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Karaciğer büyümesiyorum yapılmamış



karaciğer büyümesiKaraciğer boyutunda normal üst sınır 14 cm dir. Bunun üstüne hepatomegali denir. Karaciğerin muayenede ele geliyor olması karaciğerin mutlaka büyük olduğu anlamına gelmez. Akciğer sorunları nedeni ile karaciğer aşağı itilebilir ve bu durumda büyümüş zannedilebilir.

* Hepatomegali olmadan karaciğerin palpe edildiği durumlar şunlardır.
* Sağ diyaframın aşağı doğru yer değiştirdiği haller (amfizem, astım)
* Subdiyafragmatik lezyonlar (abse)
* Riedel lobu (sağ lobun inguinal bölgeye kadar uzandığı karaciğerin konjenital anomalisi)
* Astenik veya karın kasları zayıf kişiler
* Karaciğer derin soluk almada 1-3 cm aşağı inebilir.
* Safra kesesi, kolon kanseri yada ele gelen fekal (gaita) kitle hepatomegali ile karışabilir.

Dolayısıyla hepatomegali radyolojik inceleme ile doğrulanmalıdır

Hepatomegali nedenleri

* Sağ kalp yetersizliği
* Budd-Chiari sendromu (hepatik ven trombozu)
* Konstriktif perikardit
* Trikuspit yetersizliği
* Hepatik venüllerin tıkayıcı hastalığı (venooclusive disease)

Safra yollarında tıkanma

* Koledokta (Ana safra kanalı) darlık, taş, tümör vs

İnflamatuar bozukluklar

* Yerel enfeksiyonlar-
o amibik veya pyojenik abseler
* Diffüz enfeksiyonlar-
o viral hepatit,
o tbc , brucelloz, histoplazmoziz
o Tifo
o Sepsis
o İnfeksiyoz mononucleosis
o Sıtma, şistozomiasis, kala azar

Siroz

İnfiltratif hepatomegaliler(değişik hücrelerce veya organik maddelerce karaciğerin içten içe işgali)

* Kemik iliği ve retiküloendotelial hücreler
o Ekstramedüller hematopoez
o Lösemi,
o lenfoma
* Yağ
o Karaciğer yağlanması (steatohepatit, alkol- diyabet-toksinlere bağlı)
* Lipoidozlar
o Amiloidoz
o Hemokromatozis
o Granülomatöz hastalık (tüberküloz, sarkoidoz)

Neoplazik hepatomegaliler

* Primer(karaciğerin kendinden kaynaklanan)
* Metastatik(Başka organlardan yayılıp gelen kanserler)
* Kistik (içi sıvı dolu keseciklerle giden) Hepatomegaliler
o Kist hidatik (Köpek veya benzeri yabani vahşi hayvanların dışkısından bulaşır) dışkılarınan bulaşır
o Polikistik hastalık

Fizik muayene

Karaciğerin ele gelmesi ve ele gelirken aşağıdaki bazı özellikleri önemlidir.

– Hassasiyet
– Düzenlilik
– Kıvamı
– Keskinliği

Özellikler hakkında bazı detay noktalar:

* Hassas olması — inflamasyon , hepatit
* kenar künt olması — konjesyon (kalp yetmezliği)
* Karaciğerde pulsasyon — Hepatojugular reflü, Triküspid yetmezliğinde pozitif, Budd chiari sendromunda (-) dir
* Karaciğerin venöz konjesyonu — Ağrılı, yumuşak ve düzgün yüzeyli olurlar
* Enfeksiyon hastalıklarında– KC ağrılı veya ağrısız, yumuşak veya sert olabilir. Sistemik infeksiyonun parçası olduğunda diğer bulgulara dikkat edilmelidir. Viral markerlar, seroloji, ve kültürler faydalıdır.
* İnfiltratif hastalıklar -Hücresel boyutda karaciğerin dokusunun işgale uğraması
o Kc büyük orta sert veya sert ve genelde ağrısızdırlar
o Birikebilen Maddeler: glikojen, lipid, galaktoz, amiloid, demir, bakır
o Hücreler:lösemi, lenfoma, myeloproliferatif hastalıklar sarkoidoz
* Kenar sert -sirotik karaciğer
* Ağrısız büyük safra kesesi– pankreas başı ca ve kronik pankreatitde olabilir ikter ön plandadır
* Kaya sertliğinde- karaciğer tümör
* En çok büyüten hastalıklar– karsinom, yağlı infiltrasyon, konjestif kalp yetmezliği, hodgkin hastalığı, amiloidoz
* KC boyutlarının hızla azalması –konjestif kalp yetersizliği, masif hepatik nekroz
* Frotman (karaciğer üstünde sürtünme sesi)à yeni yapılan biyopsi, tümör, perihepatit
* Venöz hum — portal hipertansiyon
* Arteryel üfürüm — Hepatosellüler karsinom (primer karaciğer kanseri)



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