter, indirect (bound) up to 15.4 µmol per
liter, straight (not connected) – 2 -5.1 μmol / l.

  • Jaundice при повреждениях печеночных клеток носит название
    parenchymal and is characteristic of hepatitis, syndrome
    Dubin-Johnson and other functional disorders. Reason for this
    the kind of jaundice becomes a disturbance of the transformation
    (toxic) bilirubin in indirect. Jaundice имеет лимонный
    shade. In parallel with this, due to the exchange of bile
    pigment urine becomes the color of beer, and feces – light clay. AT
    biochemical analysis of blood will increase overall and direct
    bilirubin.
  • Холестатическая jaundice характерна для нарушения проходимости
    желчных протоков как внутри the liver, так и вне ее. With this stagnation
    bile provokes staining of the skin yellow with a greenish tint.
    mucous and sclera. AT биохимии будет высокий общий билирубин и
    повышен непрямой (связанный) bilirubin.
  • Hemolytic is called jaundice, in which the blood increases
    уровень прямого bilirubin. With Krieger-Nayar syndrome.

Other symptoms

Other manifestations of hepatic diseases are associated with toxic
the action of products that are not completely neutralized by the sick
body.

  • Against this background, itching, insomnia, disturbances may occur.
    of memory.
  • Other symptoms on the skin: spider veins, small
    hemorrhages in the skin – the result of a violation of coagulability.
  • Also characteristic of a number of liver diseases:
    • red palms (плантарная эритема)
    • fatty plaques on the eyelids
    • малиновый лакированный язык на фоне дефицита витамина AT12.

Hepatic Syndromes

При описаниях болезней the liver принято многие их проявления
unite in groups (syndromes). From them, as from the designer, it is possible
to put a picture of those or other liver ailments.

Cytolytic syndrome

Он развивается вследствие повреждений клеток the liver
(hepatocytes), first of all, their walls and cell membranes
structures. This leads to an increase in hepatocyte penetration.
various substances that can be replaced and cell death. TO
cytolysis can be caused by viral, medicinal, toxic
damage starvation. Гепатиты, цирроз, опухоли the liver
accompanied by cytolytic syndrome.

Laboratory criteria for this syndrome – increased transaminases
blood:

  • ALAT, ASAT (more than 31 g / l for women and 41 g / l for men) (LDH
    (more than 250 U / l)
  • bilirubin (by direct)
  • the increase in serum iron (26 μmol / l in women and 28,
    3 µmol / l for men).

Cytolysis activity is described by the De Ritis coefficient
(the ratio of ALAT to AsAT). Its norm is 1.2-1.4. When the ratio is more
1,4 There are severe liver cell damage (chronic
high activity hepatitis, tumor or cirrhosis).

Mesenchymal inflammatory syndrome

Mesenchymal inflammatory syndrome дает представление об
activity of hepatic immune inflammation. TOлиническими
проявлениями синдрома становятся boost temperatures, боли в
joints, swollen lymph nodes and their soreness,
spleen, vascular lesions of the skin and lungs.

Laboratory values ​​vary as follows:

  • total blood protein decreases (below 65 g / l)
  • увеличиваются гаммаглобулины сыворотки (>20%)
  • thymol test exceeds 4 units
  • неспецифические маркеры воспаления (серомукоид >0,24 ед,
    С-реактивный белок >6 мг/л)
  • повышаются в крови специфические антитела к ДНTO, а также
    immunoglobulin fractions.

    • At the same time, an increase in Ig A is characteristic of alcoholic lesions.
      the liver
    • Ig M – for primary biliary cirrhosis
    • Ig G – for active chronic hepatitis
  • in the analysis of blood from the finger, the ESR is accelerated (above 20 mm / hour in
    women and above 10 mm / hour in men).

Cholestasis syndrome

It indicates a stagnation of bile in the intrahepatic
(primary) or extrahepatic (secondary) bile ducts.
Manifestation of jaundice syndrome with a greenish tinge, skin itch,
the formation of flat yellow plaques on the eyelids (xanthelasm),
darkening of the urine, lightening feces, skin pigmentation. AT биохимии
крови повышается щелочная фосфатаза (>830 нмоль/л),
gammaglutamine transpeptidase (GGTP), cholesterol (higher than 5, 8 mmol / l),
bilirubin (due to indirect). AT моче растет количество желчных
pigments (urobilinogen), in feces falls or disappears
stercobilin

Portal Hypertension Syndrome

Он характерен при циррозе или опухолях the liver, как результат
blood flow disturbance in the portal vein. It can also lead to
токсические поражения the liver, хронические гепатиты, паразитарные
lesions and vascular pathologies. Portal hypertension passes 4
stage.

  • The initial manifests appetite disorders, abdominal distention,
    pains in the upper abdomen and right hypochondrium, unstable chair.
  • Moderate hypertension gives an increase in the spleen, the initial
    manifestations of esophageal varicose veins.
  • ATыраженная присоединяет к себе накопление жидкости в брюшной
    полости (асцит), отеки, bruises on the skin.
  • Complicated by bleeding from the esophagus and stomach,
    disorders in the stomach, intestines, kidneys.

Syndrome of hepatocellular failure

It is characterized by dystrophy or replacement by connective
tissue of liver cells, the fall of all hepatic functions. AT
The clinic of this syndrome appear:

  • boost temperatures
  • weight loss
  • jaundice
  • bruises on the skin
  • red palms
  • lacquered raspberry tongue
  • spider veins on the chest and abdomen.
  • due to changes in the exchange of sex hormones in women appears
    excess hair growth, menstrual disorders, atrophy
    mammary glands, uterine involution
  • men suffer from gynecomastia, testicular atrophy, disorders
    libido

In the blood protein decreases due to the fall in albumin, prothrombin
(ПТИ<90%), падают факторы свертываемости, холестерин, растут
bilirubin (by direct), AlAT, AsAT, hepatic enzymes.

Acute and chronic liver failure

As a rule, this term implies a large hepatic
deficiency in which, in addition to hepatic insufficiency
cells (hepatocellular failure syndrome) is present and
damage to the central nervous system by ammonia, phenols, which
called hepatic encephalopathy. When this is noted
sleep disorders (sleeplessness at night and sleepiness during the day), memory,
hand shake, inaccuracy of movements.

Causes of acute liver failure are lesions.
liver poisoning (paracetomol, toadstool of the toadstool),
viral and autoimmune hepatitis, Wilson-Konovalov disease,
acute fatty liver disease in pregnant women. Chronic Hepatic
failure – the outcome of cirrhosis or tumor, as well as vascular
pathologies of the liver. It is divided into four stages.

  • Compensated failure – manifested by violations
    sleep rhythm, unstable mood, decreased motor
    activity. Celebrated лихорадка, jaundice, спонтанные кровоизлияния
    into the skin.
  • Severe or decompensated deficiency manifests
    increase of all manifestations of the first stage. Celebrated
    inadequacy, sometimes aggression, alternating drowsiness and
    disorientation, slow speech, pronounced tremor. Appears
    hepatic smell from the mouth.
  • The terminal or dystrophic phase is drowsiness,
    depression of consciousness, difficulties with awakening, which
    accompanied by anxiety or confusion. Broken
    patient’s contact with others, but pain sensitivity
    persists.
  • Hepatic coma – loss of consciousness, individual movements and reaction
    to pain that disappears as the coma develops. Divergent
    strabismus, lack of reaction of pupils to light, convulsions. Probable
    death.

Read more about liver failure.

On the activity of certain enzymes

Enzymes determined by biochemical analysis of blood can
tell in which direction to search for liver diseases.
So, gammaglutamintranspeptidaza (GGTP) is very characteristic increases
with steatohepatitis. AlAT – with chronic viral hepatitis, and
AsAT – with alcoholic lesions.

Alkaline phosphatase is characterized by the following changes.

3 times magnification 5 times magnification 10 times magnification 20 times magnification
  • Acute alcoholic hepatitis
  • Acute viral hepatitis
  • Acute fatty liver
  • Cirrhosis
  • Postnecrotic cirrhosis
  • Stones in the bile ducts
  • Primary biliary cirrhosis
  • Liver cancer or liver metastases
  • Drug hepatitis

Manifestations of liver disease

Disease Manifestations Laboratory tests
Acute Drug Hepatitis Beginning in 2-8 days from taking the drug (isoniazid,
paracetomol, methyldof, atenolol, rifampicin, niacin, ketoconazole).
The clinic is similar to acute viral hepatitis.
Similar to acute viral hepatitis.
Chronic drug hepatitis More often in the elderly with long-term administration of clofibrate, isoniazid,
sulfonamides, chlorpromazine, paracetamol. Scanty symptoms:
dull pain in the right hypochondrium, decreased motor activity,
увеличение the liver, умеренная jaundice.
  • Холестатический тип: АлАТ/АсАТ<2, щелочная фосфатаза
    increased, AlAT is the norm.
  • Hepatocellular variant: increase in ALT,
    АлАТ/АсАТ>5.
Acute viral hepatitis А From the moment of infection to the clinic 14-45 days:

  • Predictum period (intoxication, headache, malaise,
    может быть подъем temperatures, боли в подреберье, тошнота, рвота,
    unstable chair) Less often – joint pain, nasal bleeding.
    Always – liver enlargement.
  • Желтушный период – jaundice, плотная большая болезненная печень,
    may be itchy skin, enlarged spleen. Dark urine, light
    feces
  • Post-yellowing period
  • Slow normalization of liver size and function
    from a month to six months.
The increase in AlAt is greater than AsAT, the increase in total and direct
bilirubin, alkaline phosphatase.
Viral hepatitis E The incubation period is from 40 to 60 days. The clinic is similar
hepatitis A.
Similar to hepatitis A
Chronic viral hepatitis B The incubation period is 1-6 months.

  • Asteno vegetative syndrome (weakness, fatigue)
  • Dyspepsia (nausea, flatulence, bloating, unstable stool)
  • Dull pain in right hypochondrium
  • There is no jaundice, there is subictericity (slight yellowness of the skin and
    sclera)
  • Hemorrhagic syndrome (bruises, nosebleeds)
  • Palmar erythema, spider veins – in half
    the sick
  • Enlarged liver and spleen
  • Increased AlAT, markers for hepatitis (HBv)
  • Minimum activity – AlAT and AsAT increased by 2 times
    bilirubin, thymol test normal
  • Низкая активность – АлАТ больше нормы в 2,5 times повышен белок
    and gamma globulins
  • Moderate activity – ALAT more than 5-10 times, increased overall
    белок and gamma globulins
  • ATысокая активность –АлАТ > в 10 раз, высокий белок,
    thymol test, reduced PTI and sublimate test.
Chronic viral hepatitis C The long latent weak symptom course with the subsequent rough
increasing symptoms and outcome in cirrhosis or carcinoma.
Similar to hepatitis B
Acute alcoholic hepatitis
  • Jaundice: pain in the side, fever, dyspepsia, rejection
    еды, падение веса, умеренная jaundice без кожного зуда.
  • Cholestatic variant – cholestasis syndrome, proceeds more
    hard than jaundiced option.
  • The latent variant flows hidden, manifested by an increase in the liver
    and dyspepsia.
Увеличение АсАТ>АлАТ, увеличение ГГТП
Chronic alcoholic hepatitis Weakness, lack of appetite. Enlarged liver. У 30% the sick
– cholestasis syndrome
АсАТ>АлАТ
Liver steatosis Nausea, vomiting, dyspepsia, pain in the right hypochondrium, increase
the liver
Increased AsAT prevails over ALT, Increased GGTP
Cirrhosis Hepatic cell failure syndrome, encephalopathy,
portal hypertension syndrome
Увеличение билирубина, ГГТП, АсАТ>АлАТ, падение тромбоцитов,
decrease in PTI, increase in gamma globulins.

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