The edges of the liver may be palpable and soft in normal people with a thin body. A moderately hard liver is seen in hepatitis, liver abscess, schistosomiasis, fatty liver, and malaria. A hard liver is seen in cirrhosis, advanced schistosomiasis, bruising cirrhosis, malignancy, leukemia, hepatic amyloidosis, and syphilitic liver, all of which can manifest as hepatomegaly. Physical examination is mandatory for the examination of hepatomegaly, and the specific examination steps are.
(a) extent of lesion
1.Diffuse enlargement
Due to generalized liver lesions, seen in various hepatitis J fatty liver, hepatic amyloidosis, liver stasis, cirrhosis, hepatocellular carcinoma, metastatic carcinoma, and cholangiocarcinoma.
2.Limited enlargement
Due to intrahepatic occupying lesions, seen in liver abscess, liver cyst, liver tumor, liver worm, etc.
(II) Hardness of the liver
The edge of the liver can be palpable and soft in normal people with a thin physique. Medium hardness of the liver is seen in hepatitis, liver abscess, schistosomiasis, fatty liver, malaria, etc. A hard liver is seen in cirrhosis, advanced schistosomiasis, bruising cirrhosis, malignancy, leukemia, hepatic amyloidosis, syphilitic liver, etc.
(iii) Margin and surface of the liver
The edges of chronic hepatitis and bruised liver are blunt and the surface is still smooth, while the edges of cirrhosis are sharp and the surface is nodular.
(IV) Pressure pain
The pressure pain is obvious in acute hepatitis, acute liver stasis, acute cholangitis or biliary colic attacks, more intense in bacterial or amebic hepatoma, mainly limited pressure pain, often no obvious pressure pain in hepatocellular carcinoma, light pressure pain in chronic hepatitis, cirrhosis * fatty liver, liver amyloidosis and syphilitic liver usually no pressure pain.
(E) Xanthogranuloma
Viral hepatitis, biliary cirrhosis, extrahepatic biliary obstruction are common.
(F) Wasting
Hepatocellular carcinoma and cirrhosis may be associated with significant wasting.
(vii) Ascites
It is seen in hepatocellular carcinoma, cirrhosis, acute and subacute hepatic necrosis, and circulatory disorders.
(viii) Spider de and moon palm
Seen in chronic hepatic substantive lesions.
(ix) Purple epilepsy, gum bleeding and other bleeding and coagulation abnormalities
Seen in severe liver disease, long-term obstructive xanthogranuloma, blood disorders, leptospirosis, etc.