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hepatomegaly

   
[Intro]

hepatomegaly caused by many diseases, is an important clinical signs. Normal liver size of the upper and lower diameter 25 cm x 15 cm x diameter anteroposterior diameter of 16 cm. The average adult male citizens of the liver weight 1342 g, female 1234 s, about weight l is 0, the fetus and newborn than adult liver relatively large weight about 1 / 20. Normal liver dome on the boundary line with the implicit, from the right axillary line at the 7th rib to the right subclavian central line level 5 rib, and then to the left after crossing the midline before the sternal body and xiphoid junction, to the left subclavian slightly inside the middle fifth intercostal space level, the lower bound of the liver consistent with liver edge, the right axillary line starting at the 11th rib, along the lower edge of the right costal arch costal cartilage tip to 9, left chest bow, oblique to the left of the xiphoid under the following previous midline beyond the xiphoid about 3cm. Liver position and gender, age, body related, can be with the breath, visceral activities and position of the different changes that occur to some extent, standing and inspiratory decrease and expiratory increase in supine position, in quiet breathing movements of the difference of about 3 cm, 5-year-old children, more water, dinner, evening, exercise, high altitude for more than 2 months of life of people, In the costal margin l-2 cm, the liver can often be touched, sharp edges, the more quality, no tenderness. Sometimes help is not due under the touch of liver hepatomegaly, but because of the location of the liver down, this can be found in the abdominal wall relaxation by the middle of women who were singing or playing too well-developed diaphragm movement. Emphysema, pleural effusion, large, axillary abscess. Sometimes gallbladder enlargement, transverse colon cancer, pancreatic, stomach, right kidney ptosis, water right kidney, right renal cyst, pheochromocytoma, also can be mistaken for hepatomegaly, but respiratory mobility of the liver as large as the edge clear the liver, it should be combined with a history of liver location, shape, texture. Breathing mobility, tenderness and any other test results to determine the pathological hepatomegaly.

[Cause]

balanitis is caused by what the?

(a) causes

by a variety of different causes of acute and chronic inflammation, such as phimosis, wound , local physical factors such as irritation and infection factors.

(B) the pathogenesis

local factors, physical factors such as irritation and infection, causing acute and chronic inflammation of the glans mucosa.

[Sign]

What are the early symptoms of balanitis?

common are the following:

1. Acute superficial balanitis (acute superficial balanitis) is the glans acute inflammation, usually due to trauma, friction, soap, cleaning agent caused local irritation. Mainly localized edema, erythema, erosion exudate, can occur in severe blisters and bullae. After the formation of secondary bacterial infections ulcers and purulent discharge. The symptoms may be local friction, the foreskin turning bad, accumulation of secretions, leaving the wound to stimulate inflammation. Conscious pain and tenderness. Significantly by localized inflammation, may be associated with mild symptoms.

2. erosive balanitis ring (circinate erosive balanitis) has two types of clinical manifestations. One is an early manifestation of Reiter's disease; other is persistent, recurrent balanitis, with circular or ring damage. At the beginning of the glans and foreskin erythema, and gradually expanded in a ring or ring, after the formation of superficial ulcers. Flip bad person because the foreskin in the local accumulation of secretions, often leaving symptoms secondary to infection, loss of the ring features the difference is not easy and superficial ulcers.

3. candidal balanitis (candidal balanitis) Candida balanitis can be primary, but also for the secondary. Which is often secondary to diabetes, wasting disease and age of antibiotics and hormone therapy after. Clinical manifestations of erythema, smooth surface, the edge of mild scaling and satellite distribution of mound-like herpes and small pustules, slowly expanding to the surrounding, state general clear. Groin may also be involved. Acute attack of glans mucosa edema, erythema, state is not clear, may have erosions, exudate. Lesions can be found in Candida microscopy and culture. Repeated episodes of Candida balanitis, circumcision can cause dry, fibrosis and sclerosis change.

4. plasma cell balanitis (plasma cell balanitis or plasma cell balanitis of zoon) inside of the foreskin and the glans is a chronic inflammation with plasma cells. Only to state clearly the number of inflammatory erythema, moist and shiny surface, sometimes accompanied by erosion and spotting. Looks like the varnish is not dry, the surface seems kind of small chili powder spots. Biopsy shows epidermal atrophy, disappearance of the stratum corneum and granular layer, the dermal papilla large number of plasma cells, telangiectasia, have hemosiderosis.

5. mica-like and keratotic balanitis false epithelial tumors (micaceous and keratotic pseudoepotheliomatous balanitis) occur in the elderly, more than a circumcision surgery. Performance appear on the glans covered silver mica-like scales of verrucous vegetation, like psoriasis-like lesions, chapped and ulcers can form, the affected area gradually loses its elasticity, the course of time showed atrophic changes. Histopathology showed epidermal hyperkeratosis, parakeratosis, was false tumor-like epithelial proliferation, acanthosis, chronic inflammatory cell infiltration in the upper dermis.

In addition, amoeba, Trichomonas infection may also cause balanitis. Amebic balanitis come from intestinal amebiasis, trichomoniasis balanitis have sexual intercourse with women infected with trichomoniasis history and so on. Secretions can be found in amoeba or trichomoniasis.

based on clinical manifestations, skin lesions characteristic pathological characteristic can be diagnosed. By laboratory tests and pathological features of diagnostic classification.

[Aftertreat]

balanitis ate?

balanitis diet (The following information is for reference only, details need to consult a doctor)

1. loofah 1, rice 50g, sugar amount. The first until half cooked porridge, porridge to be cooked into the gourd to gourd sugar, eating porridge, can detoxification, cooling carbuncle.

2. mung bean 50g, rice 100g, a total of porridge, to detoxify and eliminate edema.

3. melon drink: soft melon (about 500g) 1, washed with Green Peel and cut into pieces, add water, a little salt, spices, cooked food, there is clearing away heat effect.

4. Chixiaodou 50g, rice 500g, porridge, to detoxification benefits of water swelling.

5. trotters four wash, add onions 50g, salt amount, into the pot simmer and cook until Shulan Chinese, sub-Dayton meat soup, a detoxification swelling of the effect.

6. fresh cedar leaves 250g, washed, chopped, transfer batter and a little salt, vegetable oil 500g, pan, put oil in the paste, fried yellow fishing out, eat. To heat and dampness, detoxification swelling.

balanitis patients what to eat for good health?

in the diet should be light, fresh vegetables and fruits.

balanitis patients to eat what is bad for your health?

1, Jishi irritating foods: such as pepper, mustard and so on.

2, cigarettes and drinking habits should quit.

[Prevent]

hepatomegaly should be how to prevent?

prevent exercise-induced hepatomegaly, the first increase in the amount of exercise should be gradual to avoid Yibaoshihan or anxious. After exercise, "hepatomegaly" phenomenon, generally not more common in peacetime training and lack of comprehensive training of people. Second, the movement to make full preparations before the activity, mobilization of cardiovascular function, in order to reduce the resistance to venous return, reduce acute liver congestion. Finally, the movement to pay attention to rhythm, the pace of breathing and coordination, try to make some deep breathing to reduce the hepatic venous pressure.

[Treat]

treatment of osteosarcoma Notes?

1. population in the primary prevention of osteosarcoma incidence of malignant bone tumors account for 1 or 2, and a high degree of malignancy, the patient's quality of life and life great harm, it should pay serious attention. The earliest symptoms of the disease is persistent pain, then disease may continue for some time, many patients will always be interpreted as pain around the joint sprain, until the occurrence of persistent pain or palpable mass party to seek treatment. Therefore, people should focus on preventing the spread of knowledge, so that people increase their knowledge and understanding of osteosarcoma, vigilance. Sanitation, health care quality improvement is the early detection of security, and crowd the popularization of knowledge is the basis for early detection. It should be stressed that young people found no significant injuries around the knee pain, early should go to a certain level of hospital, in order to facilitate early detection and early treatment, improve survival, the people, self-serving.

2. individual prevention

(1) primary prevention: early disease may not have symptoms, the earliest symptom is often pain. Once the pain, especially without a clear history of trauma, treatment of these young people should be checked as soon as possible. The disease may occur with some external stimuli, such as X-rays. Therefore, to avoid exposure to these risk factors, as a result of certain factors have to contact, should pay attention to protection in the future to regularly review until after the age of 20. Some benign lesions can also be transformed into osteosarcoma, such as osteochondroma, giant cell tumor, fibrous dysplasia of bone disorders. For patients with these diseases, should be vigilant, should be prescribed regularly reviewed. Alert to the possibility of malignant transformation of the signal, such as the pain had no pain, had a sudden growth of slow-growing so rapidly. If these signs occur, you should immediately see a doctor to conduct a detailed examination, if necessary, possible biopsy.

(2) secondary prevention: the prognosis of osteosarcoma patients discovered with the disease sooner or later have a close relationship, so when for unknown reasons the incidence of young people in the knee around the pain, the parents must not be taken lightly, thought it was a naughty child trauma. Monoclonal antibodies appear early detection of many tumors is possible, but osteosarcoma monoclonal antibody kit preparation for further study. Current are found to follow the stages of osteosarcoma in 1980, Enneking's surgical staging system, the GTM surgical grading system. One positive for the G0, low grade of G1, high grade of G2; tumor located in the capsule for the T0, located between the interior of T1, located in the outdoor as T2; no local or distant metastasis, compared to M0 with M1. For low-grade sarcoma, osteosarcoma and adjacent cortex can be partial resection or tumor resection and chemotherapy with the program, such as high grade, preoperative chemotherapy should be used after amputation plus chemotherapy program. So sooner or later, the discovery of osteosarcoma and the nature of the choice of measures for the surgery, the prognosis is of great significance. The past, the traditional method of treatment of osteosarcoma amputation and radiotherapy, the 5-year survival rate of this treatment in about 20%. The rise of chemotherapy, the 5-year survival rate has greatly improved. Now many are being used in large doses of methotrexate-based chemotherapy. On this basis, the formation of a variety of different options, similar, are based on tumor cell proliferation kinetics, selection acting on different cycles of chemotherapy drugs, but one thing is common that large doses of methotrexate. 1967 Djerassi first application of large doses of methotrexate used in combination formyl CF detoxification method for treating osteosarcoma. Jaffe in 1968, using this method the treatment of metastatic bone sarcoma and success, known as the methotrexate dose treatment of malignant tumors in the history of a revolution, so that patients with osteosarcoma of the 5-year survival rate has greatly improved. Therefore, we emphasize the completion of surgery is not the end of treatment, patients should be prescribed adhere to regular chemotherapy, it may have a good prognosis until cured.

(3) Tertiary prevention: Because a high degree of malignancy of osteosarcoma, it is the current surgical method to use more amputations. Attention should be paid in tumor-free surgical operation, try to avoid planting caused by surgery or distant metastases. Local recurrence or distant metastasis for isolated lesions, still has advocated the use of preoperative chemotherapy plus surgery plus postoperative chemotherapy program may still have a better prognosis. Such as distant parts of the wide range of transfer, can be used with chemotherapy, supportive care, the key parts of the radiation and other methods, aims to support and minimize the suffering of patients, such patients with poor prognosis.

As prosthetic technology improves, the requirements of the stump after amputation unlike in the past has been less stringent, so we mainly ensure the complete removal of tumor tissue does not violate the principles of cancer surgery premise, as far as possible to retain the limb length.

Chinese medicine treatment of osteosarcoma

prescription: ① Codonopsis 9g, Astragalus 9g, the final end 9g, Radix 9g, Bai Zhu 9g, Sichuan off 12.5g, parasitic 31g, Vaccaria 9g, oysters 31g, Prunella 12.5g, dried tangerine peel 6g, woody 5g, seaweed, kelp of 12.5g (including fry) . At the same time, plus serving two yellow pills (Wuli installed), swallow a week.

effect: Shuguang Hospital of Shanghai Medical College, reported a case of osteolytic sarcoma cure.

② Oral side: Xuan Wu, frankincense, myrrh, Salvia, safflower, Siphonostegia, Achyranthes, Dipsacus, Motherwort the 9g, hematoxylin, Blood of the 6g, Eupolyphaga 3g, decoction. Outside the dressing: Angelica 12.5g, red peony, catechu, realgar, Siphonostegia, Blood the 9g, frankincense and myrrh to 6g, saffron 2g, borneol 3g, musk 0.15g. Powder transfer wrap the affected area for 3 Tianyi, remove the little drug re-apply.

effect: Hunan Institute of Medicine reported a case of giant cell tumor of bone healing.

recipe: Yiyiren 30 grams, 30 grams green beans, heart, red bean 30 grams, cooked such as porridge, eating bean soup.

Western osteosarcoma treatment

(a) treatment

after diagnosis, should be an early amputation or joint amputation surgery, before and after surgery with chemotherapy and radiotherapy may improve the efficacy of chemotherapy or radiotherapy alone is largely ineffective.

2) commonly used exercises. To control high cholesterol, high fat foods, eat more vegetarian food. At the same time to control the total calorie intake, limiting weight gain.

2 should be the law of life, avoid excessive stress; maintain adequate sleep, develop a variety of taste; to maintain emotional stability and avoid impatient, agitated or depressed.

3 to maintain proper physical exercise activities to improve physical fitness.

4 more tea, according to statistics, the incidence of coronary heart disease do not drink tea was 3.1%, 2.3% down to tea occasionally, and often drink tea ( drink more than three years) is only 1.4%. In addition, the increased coronary heart disease, and coronary insufficiency, and thrombosis. The polyphenols in the tea and tea polyphenols in the phenol oxidation process of continuous boiling tea pigment formed by the animal in vitro experiments are suggestive of significant anticoagulation, and promote fibrinolysis, anti-thrombosis and so on.

5 non-smoking, drinking: smoke can shrink the arterial wall and promote atherosclerosis; and alcohol are easily agitated, high blood pressure.

7 prevention of coronary heart disease should be a positive step. The following patients should be the standard blood pressure 130/80mmHg, including: diabetes, chronic kidney disease, coronary artery disease (CAD) risk equivalent status, carotid artery disease (carotid murmur, ultrasound or carotid angiography confirmed abnormal), peripheral arterial disease, abdominal aortic disease. Framingham risk score ≥ 10%. None of the above standard blood pressure of 140/90mmHg. The performance of patients with myocardial ischemia, blood pressure should slowly drop, diabetes, or> 60 years of age diastolic blood pressure (DBP) blood pressure less than 60mmHg to be careful. The larger pulse pressure in elderly hypertensive patients, systolic blood pressure (SBP) decline, DBP will drop very low (<60mmHg). Should pay close attention to symptoms of myocardial ischemia. Very old elderly (> 80 years of age), antihypertensive therapy can reduce stroke risk, but can reduce the CAD, not sure.

2, save the heart of the oil, rub the pain out of place and time for deep breathing exercise.

3, triangular, Curcuma powder of 1g, warm water, 2 to 3 times a day.

4, Corydalis, wide turmeric, sandalwood, etc. into the end of each 2 ~ 3g, warm water, 2 to 3 times per head.

5, ginseng notoginseng powder, incense powder, blood powder (2:1:1 and uniform), warm water, each 2g, day 2 three times.

6, kaempferol, Asarum, 2 copies of clove, frankincense, myrrh, borneol of 1, a total for the end of warm water, each serving 1.5 ~ 2g, 2 or 3 times a day.

7, coronary cream, in the smell of mutton, Xin Yu, empty inside, or chest, the attached one, two points for each optional.

8, gardenia, peach kernel 12g powder, add 30g refining honey into a paste, apply in mind before sharing area, gauze mulching, 1 week every three days dressing 1 for 1 week later, six times as a course of treatment. Neiguan the Pericardium by combined points, Pericardium by starting in the chest, next to the contact triple burner, the meridian line on the breast side up, onto the outside of the inner arm, down to the middle finger. In medicine, heart-centered, pericardium and heart by the network after you contact each other, evil heart, by its Envelope straight over, if the heart is sick, can be reflected upon in the Envelope, which closed the Pericardium network through the important combined points, they are able to cure coronary heart disease and other heart disease. When angina pectoris, arrhythmia attack, the force constant by Neiguan point, every 3 minutes, intermittent 1 minute, can quickly relieve pain or to adjust heart rate.

(2) rub Ling Road hole, Shao Ling Road to the heart by the hand of Meridian, located in the little finger on the inside of the wrist joint 1 inch (referring to the same body-inch Chinese law) at. It was found that about 91% of coronary heart disease, left Ling Road obvious point tenderness. Coronary heart disease fall ill, the available thumb hole before gently Ling Road, 1 minute, then the weight of massage for 2 minutes, the final knead 1 minute, every day rub 1 in the afternoon, 10 days for treatment, intermittent 2 to 3 days can proceed to the next course of treatment. After observation, Rouan treatment significantly reduced symptoms of angina, ECG also improved.

(3) selection of points on both sides of the bladder or back the smell of mutton by the Feishu, Xin Yu, Jue Yin Yu and other points, for the rubbing method with the thumb, wrist and push the law, one finger tap method, every 15 minutes, 1 day, 15 times as a course of treatment, stop taking cardiac drugs and other drugs. After a course of treatment were followed up 30 cases of coronary heart disease with left ventricular dysfunction, results, chest pain, palpitations, shortness of breath, paroxysmal dyspnea have different degrees of improvement.

in medicine: the human body meridians inline organs, outside the contact limb. Coronary heart disease in the hand Shao Yin Heart Sutra, Pericardium Meridian Meridian points, before the Tanzhong chest, back shu points of the heart, are more sensitive point of tenderness, massage these points, can play and clear the blood, the effect of cardiac pain. Especially important for the ease by Neiguan angina pectoris, arrhythmia, myocardial infarction critical state, in a timely manner to a patient is important. Can be added with enteric-coated aspirin 100-325mg 1 / d, note that the treatment of coronary heart disease risk factors such as antihypertensive therapy, lipid-lowering therapy, diabetes, smoking, alcohol and so on. GIK also use drugs and nitric acid lipid infusion.

in middle-aged people over 60 years of age or social groups, the risk of coronary heart disease who are not curiosities. Because some people without symptoms, ECG normal. This is hidden coronary heart disease, heart disease until the symptoms have stopped only when people's attention. Infestation has been diagnosed with coronary heart disease patients should learn how to correctly grasp of several drugs, such as nitroglycerin, isosorbide dinitrate, stability, medicine balls, the proper use of heart-protecting. Heart attack, the patient has a sense of self, the aura symptoms, such as precordial men Tong, a sense of strangulation, fear, etc., according to their past experience self-medication, place to rest, when the oxygen conditions, You can get good results, and do not have a doctor, to prevent a serious attack. Special emphasis on smoking cessation, smoking when frequent episodes of angina. Coronary heart disease patients should carry nitroglycerin and other drugs, including clothing immediately if chest pain, and be careful not to use the failure of the drug. Stable angina at rest and with nitroglycerin will relieve angina, unstable angina is a serious and potentially dangerous diseases, should be immediately sent to hospital for treatment and close observation.

2, myocardial infarction: acute myocardial infarction mortality rate is high, more than half the patients in the hospital before death, most deaths occur within 1 hour after the onset, generally caused by ventricular fibrillation. Therefore, first aid measures in place and quickly transferred to the hospital is essential. In high-risk patients (hypertension, diabetes, previous angina hair authors) in the event of the following: chest discomfort, extreme fatigue, breathing difficulties, especially with sweat, dizziness, palpitations, sense of impending doom, we should place a high degree of suspicion a myocardial infarction should be immediately sent to the closest, qualified for the ECG, ECG, direct current defibrillation, intravenous thrombolysis of medical institutions. At the same time to remain calm, do not cause the patient's panic and fear, and with nitroglycerin, or Suxiaojiuxin Pill, Guan Xin Shu-balls, are qualified to intramuscular injection of papaverine, or pethidine, and stability, and maintain ventilation and smoke oxygen, without contraindications, immediate oral aspirin 300 mg. In case of ventricular tachycardia, ventricular fibrillation and other arrhythmias immediately to the direct current defibrillation malignant. In the event of cardiac arrest should be immediately closed chest cardiac massage and artificial respiration, cardiopulmonary resuscitation.

3, acute heart failure and cardiogenic shock: acute myocardial infarction and ischemic cardiomyopathy, acute heart failure can occur due to myocardial necrosis caused by a large area. mostly acute left heart failure, patients with severe breathing difficulties, with irritability, a sense of suffocation, looking schungite, lips cyanosis, sweating, cough, cough a lot of white or pink foam phlegm, this situation must be immediately sent to hospital. Drug is based on intervention in the last 20 years developed after 2000 has matured, not only control symptoms, and may completely cure, hold up the blood vessels to narrow. Involved in a simple, noninvasive, without thoracotomy, and the immediate, technically high-risk, needs some training, there are certain conditions in order to do also need the patient's cooperation. Stent thrombosis would be to go wrong once, and the incidence of 1%. Overall, it is now also pursuing other life except the pursuit of quality of life, a 40-year-old male, went out every day to run or play golf, to hiking, to take medicine every day, although the living dead, but that means nothing, you need to do to intervene. Do not intervene or economic conditions are relatively poor, do seventy-eight stent intervention to resolve, it just give up, consider the bridge.

actually involved with bypass surgery is a thing, to intervene is to clear the inside of the distraction plug, bypass is get a chest tube from upstream to downstream to re-open a channel. In theory, drugs, surgical intervention with the stability of low-risk patients with the same effect, do intervene Ye Hao, do bypass Ye Hao, Ye Hao medicine, not dead, it is acknowledged the findings. But the middle of the process involved in the treatment of surgical injury to the patient to be much less than surgery, recovery time much shorter up, general surgery and surgical intervention have different indications, patients will generally consider the economic resilience and physical suffering disease specific situation. one hundred 40-year-old who take medicine, or intervention, or bypass are the last person to die as much. Intervention people can Pa Xiangshan, but people do not take medicine mountain climbing, you can build a bridge climb. But the bridge less those who relapse, recurrence and more people involved, people bypass the small risk of restenosis, stent now, can prevent relapse, drug stents and bypass the recurrence rate is estimated about the same.

1. heart yang deficiency: lack of heart yang severe shortage of gas for the heart. The ancients said: "The Gate of the pericardium is attached with fire." Heart of the root causes of lack of sun but Vital Huoshuai, cubic to aconite (the amount is 10g or so, this product has a big drug, not multi-purpose), Gui Zhi kidney in the real the fire. "Renowned party," said: "angry little fire, fire is strong fresh air", so do not use cinnamon and cassia twig, and with, not the amount of Guangxi, and its meaning is a little fire, to prevent too dry Shangyin. Qi of the multi-purpose red ginseng products (preferably Jilin ginseng or ginseng). Coronary heart disease has different degrees of systolic blood stasis, so much together with safflower, peach kernel, Salvia, etc. Traditional medicine. In the blood circulation at the same time, care should be qi, qi, is intended to adjust the internal organs of the cutting machine to conditioning the blood, the blood and the new health. Coronary heart disease can result Haner coagulation of blood stasis, but also due to thermal and knot. Hanning stasis for a long time and can be the heat. Where the hot junction and the long stasis stasis or heat, such as the still warm through the goods, must help heat Shangyin. Instead, cooling circulation, and its meaning is protecting shade. In addition, there are varying degrees of coronary heart disease patients of phlegm on the block, it is often used aromatic Huazhuo, temperature of phlegm law Pinellia, Citrus, Arisaema, Kou-jen, spring Amomum. However, Yun-long hot as those of the product is still warm, heat Shangyin will help at this time to Thanh Hoa.

2. Yin damage the heart: coronary heart disease were more common in the elderly, the elderly common ferrite Yin. In the disease process, and more prone to the symptoms of kidney yin deficiency, especially, the long sinister gas injury, or generate enough body fluid deficiency, Qi and Yin Deficiency symptoms can appear. Therefore appropriate to adopt the method of nourishing treatment. Schisandra, heterophylla, white peony root, Ophiopogon, Dendrobium are used nourishing of the product. Smell, although small, and both qi, heat, yin, yang four law convergence. Yin can increase the blood source, Qi Blood Circulation, thus nourishing the same time, but also to promote the role of blood circulation. Heterophylla, Schisandra, Radix is ​​Shengmaisan, according to modern pharmacological studies, that Shengmaisan a stable and lasting cardiac effects, the damage has been the role of coronary artery wall to be repaired, while stable and normal blood pressure . If prepuce or phimosis circumcision should be.

(2) Cnidium, Sophora, Kochia scoparia, fresh white skin of the 30g, dry alum 10g, Jianshui wash.

(3) indigo powder for external use.

(4) Treats moderate to pig bile Sunburn through to the end of the external surface of the skin.

(5) Toosendan, berberine, Poisson, Chuan Jiao, onion roots, leaves of equal parts, Jianshui wash.

(6) verbena leaf 300g, stir liquid topical lesion.

(7) the amount of ginkgo, mashed Waicha.

(8) clam, berberine, indigo equal parts, research and go topical.

(9) honeysuckle, wind 6g, mint, Cork, licorice 3g, decoction outside the wash.

(10) Fan wood turtle scattered: Fan wood turtle (calcined ashes) 30g, borneol 6g, research to fine, and topical.

(11) willing to participate in snake soup Park: Sophora flavescens 30g, Cnidium 20 g, Treats 15g, Nepeta, raw herb 12g, decoction outside the wash.

(12) chancre side: borneol, pearl, light pink, baby tea, the amount of research to fine, dry those sesame oil dressing, wet dressing were dry at the end.

(13) balanitis side: Cnidium, skullcap, honeysuckle, Sophora each 30g, Coptis, Lithospermum, Cyperus rotundus, Houttuynia 20g, rhubarb Rhizoma, licorice 10g, borneol 4g, Jianshui wash the affected area.

(14) Mystic Powder: baby tea, myrrh, gall, the keel of the 6g, pearl 3g, research for the go-between, the first medlar boil wash the affected area, after before putting the drug.

(15) honeysuckle, Nepeta, Pu Xiao, Cnidium, nard, Angelica, betel nut of 30g, Jianshui wash.

(16) pearl cream for external use.

(17) Clematis 15g, Jianshui wash.

(18) Gefen casual: Gefen, calcined gypsum of 30g, light pink, Treats each 15g, research for the go-between, sesame oil paint for external use.

(b) the prognosis

currently no related content description.

[Examine]

hepatomegaly should do what check?

A history

history can often provide clues to the diagnosis of liver disease, to pay attention to understand the history of exposure to any infectious disease, history of receiving blood products, the history of living in endemic areas, this helps the diagnosis of infectious and parasitic diseases. History of exposure to drugs or toxins, can cause toxic hepatomegaly. Often in patients with previous hepatitis with cirrhosis, jaundice, chronic alcoholism and other medical history. Pain were more common with liver inflammation in the liver, acute liver congestion, liver lesions, mostly dull, but the pain can be quite severe liver cancer. Hepatitis prompts often accompanied by fever, liver abscess, biliary tract infection, liver cancer or other acute infectious diseases. Blood disease, connective tissue diseases. Viral or drug-induced hepatitis associated with anorexia.

Second, the physical examination

(a) the extent of the lesion

1, diffuse enlargement of the liver disease caused as universal, found in all kinds of hepatitis, J fatty liver, liver amyloidosis, liver congestion, cirrhosis, hepatocellular carcinoma, metastatic carcinoma, cholangiocarcinoma.

2, enlargement of the limitations of space-occupying lesions in the liver as found in the liver abscess, liver cyst, liver cancer, liver hydatid and so on.

(b) of the liver stiffness

normal physical thin edge may reach the liver and soft. Hepatitis seen in medium hard liver, liver abscess, schistosomiasis, fatty liver, malaria. Liver hard, seen in cirrhosis, advanced schistosomiasis, congestion of liver cirrhosis, cancer, leukemia, liver amyloidosis, syphilis, liver and so on.

(c) of the liver edge and surface

chronic hepatitis, liver congestion blunt the edge of the surface is still smooth, sharp edge of cirrhosis, nodular surface.

(d) tenderness

acute hepatitis, acute hepatic congestion, acute cholangitis or biliary colic attack tenderness , bacterial or amoebic liver swelling and tenderness is more severe when the main limitations of tenderness, liver, often without obvious tenderness, tenderness mild chronic hepatitis, cirrhosis of the liver * fatty liver, liver liver amyloidosis with syphilis general no tenderness.

(e) jaundice

viral hepatitis, biliary cirrhosis, extrahepatic biliary obstruction more common.

(f) weight loss

liver cancer, cirrhosis of the liver may be associated with significant weight loss.

(g) ascites

liver cancer, cirrhosis, acute, subacute hepatic necrosis, circulatory disorders can be seen.

(eight) on the palm and spider Germany

seen in chronic liver parenchymal disease.

(nine) purple epilepsy, gingival bleeding, the coagulation abnormalities

seen in severe liver disease, long-term blocking jaundice, blood disease, leptospirosis, and so on.

three laboratory

(a) blood test

bacterial infection or amoebic liver abscess leukocytosis, viral infection or hypersplenism leukopenia. After the rupture of esophageal varices, hypersplenism or folate deficiency of red blood cells and hemoglobin. Cirrhosis, severe hepatitis, long-term obstructive jaundice in liver protein synthesis disorder or disseminated intravascular coagulation caused by abnormal blood clotting mechanism. Viral serum antibody titer can be increased or virus isolation positive and was diagnosed. Leptospirosis, syphilis, fungal disease, trematodes and other specific antibodies can be detected in serum, hydatid disease, trematodes, tuberculosis skin test can be done.

(b) of the stool examination

eggs can be found in the feces or trophozoites.

(c) of the duodenal drainage

for the diagnosis of biliary tract infection caused by hepatomegaly help, drainage fluid can be found in pathogenic bacteria.

(D) liver function tests

1, protein metabolism of the test

(1) plasma proteins: albumin and prealbumin could be used as an indicator of prognosis of chronic liver disease; liver disease if al globulin increase reflects the less severe, reducing the often prompt serious condition, the liver is significantly increased ; p globulin increase is often accompanied by an increase in lipid and lipoprotein set globulin in acute hepatitis normal or slightly higher, significantly higher in liver cirrhosis; liver disease in alpha-fetoprotein increased, reflecting the regeneration, and disease activity sex-related, positive alpha-fetoprotein is not unique to liver cancer, viral hepatitis, cirrhosis, teratoma. Gastric cancer, pancreatic cancer, colon cancer, pregnancy and other serum alpha-fetoprotein can be increased.

(2) serum flocculation turbidity test: cephalin cholesterol flocculation test (CCFT) is a diagnosis of acute hepatitis, hepatitis prognosis, and many other diseases can also be positive and false positive reactions. Zinc sulfate turbidity test (Zn "I" I ") can identify hepatitis and cirrhosis, chronic hepatitis and cirrhosis to determine the diagnosis and prognosis. Clam vanilla phenol turbidity test (n "IT people are not special liver function tests, only reflect the degeneration of liver cells, but the false positive rate above several trials, although some were eliminated, but understanding the actual significance of this knowledge is still a certain .

(3) ammonia tolerance test: This test for to determine whether the collateral circulation in patients with cirrhosis have a certain diagnostic value, but the risk of causing hepatic coma.

2, sugar test is the test of insulin resistance when glucose metabolism in chronic liver disorders are characterized by one; liver cells in hypoxia can be blocked by the liver metabolism of galactose, which is a special liver disease factors.

3, lipid metabolism in experimental determination of the serum phospholipids of liver cells and the identification of obstructive jaundice meaningful.

4, liver enzyme tests are indispensable in clinical biochemical means, for the detection of hepatobiliary disease, to clarify the nature of the disease process, the intracellular location specific lesion is important.

(1) is mainly used for enzymes of liver damage: ① class mainly aspartate aminotransferase aminotransferase GOT, alanine aminotransferase Gr and GOT isozyme. ② gland of deaminase ADA, its advantages recovery for the diagnosis of acute hepatitis, assist in the diagnosis of chronic liver disease, hepatocellular jaundice and distinguish obstructive jaundice. ③ glutamate dehydrogenase GDH, may reflect the activity and severity of liver disease. ④ amylase, acute liver cells necrosis serum amylase, often associated with elevated aminotransferase parallel.

(2) is mainly used for diagnosis of cholestasis enzymes: ① alkaline phosphatase ALP, the differential for jaundice, liver lesions and the diagnosis of jaundice of biliary tract disease-free. ② Y a glutamic acid transferase GGT, liver and gallbladder disease can be screened, the diagnosis of liver cancer, identification of obstructive jaundice and hepatocellular jaundice, acute hepatitis, recovery of the diagnosis of chronic liver disease activity and prognosis, diagnosis of alcohol-induced liver injury.

(3) for the diagnosis of liver fibrosis of the enzyme: ① monoamine oxidase WaD, other diseases and certain liver diseases can cause this outside activity changes. ② N an acetate card, glucosamine helps to reflect fibrosis former enzyme activity. ③ proline hydroxylase PHO, its activity in parallel with progressive fibrosis.

(4) is mainly used for diagnosis of liver tumors of the enzyme: ① 5 "core of acid phosphodiesterase, the combination of AFP and clinical diagnosis of liver cancer is one of effective methods. ② flash antichymotrypsin ACT, especially in liver cirrhosis as a means of diagnosis.

5, bilirubin hormone and bile acid metabolism of the test serum bilirubin can be understood without jaundice, jaundice of the extent and evolution of the degree of liver cell damage and prognosis. urine and jaundice biliary obstruction identification identification of serum bile acid sensitive early detection of mild liver damage, can be hepatitis, cirrhosis of the liver and intrahepatic or extrahepatic cholestasis and normal liver cell function were identified.

6, Han pigment phthalocyanine sulfonamide sodium excretion test ① SP release test with the amount of blood flow may reflect the functional state of liver cells, and this trial judge found as a sensitive indicator of liver disease. Indocyanine green ICG excretion test is a test of liver function The best, most practical value of the dye, compared with BSP security, application in chronic liver disease than BSP test.

7, except test in hormone metabolism or endocrine disorders the case of other relevant factors, serum, urine or other hormone metabolites, liver function can reflect the state liver disease decreased serum T3 and anti-Ts corresponding increase.

8, vitamin metabolism vitamin metabolism and experimental liver disease associated with a series of biochemical reactions in vivo may be abnormal, the cellulose in vivo detection of metabolic state, not only for the treatment of patients with liver disease with nutrition guide, and help understanding and awareness of the various clinical manifestations of liver disease pathogenesis, in rare cases, can also be used to determine liver function and assist in the diagnosis. liver disease and obstructive jaundice, when reducing the absorption of vitamin E, plasma concentration decreased, but not a liver disease severity proportion of blood enzymes of alcohol and ketone turn may reflect the in vivo determination of vitamin B; metabolic state.

9, experimental drugs into drugs into functional capabilities and consistent changes in liver synthetic function, where lower plasma albumin, prothrombin time injection of vitamin K with no response, the drugs also see reduced transformation function, the sensitivity is higher than the plasma protein bilirubin and prothrombin time, sodium and sulfur Australia phthalate excretion half lactose removal test similar, but not as good as GPT and milk stamp cyanide green excretion test. mild liver damage, drug transformation function tests are still normal, moderate or severe liver damage then was reduced at this time to help determine the prognosis of liver disease.

four, equipment check

(a) ultrasound

ultrasound in the diagnosis of hepatobiliary disease can be used to measure liver and spleen and gallbladder location, size, shape, and hepatic venous vein and its branches * changes; to determine the nature of hepatobiliary disease, location and extent, confirmed the clinical impression of diagnosis and resolution of specific problems ; be under the guidance of the ultrasound probe for percutaneous transhepatic cholangiography and drainage, liver puncture biopsy; hepatobiliary disease have been diagnosed for treatment follow up study; further validate the results of radionuclide examination to determine the nature and disease depth, liver and gallbladder diseases and adjacent organs week relationship. B-ultrasound for the diagnosis of liver lesions greater significance, more than Icm diameter of lesions can be detected.

(B) X-ray examination

1, across the chest to determine the right location, shape and movement.

2, gastrointestinal barium meal can be found in esophageal varices, and the discovery of pancreatic cancer or ampullary cancer, bile duct obstruction caused by the help.

3, gallbladder or cholangiography or biliary obstruction of the cystic lesions have diagnostic value, but not suitable for jaundice, and you should do the percutaneous transhepatic cholangiopancreatography to clarify whether the stones or tumor obstruction, the bile duct lesions on the clarity of the image than Endoscopic retrograde cholangiopancreatography is good but when the prothrombin time was significantly longer taboo. duodenal endoscopy retrograde cholangiopancreatography and percutaneous results were similar.

(c) CT and MRI

cirrhosis, fatty liver, liver adenoma diagnosis, MRI better than CT, but the liver cyst, the diagnosis of hepatic hemangioma is superior to MRI CT.

(d) radionuclide scanning

can be dynamically observed in the liver, bile duct, gallbladder radioactivity concentration and by the circumstances, the liver can show the size, location, shape, mainly used for diagnosis of liver lesions, vascular tumors of the blood pool filled with confirmed significance, but also to assist in identifying intrahepatic cholestasis or extrahepatic obstructive jaundice the longer X-ray hepatobiliary imaging is superior.

(e) laparoscopy

for the diagnosis and identification of various liver diseases diagnosis of some help for the diagnosis of hepatitis, hepatitis stage of disease, hepatitis complications; cirrhosis of the causes, nature, extent; nature of the tumor, location, extent; deciding whether to laparotomy, and whether the removal of the tumor; the differential diagnosis of extrahepatic obstruction and intrahepatic cholestasis also be helpful.

(VI) the liver angiography

licensed portal contrast, hepatic venography, hepatic arteriography, the umbilical vein of portal imaging and other methods. splenic portography can understand the portal vein obstruction cases and determination of portal vein pressure hepatic venography can understand the hepatic vein obstruction case. hepatic arteriography of liver tumors the possibility of surgical resection and removal of an estimated range of some help. MRI can replace part of the invasion of human angiography.

(g) of liver blood flow map

is a non-invasive examination of the liver and vascular function method, liver tissue by measuring the impedance of the high-frequency current to reflect the state of the liver's blood circulation, and to determine liver function and pathological changes, diagnosis and understanding of the evolution of the disease. prognosis and outcome, although no cause of liver blood flow diagram of the specific, but reflect the degree of liver lesions with significant, chronic hepatitis, cirrhosis, portal hypertension early J to determine cardiac liver congestion, liver cancer diagnosis and localization have some value.

(h) of liver puncture biopsy

because its indications are not clear hepatomegaly, off-shift effect on the diagnosis and prognosis, about the evolution of various liver diseases, to provide a reliable scientific basis in severe jaundice, ascites

or clotting disorder, compared with taboo.

[Diff]

hepatomegaly easy to confuse the symptoms with which?

the differential diagnosis of hepatomegaly, first of all distinguish between infectious and non infectious hepatomegaly hepatomegaly. Hepatomegaly is further distinguished infectious viral, bacterial, parasitic infection. Have to distinguish between non-infectious hepatomegaly is toxic, congestive, biliary stasis nature of metabolic disorders, liver cirrhosis J tumors and cysts or other. Awarded under the female.

one infectious hepatomegaly

(a) virus infection

1, viral hepatitis

influenza incubation period than in the 15-40 d. From the onset to the first 9 d 17 d after the onset detected from fecal HAV, SGPT often reached a peak in the first week more than 500 units, SGPT> SGOT, AKP increased more than it SGPT / AKP ≤ 7, serum anti- HAV-IGM positive, acute and convalescent serum total anti-HAV antibody titer ≥ 4-fold rise in serum or stool detected HAV-RNA. Clinically divided into acute jaundice type, and acute non-fulminant type jaundice. Type of acute jaundice: jaundice can be divided into three d ① early, usually 2-16 d. ② jaundice period, about one week after the onset of hepatosplenomegaly, jaundice, each one in 2 weeks and reached the peak, then gradually reduced, generally subside within 2-4 weeks, children in particular speed. ③ recovery, the waning jaundice, liver swelling and other symptoms are also reduced, appetite normal, but still weak and mild liver pain, this period of about a month. Children's lighter, heavier adults, jaundice lasts about 3-4 weeks.

2, forming viral

Viral Hepatitis wide range of popular, some areas forming viral clinical viral hepatitis can be accounted for 50% of the popular all year round, but more common in autumn and winter, often in the rain or after the flood, to water pollution caused by epidemic. Before the onset of l-4 d can be detected in the feces within 2 weeks after the onset of HEV is still detoxification. About half of patients have onset of fever, joint pain. Jaundice, cholestasis, and clay-like when compared with viral hepatitis is more common, more general symptoms of viral hepatitis as the most important.

3, infectious mononucleosis syndrome

The disease often have hepatomegaly and abnormal liver function, hepatitis but higher than the heat, than a long duration, often throat pain, congestion and secretions, neck and other parts often swollen lymph nodes, spleen and tenderness more apparent.

4, cytomegalovirus infection

normal adults infected after emergence of infectious mononucleosis-like syndrome of Symptoms, signs and typical blood, but negative heterophile agglutination test, liver swelling, and mild liver function abnormalities, liver biopsy shows inflammatory infiltration and mild liver cell necrosis, or granulomas and giant cells were small, and in the liver Cytomegalovirus inclusion bodies identified within the few opportunities. Immunosuppressed patients may be asymptomatic after infected, or a majority of organ involvement, such as hepatitis, pneumonia, arthritis and many other lesions, may have fever, leukopenia, lymphocytosis, abnormal lymphocytosis, hepatosplenomegaly , myalgia and joint pain. Rely mainly on the diagnosis from the blood, urine, sputum or stool virus isolation, centrifugation of fresh urine, or oropharyngeal secretions smear staining inclusion bodies, or do double serum complement fixation test or neutralization test, anti-CMV titer step-up and anti-EBV-negative heat of rickettsial infections, may have fatigue, anorexia, nausea and vomiting J, most associated with right upper quadrant pain and hepatomegaly, tenderness may significantly; some patients with splenomegaly and jaundice. Course of reaction may have positive cloud flocculation and serum aminotransferase. Increased alkaline phosphatase activity, very similar to viral hepatitis.

(b) bacterial infection

1, acute obstructive suppurative cholangitis (AOSC) of the disease is due to bile duct obstruction secondary infection caused by acute complete bile duct obstruction and acute purulent infection. Is characterized by acute onset, rapid, severe illness, often accompanied by septic shock. With previous history of repeated episodes of biliary tract infection, highlighting the high fever, right upper quadrant pain, tenderness, pain, J hit the obvious, there are jaundice, gastrointestinal symptoms, liver enlargement uniformity.

2, chronic cholecystitis longer duration, slow onset, with persistent right upper abdominal dull pain or discomfort, right swollen shoulder pain, gastrointestinal symptoms, symptoms get worse after eating fatty foods, gallbladder area may have mild pain or percussion tenderness but no rebound tenderness, may have hepatosplenomegaly, jaundice, even now. Duodenal drainage of bile in a large number of white blood cells, or parasite-positive bacterial culture.

3, primary sclerosing cholangitis is a rare disease of unknown cause may be related to infection. Characterized by long duration and slow pace, mainly jaundice, intermittent fever, right upper quadrant dull discomfort, hepatosplenomegaly, gastrointestinal symptoms. Alkaline phosphatase, serum bilirubin and peripheral blood eosinophils increased, there is a certain degree of liver function damage.

4, bacterial liver abscess with previous biliary tract infections, skin abscess, boils or sepsis history, often with chills or chills, high fever, right upper quadrant pain, hepatomegaly and tenderness as the main symptom onset, its performance is similar with amebic liver abscess, but more severe, the condition is more acute. Significantly increased white blood cell often left with the neutral core. X-ray examination showed the right lobe of the right diaphragm abscess increased, limited mobility, left lobe of liver abscess visible reward door, lesser curvature and the duodenum shift. There are several radioactive nuclide liver scan defects.

5, hepatic tuberculosis, hepatic tuberculosis is no specific symptoms and signs, more than the existence of extrahepatic tuberculosis lesions, commonly fever, remittent fever or fever, a small number of missed heat, rarely accompanied by chills, hepatomegaly with tenderness, weight loss, anorexia, weight loss, fatigue, upper abdominal pain, nausea, vomiting, sweating, may have splenomegaly, jaundice.

6, have liver disease brucellosis and cattle, sheep, contact history, clinically manifested as acute hepatitis, chronic hepatitis and cirrhosis III. Acute hepatitis type corresponding undulant fever epidemic history of high fever, a long, joint pain, sweating. After chronic hepatitis type hidden, prolonged course, intermittent fever, liver and spleen, inflammation associated with arthritis and dizzy pills.

7, leptospirosis is Leptospira infection in endemic areas 1 to 3 weeks of the summer season there is a history of exposure to contaminated water, rapid onset, with chills, fever, head, body, leg pain, fatigue, conjunctival hyperemia, jump intestinal muscle tenderness, axillary and inguinal lymph nodes, may have bleeding and kidney damage, some patients may have jaundice and hepatomegaly.

8, liver liver syphilis and congenital syphilis, acquired syphilis the liver. Congenital syphilis of liver except liver, spleen or mild yellow value, in general, no special presentation, diagnosis of congenital syphilis depends on the signs and serum F-positive. Acquired syphilis in patients with syphilis or history of exposure to infection, the lack of significant gastrointestinal symptoms, but there are other symptoms of secondary syphilis, early clinical manifestations of mild, mild jaundice and hepatosplenomegaly, easy to be confused with viral hepatitis, liver function abnormal, serum alkaline phosphatase was significantly higher, F-positive. Late enlargement of the liver, nodular surface uneven, hard, no tenderness, general condition good, extensive lesions, or involving the portal circulation and the bile duct, the more the performance of portal hypertension and cholestasis. Mildly abnormal liver function, alkaline phosphatase, sodium methyl phthalate leave Australia, F-positive.

(c) of the parasitic infection

1, Ami had liver abscess (ALA) more than a amoeba history of dysentery. Most occur in the gastrointestinal infections, suppurative biliary tract disease, the clinical manifestations of the lesion location, number, size varies, especially the greatest impact on the location of abscess, fever, persistent pain and then liver, toxemia often not significant , significant liver enlargement, the edge blunt, full of quality, abscesses more common in the right lobe, there are clear limitations on the hit tenderness pain, squeezing pain, jaundice rare.

2, the degree of hepatomegaly and schistosomiasis parallel condition. Complex and diverse clinical manifestations, according to the severity of infection, stage of disease sooner or later, the egg deposition site and the body's immune response and different. Schistosomiasis has a history of exposure to contaminated water, since there are intermittent, remittent type of fever, abdominal pain, diarrhea, allergies, lymph nodes, liver. Swelling over the left lobe of the dirty / chronic schistosomiasis often no obvious symptoms, and showed mild hepatosplenomegaly. Late in cirrhosis and portal hypertension, hypersplenism as the main clinical manifestations

3, the majority of clonorchiasis in patients with symptoms and signs of disease. Epidemic in the region has a history, and there are addicted to eating raw fish and undercooked fish habits, because adult parasites in the bile duct inside, it can cause some of the biliary disease clinical symptoms and signs. Temporary solution is related to the degree of infection, generally decreased appetite, fatigue, abdominal discomfort, diarrhea, liver enlargement.

4, hepatic hydatid disease hydatid disease more common in pastoral areas, most occurred in the liver, hepatomegaly, as there must be signs of liver hydatid disease, and more in the right lobe, usually unilocular, as well as multi-room, multi-cystic. Tend to have similar early symptoms of cholecystitis, chest department has a sense of fullness, upper abdominal discomfort after eating, nausea, a dull pain or traction to the shoulders radiation. Cysts grow slowly, no tenderness, cystic feeling. Blood eosinophils increased. Right across the X-ray deformation or eggshell-like calcification of the wall.

5, malaria, malaria associated with hepatomegaly more than half, more in the margin of each rib cross-refers to one or two touches, may be associated with tenderness, splenomegaly quality hard . Many have a history of repeated episodes, the onset of a typical multi-stage thermal model, and can be found in the malaria parasite. Increased serum bilirubin, flocculation test was positive, gamma globulin can be increased.

Second, infectious hepatomegaly

(a) toxic hepatomegaly

1, drug-induced liver disease, drugs or chemical agents can cause varying degrees of liver damage, often leading to hepatomegaly and jaundice. Medication history of patients without a clear epidemiological history of viral hepatitis, l-4 weeks after treatment of liver damage the performance of the clinical symptoms and signs of mild, may have fever, rash, itching and other allergy thin, and stop symptoms and signs of recovery after the drug faster.

2, patients with alcoholic hepatitis, history of heavy drinking prior to the onset of symptoms of varying severity, may have anorexia, fatigue, intermittent fever, right upper quadrant pain and hepatomegaly . Can cause acute onset of nausea, abdominal pain, jaundice, hepatomegaly and tenderness, even ascites, leg edema and even hepatic coma.

(b) stasis hepatomegaly

1, right heart failure from any cause right heart failure can be the venous pressure increased significantly, jugular vein engorgement, jugular venous reflux symptoms of liver positive, significant expansion of the heart, pulse weakened, hilar vascular shadow was, hepatomegaly with tenderness, cards can be mild swelling, jaundice, unusual or slightly , chest and abdomen without varicose veins, lower extremity edema, ascites, a small amount of slow growth, the appearance of yellow transudate. When heart failure is characterized by hepatomegaly increased when increased heart failure improved significantly after the retraction. Methyl phthalate Australia increased sodium retention, urinary urobilinogen displacement increase, serum alanine aminotransferase normal. B-ultrasonic examination showed hepatic vein dilation.

2, previous chronic constrictive pericarditis often tuberculous pericarditis, purulent pericarditis, viral pericarditis or cardiac history of trauma, jugular vein more visible filling, venous pressure is increased, there is the odd pulse, signs of liver jugular reflux is normal or slightly positive for a heart, heart beat significantly decreased, distant heart sounds, pericardial tapping sound

(c) of cholestatic hepatomegaly

1, intrahepatic cholestasis, including hilar and intrahepatic biliary obstructive lesions and functional disorders caused mainly due to who. Common in young people, hepatitis or liver poison in contact history, when the disease may be sick itching, fever, jaundice occurs relatively fast and easy to change light, early liver pain, liver a little swelling, no tenderness, intermittent earth tones of white pottery will be.

2, extrahepatic cholestasis

(1) common bile duct stones: a history of repeated attacks of biliary ascariasis and , paroxysmal epigastric or right upper quadrant abdominal cramps, fever, chills, jaundice was volatility, not necessarily reach the gallbladder, liver size was not obvious, intermittent white pottery will be earth tones.

(2) bile duct cancer: clinical manifestations of obstructive yellow is the most prominent, and jaundice may also temporarily reduce the sustainable rise, accompanied by abdominal pain, gastrointestinal symptoms , weight loss, frail, weak, showing cachexia, hepatomegaly, sometimes palpable swelling of the gallbladder, may have ascites, specific performance, as the site of cancer varies with the course of the morning and evening.

(3) pancreatic cancer: the upper abdomen or umbilical pain, left lower back radiation, aggravated sexual jaundice, itching rare skin cancer, liver, gallbladder enlargement, often pancreatitis. Duodenal drainage fluid or red blood cells visible. Barium shows duodenal duodenum ring expansion. B-ultrasonic examination showed enlargement of the gallbladder, common bile duct expansion, pancreatic substantial mass. Endoscopic retrograde cholangiopancreatography shows bile duct interrupted, narrow, shift, acinar filling defect.

(4) ampullary cancer: may have chronic cholecystitis, cholelithiasis history, more common in men over the age of 50. Continuous abdominal pain or deep pain, radiation to the back, aggravated sexual jaundice, may have volatility, common itchy skin cancer, hepatomegaly, hard non-tender, palpable mass in the upper abdomen, and may be associated with gastrointestinal bleeding, cholangitis, pancreatitis, transfer later, stool was progressive white pottery earth tones.

(d) metabolism of hepatomegaly

1, fatty liver in chronic malnutrition, chronic infection or poisoning When, for example, chronic alcoholism, chronic ulcerative colitis, tuberculosis, diabetes, severe anemia and cancer cachexia, based on liver fat accumulation, common right upper quadrant pain, mild or moderate degree of liver enlargement, smooth surface, normal quality or slightly harder, multiple tenderness, a few may have mild jaundice, hepatitis, some similar to mild or no symptoms.

2, liver amyloidosis liver amyloidosis is a substance composed of extracellular starch Cheung wall in hepatic blood and tissue caused by disease, very rare, can be divided into the following onset and type of primary, secondary generalized who can often prove the existence of the primary disease. Clinically, such as patients with hard, non-tender, smooth hepatomegaly blunt the edge of business, accompanied by chronic suppurative infections, especially chronic osteomyelitis, chronic lung abscess, tuberculosis, rheumatoid arthritis and other diseases, should consider the possibility of disease.

3, liver degeneration due to liver cell lysosomal defects, so that significant reduction in biliary copper row, resulting in a large number of copper deposition in the liver, and then release people blood deposited on the organs outside the liver, disrupting the activity of certain enzymes, resulting in a variety of dysfunction. Usually as a pioneer in liver disease may be asymptomatic or similar acute, fulminant, or chronic hepatitis, or cirrhosis of the liver, sometimes complicated by hemolytic anemia. Jaundice, portal hypertension, splenomegaly, hypersplenism, ascites, or variceal bleeding is a late disease crisis. Tremor, dystonia, pronunciation or language barrier structure is combined with multiple sclerosis Parkinson's disease, there may be spiritual in nature, the behavior of neurological disorders. Darkening of the skin, salivation, occurred KF corneal rings. Serum steel, copper oxidase, ceruloplasmin deficiency, liver copper concentration, high copper urine disease, penicillamine load test was positive. EEG, ECG may be abnormal.

4, hemochromatosis hemochromatosis iron of inborn errors of metabolism, the body of excess iron storage product, cause liver, pancreas, kidney, heart, skin and other organs of the tissue damage and dysfunction. Chronic progressive disease, long latent asymptomatic, the incidence peak after the age of 40, more men than women, gray-brown or bronze skin pigmentation may be throughout the body, but the face, neck and forearms and other exposed parts of the more obvious, in light of liver degree of swelling, the surface smooth, medium hardness, may have mild tenderness, may have splenomegaly, diabetes, endocrine d




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