Liver is largest gland of human body. The weight of this organ is from 3 to4 lb. Liver is located in the right upper area of the abdominal cavity and its color is dark red.

Importance of the liver for the organism

The liver is an extremely multipurpose organ and performs a great variety of functions. The liver absorbs various substances from the blood and releases waste materials and poisons. It is a useful reservoir of glycogen, vitamins, and minerals. The liver synthesizes many important proteins and enzymes. This organ takes part in the production of blood clotting factors such as prothrombin and fibrinogen, as well as the anticoagulant heparin. The liver removes the nitrogen of amino acids and uses it to create new proteins from carbohydrates and fats. Moreover, the liver can produce carbohydrate from fat and protein. The liver can as well create fat, store it and then discharge into the blood in the form of fatty acids used for energetic purposes. The liver takes part in cholesterol synthesis. The liver participates in endocrine function excreting various hormones such as estrogen and steroids. This organ also exerts immune functions owing to liver phagocytes that eliminate bacteria from the blood. The liver takes part in bilirubin metabolism and bile secretion. The liver activity produces a great amount of heat and in this way it regulates body temperature.

Diseases and conditions leading to liver enlargement

Liver enlargement is the most often symptom of liver diseases. The reduction of liver size is detected by physicians considerably less frequently. Liver enlargement can be caused by hepatocyte dystrophy, as it occurs, for example, in hepatoses and thesaurismoses; lympho-macrophage infiltration in acute and chronic hepatites, development of regeneration focuses and fibrosis in cirrhoses; stagnation of blood in heart insufficiency, phlebitis of hepatic veins, constrictive pericarditis; intrahepatic cholestasis in primary biliary cirrhosis of the liver and extrahepatic cholestasis in the diseases leading to the disturbances of bile outflow and the formation of secondary biliary cirrhosis; focal affections by tumors, cysts, and abscesses. The enlarged liver in some cases is already visible at the examination of the abdominal area as a tumor-like formation displacing with breathing movements in the right subcostal area or in the epigastric area. Long-term and substantial liver enlargement can lead to the deformation of the thorax; however, intercostal spaces are not usually filled in.

Methods for determining the liver size

Percussion of the organ gives rather approximate results. For determination of the liver sizes doctors find its top and bottom borders on parasternal, middle clavicular and anterior axillary to lines. In normal conditions the distance between the percussion top and bottom borders according to these lines makes 10-12, 9-11, and 8-10 cm. Besides this doctors also determine the left border of the hepatic dullness which in norm does not leave the left parasternal line.
Palpation gives more precise data. In 88 % of healthy people the lower edge of the liver can be palpated, it is of a soft consistence, painless, and smooth. In liver diseases it can be hard and sharp; in patients with cardiovascular blood stasis the edge is rounded; in neoplasm affection and parasitic diseases the edge is knobby.
The neoplasms of the gallbladder, colon, and the right kidney can be taken for the edge of the right liver lobe. Hepatoptosis can also simulate hepatomegaly. Lung emphysema, exudative pleurisy, and subdiaphragmatic abscess result in liver displacement to the bottom. To distinguish the true liver enlargements from these conditions, doctors use the palpation in various positions of the patient and survey roentgenoscopy of the abdominal cavity.
The rapid liver enlargement is typical for acute virus hepatitis and malignant tumors. The quick reduction of the organ, if it is not connected to taking of diuretic preparations in congestive heart failure, is indicative of the development of massive necroses and is bad prognostic sign.
Painfulness at palpation is particularly characteristic for the nutmeg liver, acute inflammatory changes, and as a rule it is connected to the stretching of the fibrous capsule. In chronic liver diseases the painfulness of the organ in palpation appears during the exacerbation of the process, cholangitis development, and suppurative complications. Visit to the doctor is in these cases is obligatory.