Overview
Hepatic prolapse refers to the downward displacement of the liver except for pathologic hepatomegaly, also known as hepatic subluxation. Under normal circumstances, the lower edge of the liver cannot be touched under the costal arch; the lower edge of the liver does not exceed 1 cm below the costal arch and 3 cm below the xiphoid process in those with a flabby abdominal wall and thin body; the lower edge of the liver can reach up to 5 cm below the xiphoid process in those with a slender body, but does not exceed the middle and upper third of the distance from the xiphoid process to the umbilicus. Hepatic prolapse is rare, manifested as the lower edge of the liver exceeds 1cm below the rib arch and 3cm below the xiphoid process during deep inhalation, the upper border of the liver is reduced accordingly, and the upper and lower diameters of the liver are normal, and the liver is soft in texture, smooth on the surface, and free from pressure pain.
Etiology
This disease is related to the weakening of the supporting role of various suspensory ligaments of the liver, abdominal wall and intestines and local factors pulling or causing the diaphragm to fall. Hepatic prolapse is divided into congenital and acquired, the former is mostly related to the absence or weakness of the coronary ligament or suspensory ligament. Acquired hepatic prolapse is mostly related to the lesions of liver supporting tissues caused by nutritional factors, such as laxity and lengthening of suspensory ligament, weakening of abdominal muscle tension, reduction of intra-abdominal pressure and intestinal prolapse causing the liver to lose the intestinal support, etc.; emphysema, large pleural effusion on the right side, and lung cancer, etc., resulting in the decline of diaphragm can also promote hepatic prolapse; tumors of neighboring organs are adhered to the liver, and the tumor increases and pulls the liver to make its position shift downward; high-intensity work, Exercise can also induce liver prolapse; gallbladder disease can also cause liver prolapse.
Symptoms
1. Symptoms
In mild cases, there is no special manifestation, and a soft mass in the right upper abdomen is usually detected during physical examination. In severe cases, dyspepsia, anorexia and vomiting may occur, which are mostly caused by the liver being pulled or compressed. Liver prolapse caused by severe coughing can be felt as tearing or twisting on the right side of the trunk, accompanied by severe chest or abdominal pain, and nausea, dyspnea, abdominal fullness, or even fainting can occur at the same time.
2. Physical signs
On palpation, the lower edge of the liver exceeds 1cm below the arch of the ribs and 3cm below the xiphoid process, with soft texture, smooth surface, no pressure pain, and the upper border of the liver is shifted downward.
Examination
1. X-ray
X-ray can help to understand the size of the liver, the right diaphragmatic dome and the upper and lower boundaries of the liver.
2. Abdominal ultrasound
It can more accurately show the position of the upper and lower boundaries of the liver, the thickness and mobility of the liver.
Diagnosis
According to the corresponding signs, combined with X-ray and abdominal ultrasonography, it is helpful to diagnose the case when the liver position is shifted downward but the upper and lower diameters of the liver are normal.
Differential diagnosis
The disease needs to be differentiated from hepatomegaly. Common diseases causing hepatomegaly include acute viral hepatitis, hepatic stasis, biliary stasis, liver abscess, hepatocellular carcinoma, and hematologic infiltration of the liver. Pathologic liver is mostly accompanied by fever and jaundice, and laboratory tests of liver function may reveal significant abnormalities.
Treatment
1. Conservative treatment
Including nutritional support, electrotherapy and other methods. For mild liver prolapse caused by malnutrition, nutritional support can be used. Electrotherapy can increase the muscle tension of abdominal wall. Acquired hepatic prolapse is mainly treated for the cause of the disease.
2. Surgical treatment
Surgery is aimed at restoring the position of the liver as much as possible, avoiding liver ptosis causing injury or pressure symptoms on other organs. Surgical treatment for partial hepatic prolapse includes lobectomy, partial hepatic fixation and cholecystectomy; complete hepatic prolapse can be treated with complete hepatic fixation.
Nursing care
Mainly postoperative care. Observe the vital signs and wound dressing, change the dressing regularly, and prevent infection by strict aseptic operation. Enhance the early activities of the limbs after surgery to prevent deep vein thrombosis, prohibit strenuous activities, and try to avoid violent coughing caused by various reasons.