Enlarged liver with diffuse changes in the parenchyma. Enlarged liver – to treat or not to treat? What are the signs of hepatomegaly?

Liver - important organ human body, and if it does not work correctly, this may cause serious pathologies, especially if the child’s liver is enlarged. The organ may suffer from poor nutrition, low-quality products, due to excess fat, alcohol consumption, and lack of physical activity. But for what reason can a child have an enlarged liver?

What are the signs of hepatomegaly?

Another important diagnostics image is scintigraphy. In this test, a small amount of radioactive substance is injected into the bloodstream. This substance accumulates in neuroblastoma cells. Using a special tumor dislocation chamber in the bone marrow, bones, The lymph nodes, liver or brain can be made visible.

Why does a child's liver become enlarged?

Another goal is to stage and describe the size and location of any remaining tumor. Treatment for neuroblastoma usually occurs in the context of a study for children, children, and adolescents with neuroblastoma. This is the “treatment plan” under which more than 80 children's hospitals in the federal territory and in Switzerland are continuing. One of the first steps in therapy is surgical removal tumors. If surgical removal unsuccessful, one must be satisfied with the removal of a small piece of tissue for microscopic and molecular genetic examination.

1 Etiology and pathogenesis

Causes and symptoms of hepatomegaly:

• polycystic disease;
• hepatitis - viral or drug-induced;
• vascular congestion;
• tumors;
• cirrhosis;
• infiltration.






Based on these medical data, classification is carried out as an observation patient, a patient with high risk or high risk patient. While observant patients may initially wait, risk and high-risk patients always receive chemotherapy. The purpose of this is to make the tumor functional and cause any existing colonies to disappear. Chemotherapy consists of 6 blocks and lasts about 5 months. Some of the high-risk patients also receive so-called megatherapy, which works with particularly high doses of drugs and blood stem cells received by the patient.

With an enlarged liver, the patient experiences discomfort, and heaviness is constantly felt on the right side under the ribs; this may be accompanied by heartburn, nausea and belching. The patient's skin acquires a yellowish tint.

If hepatomegaly is observed in a child, then contacting a doctor should be done immediately, because this phenomenon contributes to the very rapid occurrence of hepatitis. Even with a favorable cure for this disease, as an adult, your child will experience problems and discomfort in the liver.

More recently, this procedure was called autologous transplantation bone marrow. However, megatherapy is generally associated with more serious side effects than chemotherapy, and its effectiveness in patients with neuroblastoma has not been established. The purpose of this study is scientific basis how megatherapy is beneficial for high-risk patients. In another part of this group of patients, chemotherapy will be continued in a modified form for 3 months instead of megatherapy. The use of "Mega Therapy" or "Continuing Chemotherapy" is randomized and centralized.

2 Possible diseases

It is impossible to determine the causes of liver enlargement on your own, so it is very important to consult with a specialist, but parents should know that hepatomegaly can signal the following diseases:

• there are inflammatory processes in the body;
• there is a pathology of metabolic processes;
• the liver is affected by drugs;
• there are congenital TORCH infections;
• the functions of the pathways that remove bile are impaired;
• there is a tumor.

If in newborns or an older child hepatomegaly is accompanied by an increase in temperature, a vascular network, the mucous membrane and sclera of the eyes become yellow, rashes appear on the skin, nausea appears, he loses weight, then he needs consultation with an infectious disease specialist, hepatologist or gastroenterologist. Most likely, you will need to undergo tests and an ultrasound.

Consequences and prognosis

However, parents can reject the result and make their own choice. Subsequently, high-risk patients will receive anti-therapy. This should influence the body's immune system so that it can deal with any residual tumor that may still be present. Immunotherapy consists of 6 cycles of 5 days every two months and is spread over a total of 1 year. Side effects are a pain, but they can be treated accordingly and allergic reactions. Radiation therapy is intended only for special situations and will therefore only occur in the youngest patients.




3 Diagnostic measures




Based on all the tests, the doctor will conclude why the child’s liver has enlarged, and then he will prescribe complex treatment to eliminate the cause, because the passion of the organ itself is only external manifestation diseases.

To monitor the effectiveness of treatment and promptly counteract side effects, blood, bone marrow, ear, heart, x-ray, ultrasound and further tests are required at certain intervals. All elements of therapy can sometimes have significant side effects. Side effects.

Complications of surgery depend on the extent of surgery and the location of the tumor. Common dangers exist with bleeding and infection. Side effects of chemotherapy. Due to their growth-inhibitory effect, cytotoxic drugs interfere with the production of “normal” cells in the body. The dangers are mainly temporary hair loss, nausea, vomiting, damage to the oral mucosa, irritation Bladder, kidney damage, heart and blood dysfunction, which means whitening, bleeding and infection.

4 Necessary measures

Liver disease in children is more severe than in adults because vitality and they have less immunity. When the liver of a baby is enlarged, this phenomenon is called newborn jaundice; it could be caused by injuries at birth, diabetes, or work disorders in the mother. endocrine system. Neonatal jaundice may result from sharp increase bilirubin in the blood or if large quantities red blood cells died. This condition of the child goes away quite quickly, in about two weeks with breastfeeding. No treatment required.

Symptoms and diagnosis of hepatomegaly

The following lists some cytotoxic drugs with their specific side effects. Adriamycin may attack the heart muscle, especially in high doses. During usual dose No significant damage to the cardiac muscle is expected. However, to detect heart muscle abnormalities early, cardiac function is regularly monitored using an echocardiogram. During and after the infusion, the urine may turn red.

Both substances can damage kidney tissue. First of all, cisplatin can also attack inner ear. Recognized when listening minor damage inner ear, which is not noticeable in everyday use. During the cisplatin infusion, the patient should not be subject to any major hearing burden, for example. For example, don't you hear loud music through headphones. Besides, severe nausea often observed during and also several days after cisplatin.

An enlarged liver in a child under 7 years of age is, in principle, considered normal process, when the child gets older, it is likely that the organ will accept regular sizes. Only a doctor can determine pathological changes liver, self-diagnosis unacceptable.

Treatment of liver diseases in children and newborns is prescribed differently, it depends on the reason for the involvement of the organ, the age of the child and his general condition. Younger and older children, just like adults, are prescribed drugs that have high efficiency, but are low-toxic and do not lead to side effects from other organs and systems:

There is irritation of the bladder mucosa or inflammation. They can be recognized by the slight red coloration of the urine. As a precaution, a bladder protectant is used. Kidney damage can also be seen as electrolytes are lost. Confusional states are very rarely observed with ifosfamide.

Allergic reactions may occur during infusion. In high doses, the skin may be attacked. These substances may primarily attack peripheral nerves. The first symptoms are the disappearance of muscle reflexes, then tingling and muscle weakness. Most symptoms are retroactive after stopping the drug. Constipation and urinary retention are also observed. Chemotherapy treatment is known to be associated with a low risk of further tumor disease or leukemia. Very little is known about the decline in fertility after chemotherapy in childhood, but this cannot be ruled out.

1. 1. Ovesol - this drug contains oat extract, turmeric, peppermint and other herbs that help cleanse the liver of toxins. Treatment with this drug is prescribed for organ enlargement in children.
2. 2. Karsil - this herb can be used to treat various diseases liver.
3. 3. Essentiale is a drug that can restore liver cells in severe conditions when the organ is damaged by cirrhosis or hepatitis.
4. 4. Hepatomin - it is used when the disease is treated with antibiotics to reduce the side effects of the latter.
5. 5. Ursofalk - used for toxic lesions organ and with its enlargement.

Also written out enzyme preparations, for example, Mezim, to facilitate activities gastrointestinal tract. All of these drugs support liver function, with serious illnesses stronger drugs may be prescribed.

It is not advisable to treat liver problems in children with folk remedies. desired effect it is impossible to achieve in these ways, but to provoke unwanted complications And severe consequences- quite possibly. Folk remedies can be used as complementary therapy, and only with the permission of the attending physician.

And a little about secrets...

A healthy liver is the key to your longevity. This body performs great amount vital functions. If the first symptoms of a gastrointestinal or liver disease have been noticed, namely: yellowing of the sclera of the eyes, nausea, rare or frequent stool, you simply must take action.

Detection of changes in the size of the liver (regardless of the degree of deformation) should alert the baby’s parents. Even minor deviations from the norm can cause harm children's body. The list of reasons why a child’s liver may be enlarged is quite wide. At the first manifestations of unfavorable symptoms, it is necessary to consult a doctor to determine the causes and create a further therapeutic course.

An increase in liver size in children most often occurs between the ages of 5 and 7 years.

Pathology in children of different age groups

general characteristics

Hepatomegaly - pathological increase liver (in some cases, spleen). Similar condition can develop regardless of attachment to age group. The size of the organ can be deformed in both a newborn baby and an adult. But the development of hepatomegaly in newborns and children under 14-16 years of age differs from a similar process in adults. Pediatricians say that development pathological process is not uncommon among children and often gives a positive prognosis (if timely treatment was prescribed).

Pathology can develop due to the right and left lobes of the liver. Deformation of the left lobe indicates the presence infectious agent in the pancreas (in this case, damage will be caused to the spleen, liver and gall bladder). The right lobe is more often subject to hepatomegaly, due to its greater functionality (about 60%). Any disturbances in the body can contribute to an increase in right lobe organ.

Age characteristics

Liver enlargement in newborns is often caused by jaundice, the symptoms of which subside within 2 weeks.

Hepatomegaly is most often diagnosed in children aged 5 to 7 years. It is at this age that the most significant changes, which are diagnosed as moderate hepatomegaly. In this case, the need for diagnostic and therapeutic measures is eliminated. Needs to be supported normal condition child and conduct routine examinations of the whole body.

Development of pathology in older children age category indicates serious problems with the liver, spleen, pancreas and other organs. The danger of the pathology lies in the unfavorable symptoms and possible harm for the body ( pain syndrome, pigmentation, different kinds changes in the epidermis, vascular problems, nausea/vomiting, a sharp decline immunity).

Hepatomegaly is also typical for newborn infants. Changes can be triggered by the development of jaundice. At proper care The disease is easily tolerated by the baby, and unfavorable symptoms disappear within 14 days.

The first thing to do if unfavorable symptoms develop is to seek medical help. Why? Timely diagnosis pathology increases the chances of its speedy and effective cure.

• gastroenterologist;
• hepatologist;
• infectious disease specialist;
• nutritionist.

Diagnostics

Primary diagnosis is based on the patient's complaints and palpation of the inflamed area of ​​the abdomen. Before you do lab tests or conduct an ultrasound scan, it is necessary to collect information about the patient’s donation, the presence of other pathogenic symptoms, contacts with infected individuals.

Then it is carried out visual inspection skin. The specialist checks the presence of rashes and the color of the dermis. Possible methods diagnostics:

• general blood analysis;
• blood chemistry;
• Ultrasound (ultrasound examination);
• MRI (magnetic resonance imaging).

A blood test is performed to determine the general condition of the body and identify associated pathologies. Ultrasound and MRI are done to determine the location and size internal organs(the procedure reveals deviations of several cm, which is fundamental for diagnostic accuracy) and visualization of the data obtained.

Treatment

Treatment of hepatomegaly is complex and consists of several main components:

• conservative treatment;
• diet;
• immune-strengthening loads;
• subsequent prevention.

You can stop abnormal liver enlargement in a child by strengthening the immune system, diet, and controlling exercise.

One of the components of the therapeutic course is treatment of the root cause (this may be infection, psycho-emotional disruptions, etc.). It is necessary to change the child's diet by introducing special diet to deliver the required substances to the body to combat pathology.

Conservative therapy

Purpose medications differs for each specific case. The doctor prescribes the necessary medications and recommends an individual therapeutic course for each patient separately. Instructions are given regarding general strengthening immune system(in some cases, without prescribing special means). Parents must strictly adhere to medical recommendations so that the treatment brings benefits and does not cause additional harm.

Hepatoprotectors are often prescribed. Medicines that provide double action- medicinal and protective. The following drugs are prescribed:

• “Galstena”;
• “Legalon”;
• “Hepel”;
• "Essentiale".

Some of the medications presented above have age restrictions. Babies who have not yet turned 1 year old are prohibited from taking the above medications. Their treatment must be formulated most carefully so as not to harm the unformed organism.

Diet

• Enter fractional meals. The child should eat small portions at regular intervals 5-6 times a day.
• The last meal should take place no later than 19:00, in order to avoid overloading the body.
• It is necessary to monitor the baby's portion so that he does not suffer from overeating.
• It is recommended to eat food cooked steamed, in the oven or without heat treatment.
• Introduction of principles healthy eating with the exception of “food waste”.
• The duration of the diet is determined by the attending doctor based on the individual indicators of the body.

Traditional medicine

Any manipulations must be coordinated with the treating doctor. If your doctor approves the use of one of the methods traditional medicine, then it is necessary to strictly adhere to the recommendations regarding the dosage and frequency of use of such therapy.

Complications

Impaired liver development in children entails a risk of developing cancer.

• liver failure;
• development of oncological tumors;
• development of additional infectious processes V various parts body;
• inhibition of the protective function of the immune system and natural microflora, which leads to an increased risk of infection.

Forecast

The prognosis is made based on the baby’s individual indicators, the condition of the internal organs (size in cm, location, functionality), and the rate of development of the pathology. Hepatomegaly is a treatable pathology. A favorable prognosis is given if you consult a doctor in a timely manner and receive the necessary medical care. The prognosis of the disease will change for the worse if there are additional inflammatory processes, complications, lack of medical and parental care. In this case, everything depends on the speed of reaction of the parents and their responsibility for the health of their own child.

Preventive measures

Is it possible to protect a child from liver enlargement? Parents can carry out regular preventive manipulations to avoid causes of organ enlargement (other than physiological ones). If a child is diagnosed with various pathologies, weak protective function immunity, ambiguous reaction to preventive manipulations, it is recommended to coordinate the entire course with a pediatrician.

• Provide timely medical care and diagnostics for the baby.
• Enter a special diet. The diet involves giving up unhealthy (excessively carbohydrate, fatty, smoked, etc.) foods and switching to healthy (protein, fiber-containing) foods.
• Give your child time to rest (give the child feasible tasks, ensure the right to rest when needed).
• Enter dosed physical exercise(exercises, sports sections) to strengthen the child’s body.
• Carry out constant preventive therapy for getting rid of helminths.
• Do not self-medicate to avoid harm to the body.
• Carry out ongoing diagnostics of all systems. If you have had problems with liver enlargement, learn how to perform independent palpation (to feel an increase of several cm) or conduct routine examinations with a doctor. Table with indicators normal size liver in cm is given above.