One of the most dangerous diseases of the liver is cirrhosis, so the question of whether cirrhosis of the liver is visible on ultrasound is of interest to many.
This progressive pathology over time disrupts all liver functions, replacing functional cells with connective tissue.
When contacting a specialist, an ultrasound diagnostic is immediately assigned.
These procedures enable the attending physician to make an accurate diagnosis. Based on such data, adequate treatment is prescribed.
Symptoms of cirrhosis of the liver
The liver is a unique internal human organ, as it can self-repair at the cellular level.
Healthy cells perform the functions of affected tissues, increasing in size. At this time, the development of new liver cells occurs, which eventually replace the affected ones.
Naturally, this requires favorable conditions. Therefore, pathological changes in this organ develop rather slowly.
At the first stages, it is difficult to see the disease, since there are no exacerbations and complications.
On the other hand, it is treatment from the early stages that can preserve healthy liver tissues and the functions of this organ in full.
If urgent measures are not taken to prevent and treat abnormalities in the liver, then over time, symptoms of bloating, bleeding gums appear, and human behavior changes.
Patients complain of pain in the right hypochondrium, fatigue, weight loss. At the same time, urine darkens, feces become discolored, yellowness of the skin appears.
With pathological changes in the liver, immunity decreases sharply, so the body is susceptible to various viruses and infections.
Obvious signs of the onset of cirrhosis of the liver are redness on the palms, vascular "asterisks" on the body, crimson tongue.
In most cases, patients have breathing problems. When such symptoms occur, urgent measures must be taken to treat this disease.
Cirrhosis of the liver is an already developed disease that has a different origin.
The following causes of the appearance of this disease can be distinguished:
- alcohol addiction;
- problems with the gallbladder and biliary tract;
- metabolic disorders;
- viral hepatitis;
- venous congestion of the liver;
- the use of drugs that poison the liver;
- malnutrition, the use of products with preservatives and dyes.
At the first sign of abnormal liver function, it is necessary to undergo a medical examination.
Diagnostic procedures
Consulting a specialist will help identify possible cirrhosis of the liver. At the same time, at the first stages of seeking medical help, it is proposed to undergo an examination using ultrasound.
The picture of the disease becomes clear after comprehensive diagnostic procedures. In particular, ultrasound will help clarify the stage of development of a liver disease.
Based on such data, the most effective course of pathology treatment is determined. If all procedures are done correctly and in a timely manner, then the likelihood of a positive therapeutic result is significantly increased.
The study itself with the help of ultrasound is carried out in several stages. Three days before the procedure, the patient must refuse products that contribute to the formation of gases.
If necessary, before carrying out procedures for cleansing the intestines, even an enema is often used.
With ultrasound diagnosis, the patient lies on his back, with his stomach slightly open to the ribs. A special gel is applied to the right area, and then, using a sensor, the doctor examines the liver area, focusing on obtaining a clearer picture of the monitor.
When diagnosing, the patient is asked to take a deep breath and hold his breath. This lowers the liver down and allows for a more accurate diagnosis.
The procedure ends with a scan of the peritoneal area to determine the possible presence of fluid inside it.
This method is the most convenient and optimal, since it gives a result that is visible to a specialist, allowing him to assess the state of the liver tissue and the organ itself at the current time.
In addition, the use of ultrasound examination allows you to observe the dynamics of the therapeutic process and, if necessary, make the necessary adjustments to the treatment process.
From the photo, a specialist on the divided hepatic segments determines possible foci of the disease. These zones are then checked and analyzed in more detail.
The description of the image obtained with the help of such an examination should be as detailed as possible.
Obtained as a result of ultrasound signs of liver cirrhosis should be analyzed very carefully.
Ultrasound has become a popular method for detecting various pathological changes in the liver.
This convenient method makes it easy to diagnose the state of internal organs without interfering with the patient's body.
Using this method, you can observe an uneven increase in the proportions of the internal organ itself, its outline.
If the external contours of the liver become bumpy and uneven, then there is reason to think about a possible developing pathology.
In the later stages of the disease, nodules, seals and heterogeneity of the liver tissue are noted.
With such a disease, a clear clinical picture is manifested, which allows, based on the results of ultrasound, to make a fairly accurate diagnosis.
Signs of liver cirrhosis on ultrasound
Cirrhosis of the liver on the monitor screens with ultrasound looks different depending on the stage of the disease.
For example, at the initial stages of the development of the disease, one can observe an increase in the size of the gland while maintaining its consistency.
In the future, the size of this organ increases even more, and pain appears on palpation.
Irregularities, nodules, seals, heterogeneous structure of the liver tissue are clearly visible on the ultrasound picture with the progression of the disease.
Late-stage cirrhosis on ultrasound looks like an internal organ with heterogeneous liver tissue, with many nodules, tubercles.
The contours of the liver on the monitor image during ultrasound diagnostics look blurry and uneven.
At the same time, the dimensions of the internal organ themselves become smaller than normal, and the spleen increases.
Obvious signs of cirrhosis on the monitor screen can be considered separate seals of the liver tissue, which appear on the surface of the organ in the form of foci.
These seals can also be sites of restoration of liver cells, therefore, for an accurate diagnosis, the qualification of a specialist who will interpret these abnormalities is important.
Narrow places of a liver considerably increase in sizes in comparison with norm. A detailed description of the results of ultrasound diagnostics will ensure the correct diagnosis.
Upon careful examination of the ultrasound image in cases of cirrhosis, there are signs of diffuse changes, fibrous areas.
Using the ultrasound method, it is possible to determine direct and indirect signs of the development of cirrhosis of the liver.
Indirect symptoms include varicose veins in the area of the liver and spleen, enlargement of the spleen.
Direct signs are uneven and vague outlines, roundness of the lower edge, changes in the structure, boundaries of the liver, and a decrease in the elasticity of the liver tissues.
Cirrhosis is associated with deep structural changes in the liver, so an ultrasound examination first of all shows the general size and shape, the structure of the liver tissues, foci of malignant transformations, and the diameter of the portal vein.
In the most advanced cases, the clinical picture of the disease is clearly clarified with the help of ultrasound.
In more complex cases of diagnosis, a comprehensive examination using other methods is required.
Liver cirrhosis is a disease that is characterized by an overgrowth of connective tissue in the liver, which leads to pathological processes that can result in liver failure and portal hypertension. The normal physiological structure of the liver is also disturbed. Cirrhosis is chronic.
Dead liver cells are removed by cells of the immune system and replaced by fibrous tissue. The remaining living cells begin to actively increase in number. If individual cells die, fibrotic changes are minimal, then the liver is completely restored. However, if the cell loss is significant and the structure of the liver lobules is disturbed, disordered cell complexes (regenerative nodes) appear, which have an irregular structure and therefore cannot fully perform their functions, like a healthy liver tissue.
Cirrhosis of the liver is one of the main causes of death in patients with diseases of the gastrointestinal tract. Cirrhosis of the liver tissue often leads to liver cancer. Moreover, cirrhosis of viral origin (provoked by hepatitis B and C viruses) often transforms into liver cancer.
Cirrhosis is an irreversible disease, but with well-chosen therapy and the elimination of its cause, the patient can live for a long time.
Why does cirrhosis develop?
There are many different causes leading to this liver condition:
- viral hepatitis,
- alcohol abuse,
- accumulation of toxins
- pathologies of the immune nature,
- diseases of the biliary tract,
- metabolic disorders,
- thrombosis of the liver vessels,
- other.
Determination of the cause of cirrhosis by ultrasound is not possible, although individual symptoms can help in this.
What are the symptoms of cirrhosis of the liver?
At the beginning of the disease, before the manifestation of signs of decompensation, the patient is worried about weakness, fatigue. Often, at the initial stage, patients do not believe that they have any disease. Perhaps a slight increase in temperature, pain in the joints. One of the first clinical signs of the disease is drowsiness during the day and insomnia at night.
When decompensation occurs, an increase in the size of the abdomen becomes visible due to the accumulation of free fluid (ascites) in it, yellowness of the skin and mucous membranes, skin itching, dilation of the saphenous veins on the abdomen, small hemorrhages on the skin, bleeding from the veins of the esophagus, weight loss, muscle atrophy.
What diagnostic methods are used for suspected cirrhosis?
Blood tests show changes characteristic of this disease.
Of fundamental importance for the diagnosis, treatment and prognosis of liver cirrhosis is the determination of markers of antigens of viral hepatitis B, C, D and antibodies to them in a patient.
Of the instrumental methods of examination, apart from ultrasound, esophagogastroduodenoscopy (EGD) is used to diagnose cirrhosis, in which dilated veins of the esophagus and stomach are visible. Changes in the shape, size and structure of the liver, as well as the appearance of collateral anastomoses, are recorded on CT and MRI.
Contrast-enhanced MRI can distinguish between regeneration nodes and liver cancer.
The main and most reliable method for diagnosing cirrhosis of the liver is a puncture biopsy of the liver, which is most often carried out under the control of an ultrasound image.
In this article, we will take a closer look at the possibilities of ultrasound in liver cirrhosis and a description of the echographic signs of cirrhosis.
What are the echo signs of cirrhosis and how is it described?
The main manifestations on ultrasound are the following echographic signs of cirrhosis:
- Change in the size of the liver. First, there is an increase in size, then, in the terminal stage, liver atrophy, mainly in the right lobe. There is a decrease in the size of the right lobe relative to the left, an increase in the left lobe of the liver. Normally, the ratio of the width of the right lobe to the width of the left lobe in cross section is about 1.44. Liver cirrhosis is diagnosed if this ratio is less than 1.3. The sensitivity of the diagnosis of liver cirrhosis in this case is 75%, the specificity is 100%.
- Increase in the caudate lobe: its thickness is more than 3.5 - 4.0 cm.
- The lower edge of the liver becomes blunt- more than 75 ° in the right lobe of the liver and 45 ° in the left lobe with an increase in the liver.
- Tuberous contour of the liver due to regeneration nodes. With micronodular cirrhosis, this symptom is absent. In the case of the location of small nodules under the capsule, a “symptom of a dotted line” is possible, which is manifested by an uneven and intermittent image of the liver capsule. When registering this symptom, the presence of regeneration nodes is convincingly verified by the uneven contour of the liver. Approximately half of patients with cirrhosis of the liver with ultrasound do not visualize the nodes of regeneration, but if they are found, the likelihood of cirrhosis of the liver is practically beyond doubt, with the exclusion of another pathology. That is, if the problem of "hepatitis or cirrhosis" is being solved, finding a bumpy surface of the liver unequivocally testifies in favor of cirrhosis.
- Impoverishment of the vascular pattern of the liver. In healthy people, the vessels are normal: the pattern is small, but in sick patients, the pattern is different, which allows us to draw appropriate conclusions.
- Irregular width of intrahepatic veins.
- Changes in the structure of the hepatic parenchyma. Changes in the echostructure of the liver parenchyma are the result of cicatricial degeneration of the liver tissue and the formation of regenerative nodes in it, the sizes of which vary from a few millimeters (small and medium nodular cirrhosis) to several centimeters (large nodular cirrhosis). Cirrhosis contributes to the heterogeneity of the parenchyma, the density of which can vary significantly. The echogenicity of the parenchyma is usually moderately increased, although it can be significantly increased in the formation of cirrhosis on the background of fatty hepatosis. More specific for cirrhosis of the liver are changes in the hepatic structure, which becomes granular, diffusely heterogeneous. The heterogeneity of the parenchyma can reach such an extent that in this "echostructural chaos" one can easily view the tumor or, conversely, misdiagnose it. It should be borne in mind that even with advanced cirrhosis of the liver, especially small-nodular, the echostructure may be completely normal. However, most often in the ultrasound findings, the liver parenchyma is described as mixed or elevated.
- Enlargement of the spleen. The area of the spleen becomes more than 50 cm2. Sometimes splenomegaly is absent in 5-10% of patients.
- Signs of portal hypertension. An increase in the diameter of the portal vein is more than 12 - 14 mm, the splenic vein is more than 9 mm. Decrease in the speed of blood flow in the portal vein up to its stop or reverse flow.
- Visualization of dilated veins not visible in healthy people. With portal hypertension, the umbilical vein in the round ligament of the liver is restored. In addition, there is an expansion of the veins of the stomach, the development of additional connections (anastomoses) between the vessels in the abdominal cavity.
- There is an increase in the diameter of the left branch of the portal vein in comparison with the right. Normally, the diameter of the right portal branch is greater than the diameter of the left.
- With Doppler ultrasound, a change in hemodynamics in the vessels of the liver is recorded. An increase in the speed and volume of blood flow in the hepatic artery, a change in the shape of the portal flow, slow, sometimes reverse portal blood flow are detected.
- Expansion of the hepatic artery.
- Swelling of the wall of the gallbladder, stomach, intestines.
- Free fluid in the abdomen ascites It is detected at the final stage of cirrhosis of the liver. At the same time, a small liver resembles a wooden block floating in water.
- With an autoimmune cause of liver cirrhosis, there is enlargement of regional lymph nodes, sometimes to large sizes, when their length reaches 50-60 mm. Their shape is oblong, the ratio of length to diameter exceeds 2, in contrast to cases of a malignant tumor with metastasis, when the lymph nodes are rounded.
Lumpy masses on the liver in this patient indicate cirrhosis
Are there errors in ultrasound and why?
The ultrasound image of liver cirrhosis depends on the variant and stage of development of the pathology, however, ultrasound of the liver in the diagnosis of this disease shows an accuracy value of around 75%. Quite often, ultrasound can show splenomegaly (enlargement of the spleen) and hepatomegaly (enlargement of the liver) along with mild indicators of portal hypertension. It would seem a reliable diagnosis: cirrhosis of the liver! But no, a similar picture is possible in other cases, for example, with lymphoproliferative diseases.
In turn, the following situation can be misleading: histology confidently showed: the diagnosis is cirrhosis at an early stage, but on ultrasound there was no persuasiveness in making such a diagnosis, since the disease is still developing and abnormal transformations in the organ occur gradually. Substitution of small fibrosis nodes of normal liver tissue initially does not cause pronounced changes in the structure of the liver during ultrasound. The appearance of fibrous tissue is accompanied by an increase in the echogenicity of the liver parenchyma, which also happens with other liver pathologies.
With an ultrasound of a patient with cirrhosis of the liver, you should know that it is not at all necessary to have all the ultrasound symptoms of the disease. At the same time, key evidence symptoms should be recorded.
Despite the many ultrasound signs that are characteristic of liver cirrhosis, the data obtained from echography are insufficient for a confident diagnosis of liver cirrhosis in the initial stages of the disease and with insufficiently pronounced morphological changes in the organ. A significant diagnostic criterion is the cumulative comparison of echographic data with the clinical picture and laboratory tests.
Additional echograms
- Specificity of the disease
- The severity of the disease
- Carrying out ultrasound of the liver
- Preparing for an ultrasound of the liver
- Diagnosis of cirrhosis by ultrasound
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Cirrhosis is a serious disease of the liver with irreversible destruction of its tissues and impairment of its functions. Ultrasound for liver cirrhosis is a description and differentiation of the disease, the most important stage in diagnosing, and timely treatment is the only possibility for a positive prognosis for survival.
Ultrasound for cirrhosis is a description of the clinical picture, and with the use of additional (clarifying) methods, it makes it possible to accurately assess the disease, its stage and variety. The use of this method is an indispensable element of modern diagnostics, and it is successfully used everywhere.
Specificity of the disease
In general, cirrhosis of the liver is an organ pathology associated with the transformation of hepatic parenchymal tissue into stroma or fibrous tissue. With the development of the disease, the liver changes significantly in size (decreases or increases), becomes abnormally dense and bumpy. The pathogenesis of the disease consists in a gene change in hepatocytes and the appearance of pathologically structured cells, which leads to an inflammatory response at the immune level.
Depending on the etiological features, the disease is divided into the following main types of liver cirrhosis:
- Alcoholic cirrhosis is caused by toxins present in alcoholic beverages. Stages of development - acute hepatitis and degeneration of fatty tissue with fibrosis, necrosis of hepatocytes and the process of autoimmune orientation.
- Viral cirrhosis has an infectious mechanism (hepatitis B, C), and autoimmune processes are directed to lipoproteins.
- Congestive cirrhosis is explained by necrosis of hepatocytes due to lack of blood supply, hypoxia and congestion in the veins. Against this background, hypertension is manifested, caused by the destruction of portal vessels, ascites, splenomegaly, thrombocytopenia, leukopenia and anemia develop. Encephalopathy may occur.
- Biliary cirrhosis of the primary type is mainly due to a genetic pathology of immune regulation. The main stages of the disease are chronic cholangitis, destruction of the bile ducts, scarring of tissues and narrowing of the ducts, a large-nodular type of disease with the appearance of cholestasis.
In addition, quite rare types of the disease have been identified: medicinal, biliary secondary type, from congenital diseases (tyrosinosis, glycogenosis, galactosemia, etc.), metabolic and alimentary (with diabetes, obesity, etc.), cryptogenic, Indian and Budd-Chiari syndrome.
According to morphological features, it is customary to distinguish the following types of the disease:
- small-nodular (small-nodular) type is determined when the size of the nodes is up to 3 mm;
- macronodular (macronodular) type - nodes are larger than 3 mm;
- septal variety of incomplete character;
- mixed variety.
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The severity of the disease
To assess the severity of the disease, several methods have been adopted using a scoring system. The Child-Pugh criterion allows you to score points for the following parameters:
- ascid: 1 point - absent; 2 points - mild, easily treatable; 3 points - intractable;
- encephalopathy: 1 point - absent; 2 points - easy; 3 points - severe form;
- bilirubin (µmol/l): 1 point — up to 34; 2 points - 34-51; 3 points - over 51;
- albumin (g): 1 point - over 35; 2 points - 28-35; 3 points - up to 28;
- PTV (s): 1 point - 1-4; 2 points - 4-6; 3 points - over 6.
The points obtained for all parameters are summed up, and the severity is divided into classes: A - up to 6 points; B - 7-9 points; C - 10-15 points.
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Carrying out ultrasound of the liver
Ultrasound methods provide enough information for diagnosis. The mechanism is especially visible in gray scale mode. To improve the effectiveness of ultrasound in differentiating cirrhosis from other liver diseases and various types of the disease, modern methods of color Doppler mapping (CCK), volumetric reconstruction of blood vessels, power Doppler, pulsed wave Doppler, harmonic detection, echo signal contrast are used.
When performing ultrasound of the liver, the analysis is carried out according to the following categories: the state of the border and the size of the organ, the appearance of abnormal inclusions, the uniformity of the structure in the affected area, the sound contrast of the inclusions, the appearance of a shadow zone behind the formations, the quantitative assessment of the inclusions and their diffusion.
Ultrasound for cirrhosis includes an assessment of the condition of the right and left lobes, as well as the caudate lobe. The gallbladder is examined along with the liver. Normal indicators of the size of parts of the body are:
- right lobe: height - less than 12 cm, thickness - less than 10 cm;
- left lobe: thickness - less than 5 cm, length, measured together with the right lobe, less than 17 cm;
- caudate lobe: length - less than 7 cm, thickness - 1.5-2 cm.
An important parameter in assessing the state of the liver is the coefficient calculated as the ratio of the thickness of the right lobe to the left (the norm is at least 1.3). With illness, the coefficient tends to decrease.
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Preparing for an ultrasound of the liver
To eliminate the influence of extraneous factors on the description of the disease based on the results of ultrasound, some preparation conditions should be observed. The procedure should be carried out after 8 hours after the last meal (4 hours are acceptable for children). Before research, you can only drink drinks without gas. The body in the area where the sensors are installed is lubricated with gel. The sensor is placed alternately in three mutually perpendicular directions.
Ultrasound of children is performed when the child lies on his back and takes a deep breath. Studies are carried out using different types of sensors: the beginning of the procedure is convex-type sensors with an expanded viewing area, then linear-type sensors are used for targeted observation.
Cirrhosis is a serious disease in which healthy functioning liver cells are replaced by "useless" connective tissue, which means that the organ ceases to perform its functions. This leads to gross violations of the work of the whole organism and, ultimately, death.
One of the simplest, fastest and most effective methods for diagnosing such a pathology is ultrasound of the liver: cirrhosis is usually clearly visible to a sonologist, which allows timely diagnosis and treatment. In the review and video in our article, we will analyze the main ultrasound signs of the disease.
Is cirrhosis visible on ultrasound? Definitely yes. However, it is important to remember that the information content of this method can be markedly reduced if the patient is not properly prepared for it.
The main thing to do is to reduce the possibility of increased gas formation. Gas bubbles collecting in the intestinal loops cause the latter to noticeably increase in size and overlap the liver: visualization can be significantly impaired.
Bloating is a serious hindrance
- Carry out the examination in the morning on an empty stomach. If the ultrasound is done at another time, the last meal should be no later than 5-6 hours.
- For 3-4 days, exclude from the diet all legumes, whole milk, alcohol, strong coffee and tea. Limit consumption of meat and fish.
- On the day before the procedure, drink no more than 1.5 liters of liquid in general.
- Eat fractionally, in small portions. 5-6 times a day. 4 hours before going to bed on the eve of going to the doctor, exclude any food and liquid.
Note! Ultrasound examination can be performed in different positions of the patient. The liver is best visualized in a supine position with arms down or with the right hand behind the head, and also lying on the left side. At the time of the examination, the doctor may ask the patient to hold his breath for a short time to better contact the sensor with the skin.
What will we compare with: how a healthy liver looks on ultrasound
To understand what changes occur with cirrhosis, it is important to know what a healthy liver looks like on ultrasound.
Normally, the organ has moderate echogenicity, its internal structure is homogeneous. At the same time, the liver tissue can be called heterogeneous, since it is penetrated by many blood vessels.
Table 1. Sizes of the liver on ultrasound in adults:
Table 2. The diameter of the hepatic vessels is normal:
Ultrasound diagnosis of cirrhosis
The ultrasound method for examining the liver is safe, non-invasive and quite informative.
It allows you to see:
- organ location;
- changes in its size;
- any kind of deformation of its contours;
- emerging inflammatory processes;
- tissue destruction;
- the presence of neoplasms (scars, nodes, abscesses, tumors).
Important! If a sonologist has found a volumetric formation in the thickness of the liver, the patient will need an additional study. It is not possible to judge the nature of the tumor only on the basis of ultrasound.
Unfortunately, it is impossible to answer the question of whether cirrhosis of the liver is visible on ultrasound with a 100% guarantee. It is quite simple to explain this: in every fifth case, the disease does not manifest itself clinically or morphologically for a long time, and during an ultrasound examination, the doctor can only notice small deviations that usually do not cause concern.
And yet, in 70-80% of cases, based on ultrasound diagnostics, cirrhosis can be suspected. To do this, the specialist draws attention to the direct and indirect signs of the disease.
Direct
The description of the liver in cirrhosis includes the following direct ultrasound symptoms of the disease:
- lack of a homogeneous structure of the organ, the presence of a large number of connective tissue strands, scars, nodes;
- loss of even contours by the liver: the organ seems to be covered with tubercles of various sizes;
- violation of echogenicity: the liver tissue becomes heterogeneous, it contains both hypo- and hyperechoic foci;
- distortion of the type of circulatory network; v. portae thickens, small vessels are almost not visualized;
- well-marked compaction of the walls of the diseased organ.
Indirect
In addition to direct, there are indirect ultrasound signs of cirrhosis, which help the doctor in making the correct diagnosis.
Among them:
- large areas of fibrosis in the portal zone of the liver;
- symptoms of disruption of the biliary system;
- an increase in the size of the spleen (more than 120 mm in length and 60 mm in width);
- portal hypertension: an increase in the diameter of the portal vein up to 15 mm or more.
Note! During the formation of collateral circulation, the dimensions v. portae may remain normal.
And what does an ultrasound study show at different stages of the disease? Characteristic signs of incipient and advanced cirrhosis are in the table below.
Table 3. Changes in the ultrasound picture depending on the stage of cirrhosis:
It is interesting. Help in the diagnosis of cirrhosis and external signs of the disease, which are usually well expressed. These include yellowing of the skin and mucous membranes, a sharp weight loss of a person, muscle atrophy, expansion of superficial veins on the body and face, an increase in the volume of the abdomen due to the accumulation of fluid in the abdominal cavity, and redness of the palms.
Differential Diagnosis
If a running pathological process in the liver is difficult to confuse with any other disease, then the initial forms of the disease often appear to the doctor under the guise of a variety of diseases.
Differential diagnosis of liver cirrhosis is carried out with:
- secondary portal hypertension (against the background of thrombosis, endophlebitis and other vascular problems);
- primary cancer or metastatic liver disease;
- portal fibrosis;
- hepatitis of viral and non-infectious etiology.
The main echoes of these diseases are presented below.
Table 4. Differential diagnosis of liver diseases:
| Pathology | Ultrasound signs |
| cirrhosis | In the initial stages - hepatomegaly (mainly due to the left lobe), then a general decrease in the organ due to ongoing dystrophic processes. Increased organ density, reduced elasticity and sound conductivity. |
| Secondary portal hypertension | The liver is normal or slightly reduced in size. Changes in the portal vein. Signs of angiomatous transformation, many collaterals. Significant slowdown in blood flow. |
| Moderate enlargement of the liver due to edema and inflammation. | |
| Liver cancer | Education in the liver tissue, which may have different echogenicity, fuzzy contours. You can find hypoechoic areas of necrosis, multiple decay cavities, calcifications, fibrosis. |
| portal fibrosis | Multiple small echoes from the parenchyma, recorded over the entire area of the cut. |
The final diagnosis is made to the patient not only on the basis of ultrasound, but also on the basis of the results of clinical, laboratory and additional instrumental examinations.
Usually the doctor uses all available techniques:
- collection of complaints and anamnesis;
- inspection (see photo below);
- palpation and percussion of the abdominal cavity;
- general analyzes - UAC, OAM;
- biochemical blood test;
- coagulogram;
- tests for viral hepatitis;
- EGDS;
- radiography;
- CT, MRI;
- according to indications - tissue biopsy with subsequent histological examination.
Difficulties in determining liver cirrhosis lead to the emergence of new, effective and efficient examination methods. However, it is too early to write off ultrasound: according to statistics, it was thanks to this diagnostic method that more than half of the cases of the disease were detected.
It is important for any person to remember the great importance of preventive examinations and visit a doctor regularly. It is best to identify cirrhosis at an early stage: in this case, it is easier to cure, and the prognosis for the patient is more favorable.
The destructive influence of alcohol, hepatitis and congestion often leads to cirrhosis. Liver changes are evidenced by blood, urine and stool tests, but the most effective diagnostic method is ultrasound, which is a painless procedure that does not require surgical intervention. Ultrasound for cirrhosis of the liver helps to notice the signs of the disease in time, identify the causes and prescribe the correct treatment.
Nowadays, ultrasound devices are available in many medical and preventive institutions, which greatly facilitates timely diagnosis. Due to this, the success of treatment of patients increases every year.
For the final conclusion, a comprehensive examination is carried out, since this method is not one hundred percent, although it allows you to accurately examine the condition of the organ and identify the signs of the disease.
At the onset of the disease, it is quite difficult to make a diagnosis based on the clinical picture, since it is often completely absent or slightly expressed. The same is true with ultrasound. Ultrasound of the liver in the early stages of cirrhosis is not very informative, since the signs of damage in the tissues and vessels are small. However, statistics say that about 70% of diagnoses are confirmed by ultrasound readings. The latest devices help to accurately assess the condition and parameters of the liver.
It is important that the research is conducted by a qualified specialist. It is also necessary to properly prepare the patient for the procedure.
Study preparation
To ensure maximum information content of ultrasound and make the correct diagnosis, it is necessary:
- three days before the ultrasound, exclude all gas-forming foods from the diet;
- conduct a study 4 hours after eating, preferably in the morning on an empty stomach;
- lubricate the area to be examined with gel;
- take a horizontal position on your back.
Norm with ultrasound of the liver
During the procedure, the homogeneity of the organ is carefully checked, its shape and size are also important. In the absence of pathology, ultrasound shows the following results:
- thickness of the right lobe - 13 cm, left lobe - 7 cm,
- KVR (oblique vertical size) of the right lobe - 15 cm,
- KKR (craniocaudal size) of the left lobe -10 cm,
- the length of the right lobe - 15 cm,
- the height of the left lobe - 10 cm,
- liver length - 18 cm,
- liver diameter - 23 cm,
- sagittal size - 12 cm,
- common bile duct - from 6 to 8 mm,
- portal vein - 13 mm, hollow - 15 mm in diameter,
- liver artery - from 4 to 7 mm.
With ultrasound of the children's liver, it must be taken into account that it grows, and at each age the indicators change:
| Age | Left lobe (cm) | Right lobe (cm) | Portal vein (mm) |
|---|---|---|---|
| 1 | 3,3 | 6 | up to 5.7 |
| 3 | 3,7 | 7,2 | up to 7 |
| 5 | 4,1 | 8,4 | up to 7.6 |
| 7 | 4,5 | 9,6 | up to 8.5 |
| 9 | 4,7 | 10 | up to 9.5 |
| 11 | 4,9 | 10 | to 10 |
| 13 | 5 | 10 | up to 10.2 |
| 15 | 5 | 10 | up to 10.6 |
The study also evaluates the structure of the organ. The normal contour of the liver is clearly visible and has no tubercles, the veins are not located in the center of the organ, the structure is homogeneous (homogeneous). The structure of the organ is fine-grained; the vena cava is recognized as a ribbon-like formation that does not reflect ultrasound waves.
Ultrasound for cirrhosis
The first thing that attracts attention when examining any internal organ is its size. With cirrhosis, the liver most often enlarges, but in the last stage it atrophies (reduces in size) and shrinks. During the height of the disease on ultrasound, it is noticeable that the left and caudate lobes are enlarged, and the edges and contours of the organ are changed. With small nodes, these signs may be absent. For other forms of the disease, the presence of a tuberous contour and a blunt edge is characteristic.
In the differential diagnosis of hepatitis and cirrhosis, these features are the most important. Signs such as the presence of a bumpy contour and regeneration in the form of nodes will indicate a more serious illness.
The circulatory system of the liver also undergoes changes. In contrast to the normal small vascular pattern, depleted features appear, the veins inside the liver have an inconsistent width. The diameters of the splenic and portal veins, as well as the hepatic artery, increase. There is a connection of the vessels of the abdominal cavity, which is not characteristic of a healthy person. In the splenic vein, the blood flow decreases or stops, a reverse movement is possible.
With the formation of scar tissue, ultrasound shows a different density of the parenchyma. An inhomogeneous structure will cause different passage of ultrasonic waves through the tissue. In this case, it is enough simply not to notice or mistakenly determine the presence of a tumor.
In 90% of cases, against the background of cirrhosis, the spleen is enlarged by more than 50 cm². With the development of the disease, signs of the spread of the pathological process in the abdominal cavity appear in the form of edema of the stomach and intestines. In the future, ascites is visible, which indicates the accumulation of fluid in the abdomen and the last (terminal) stage.
In the case of an autoimmune disease, there is a characteristic increase in the lymph nodes closest to the liver. A distinctive feature is the elongated shape, while in cancer with metastases they are rounded. The sizes are quite impressive - from 50 to 60 cm in length.
During an ultrasound of the liver, the doctor makes a description of the pictures and records the dimensions. This data is then passed on to the attending hepatologist or general practitioner.
Symptoms of cirrhosis
If you have a temperature above 38ºС, swelling of the legs and weakness, you should be concerned and consult a doctor. Cirrhosis is characterized by lack of appetite, weight loss, muscle pain. In men, the mammary glands enlarge. Timely treatment to a medical institution and the appointment of treatment will help to overcome the disease. Vascular asterisks on the skin and an increase in the volume of the abdomen indicate an advanced stage. The patient's skin acquires a yellowish tint, then a more saturated color, which attracts attention.
It must be remembered that it is impossible on your own at home. This requires medications and quality examinations, not traditional medicine.
