The liver is the largest digestive gland. It is located in the abdominal cavity, occupies the right hypochondrium, partially the epigastric and left hypochondrium.
Its weight ranges from 1500-2000 g, depending on gender and blood supply; the shape is wedge-shaped.
Counts a lot of clicks, thanks to the organs that come into contact with it:
Contains 2 surfaces - diaphragmatic, visceral, they converge in front and form a sharp lower edge; 2 edges (bottom, back); the right and left lobes, which are separated by the falciform ligament.
Structure of the liver
Performs important functions for the functioning of the body, such as:
Thanks to palpation, percussion, and ultrasound, its size can be determined. This will allow us to establish a diagnosis in the future and correctly prescribe treatment.
The method for determining the size of the liver according to Kurlov is as follows:
The dimensions and boundaries can be determined through percussion (which involves tapping a section of the organ and analyzing sound phenomena). When percussing the liver, it is normal to hear a dull sound because it is dense and does not contain air.
M. Kurlov proposed the most informative method for recognizing the boundaries of the liver: 5 points are determined during percussion, which indicate its true ones.
Having determined the boundaries of five points, three sizes are measured.
For adults, normal sizes according to Kurlov:
| Sizes by points | Measurement in centimeters |
|---|---|
| First (distance between points I and II) | 9-11 cm |
| Second (between III and IV points) | 8-9 cm |
| Third (oblique) (between III and V points) | 7-8 cm |
The size of the right lobe of the liver is indicated by the first size, the left - by the second and third.
Percussion dimensions in children (according to M. G. Kurlov), in centimeters.
Sizes vary significantly depending on individual accessories.
In newborn children, the liver is functionally immature and large. In newborns, the left lobe is large, which decreases at the age of one and a half years; The segmentation of the liver is not clearly expressed and is formed by the end of the first year of life.
Determining boundaries according to Kurlov in children under 3 years of age is not effective enough; preference is given to palpation. Normally, the lower edge protrudes 1.5-2 centimeters below the right costal arch, and subsequently does not protrude from under the costal arch.
In a child, the histological structure of the liver corresponds to that of an adult at 8 years of age, and by that time it has poor development of connective tissue, manifested by large vascularization and inadequate differentiation of parenchymal tissue.
An upward shift of the upper limit is observed in the following diseases:
Moving the upper limit down (low aperture).
The health of the liver is always reflected in its size. With most viral and bacteriological infections, this organ enlarges due to inflammatory and degenerative processes in the parenchyma. Therefore, it is important to know exactly the size of the liver - the norm for an adult has long been established in medical practice; any deviations from these indicators indicate the presence of a disease.
The reference values for adults do not depend on gender, so the normal sizes of the organ in question in women and men are approximately the same. It is worth noting that the indicators are not affected by the patient’s age, weight, or height.
To determine the described values, you should run .
The normal dimensions of the liver for the right lobe of the organ are as follows:
The total length of the liver should be at least 14, but not more than 18 cm, and the diameter should be from 20.1 to 22.5 cm.
Normal liver size on ultrasound for the left lobe:
It is worth noting that it is important to set additional parameters during the examination:
The indicated diameters are given for studies during inhalation. During exhalation they are slightly lower.
During an ultrasound examination, it is important to evaluate not only the size of the liver, but also the structure of its tissue, condition, clarity of contours and location of the organ.
The described technique involves palpation (finger) examination of the liver, which is also called an assessment of hepatic dullness. First, the entire area where the organ is located is tapped; when a dull sound is detected, the distance between two points of the lower and upper border of liver dullness is measured. You need to use straight vertical lines.
Svetlana Sharaeva
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Dimensions are determined by palpation. This diagnostic method helps the doctor decide on therapeutic tactics. In this article we will look at the main dimensions of the liver according to Kurlov, which make preliminary diagnosis more accurate.
At the initial stage of liver disease, there may be no specific signs or changes in the structure of hepatocytes. When an organ increases in size, a pain syndrome appears, caused by stretching of its membrane. The nature of the pain varies from aching to acute.
Liver pathology can be detected at an early stage using palpation and percussion. These are accessible diagnostic techniques that do not require time.
With their help you can:
It is not considered a deviation from the norm if the edge of the liver protrudes 2 cm along the midclavicular side and 6 cm along the median border.
Note! Due to lung resection, the liver may be located higher than it should be.
The soreness of the organ is determined during palpation. To determine the size of the liver, the Kurlov method is used.
The famous Russian and Soviet therapist M.G. Kurlov proposed his own method for determining the boundaries of the liver. This method is considered the most informative.
The calculation technique involves identifying 5 points using percussion.
Table 1. How to identify Kurlov ordinates?
The tablet provides information about the size of the liver proposed by M. Kurlov.
Table 2. Three liver sizes.
In infants at 1 month of life, liver function is poorly developed. The size of the organ is increased. The right lobe of the liver is smaller than the left. These parameters are reduced to one and a half years.
The segmentation of the liver in newborns is not clearly expressed. It is fully formed by 12 months. The lower edge of the liver does not protrude.
The histological structure of the liver is finally formed only when the child reaches the age of eight. Until this time, the connective tissues of the organ are poorly developed, the parenchyma is not completely differentiated.
Note! The Kurlov method is not effective for children under three years of age. The optimal age for such diagnosis is 7 years. Before this, the boundaries of the liver are determined by palpation.
The norms for liver size in children are presented in the table.
Table 3. Liver sizes in children according to M. Kurlov.
| Age | Left share (cm) | Right lobe (cm) |
|
|
3,3 | 6 |
|
|
3,7 | 7,2 |
|
|
4,1 | 8,4 |
|
|
4,5 | 9,6 |
|
|
4,7 | 10 |
|
|
4,9 | 10 |
|
|
5,0 | 10 |
One of the primary symptoms of the development of a pathological process is a shift in boundaries.
Table 4. Diseases that develop when the upper limit is shifted.
| Pathology | % occurrence |
|
|
30 |
|
|
22 |
|
|
38 |
|
|
12 |
This condition is called low diaphragm. The occurrence rate is 36%.
Table 5. Probable diseases.
| Disease | % occurrence |
|
|
50 |
|
|
35 |
|
|
27 |
The occurrence of possible pathologies is presented in the table.
Table 6. Diseases accompanying an increase in the lower limit.
| Disease | % occurrence |
|
|
28 |
|
|
56 |
|
|
32 |
|
|
60 |
This deviation occurs in 42% of cases. Information about possible diseases is presented in the tablet.
Table 7. Pathologies accompanying a decrease in the lower limit.
| Disease | % occurrence |
|
|
65 |
|
|
78 |
|
|
12 |
|
|
23 |
By moving the fingers, the doctor can determine by touch the boundaries of the liver and clarify the level of pain. The presence of pain, which intensifies during palpation, signals a violation of the liver. This criterion is used in differential diagnosis.
Note! Palpation is performed according to the method proposed by Strazhesko and Obraztsov.
The instructions look like this:
Palpation reveals the parameters of the following lines:
A healthy person's liver is round, soft and smooth.
This method was discovered in Austria in the 60s of the 18th century, but gained popularity only 100 years later. The definition of absolute dullness is of clinical importance - parts of the hepatic lobes not covered by lung tissue.
The criterion for determining the boundary is the change in percussion sound. The range can range from clear pulmonary to dull.
When deciphering the obtained data, the age of the patient is taken into account. In adult patients, the weight of the organ under study is 2-3% of the total weight. In infants, the liver weight is 6%.
The younger the child, the larger the volume of the abdominal cavity is occupied by the hepatic lobes.
Data on modern diagnostic methods are presented in the table.
Table 8. Other methods for studying the liver.
| Method | What determines? |
|
|
Borders of the liver |
|
|
Liver volumes |
|
|
Liver dysfunction |
In order to prevent the development of dangerous liver diseases, it is necessary to undergo a medical examination once every six months. You also need to adhere to preventive recommendations.
More detailed information about the Kurlov method, palpation and percussion can be found in the video in this article.
The liver is one of the largest human organs. There are certain standards that it must meet depending on the gender and age of the person. Any deviation from these indicators is the first signal that it is not working correctly. Let's consider what liver sizes are normal and what it means if the diagnosis reveals that the organ does not meet the norms.
The most optimal examination method is ultrasound. Ultrasound allows you to fully study the boundaries and structure of the organ. The specialist takes into account the fact that the size of the liver can fluctuate within a certain range depending on the gender and age of the patient.
Ultrasound diagnostics are permitted for patients of all age categories and have no contraindications. Ultrasound is indicated when the patient complains of pain, discomfort in the right hypochondrium, in the presence of diseases (for example, cirrhosis, hepatitis) to determine the progression of the pathology.
An ultrasound examination is prescribed in the presence of symptoms such as:
The procedure is fairly quick, painless and does not cause the patient any discomfort. In most cases, ultrasound is performed with the patient on the couch in a supine position. If necessary, for a more detailed examination, the doctor may ask the patient to change position.
A special gel is applied to the area to be examined, and then the doctor conducts an examination using an ultrasound probe. An ultrasound sensor emits sound waves of a certain frequency and strength. Visualization occurs on a computer monitor.
The location of the liver allows us to examine the organ in as much detail and in an accessible form as possible. However, it is impossible for a doctor performing an ultrasound procedure to immediately visualize the entire liver at once due to its large size. Therefore, the doctor takes several slices of images to create a single picture. Using ultrasound, it is possible to determine the contour of an organ, its size, shape, and structure.
The caudal lobe, quadrate lobe and their segments are examined in as much detail as possible. Using this diagnostic technique, existing pathologies are identified.
When diagnosing a patient using ultrasound, the following indicators are determined:
Doctors note that the main result and diagnosis is made on the basis of data on the vertical oblique size, especially in relation to the right lobe of the liver.
Normally it should not exceed 150 mm. If this indicator is increased, there is a high probability of hepatomegaly (poisoning by poison or toxic waste). Deciphering this data is very important for further diagnosing the patient.
During ultrasound diagnostics, a specialist determines the density of the organ (echogenicity). Overestimated or underestimated values are another sign of serious pathology. If data on liver size have a certain error depending on the age and weight of the patient, then these parameters do not have any effect on echogenicity.
As you know, the liver is one of the largest unpaired organs. Normally, for an adult (male) it can weigh up to 1.6 kg. Women weigh slightly less - about 1.3 kg. A healthy organ has a clear contour, a pointed edge, and a smooth, even structure.
The liver performs the following functions:
The liver performs extremely active work every day. It is extremely important to monitor its operation, as well as the overall condition of the organ, since the risk of failure is high. It is worth familiarizing yourself with the normal sizes for an adult (Table 1) and for a child (Table 2).
Table 1 - Normal indicators for an adult
Experts note that women have slightly different organ sizes compared to men. Men have larger livers.
Table 2 - Optimal liver sizes for children
When diagnosing, a method for determining the size of an organ according to Kurlov can be used. A doctor of medical sciences suggested determining the size by visually dividing the organ with borders and points:
According to the distribution of the liver along these boundaries, the specialist identifies the true size of the organ. According to Kurlov’s method, the right lobe in an adult has a size from 9 to 11 cm (determined by the distance of the first and second boundaries), and the left lobe – from 7 to 8 cm (borders 3 and 4).
A change in the size of the organ is a direct signal that there are liver pathologies. If the overall size of the organ does not correspond to acceptable values, then we may be talking about a progressive inflammatory process.
It can be caused by various diseases, such as hepatitis, fibrosis or cirrhosis. Also, such a violation may indicate stagnant processes. If a deviation from the norm is observed in only one lobe of the organ, this may mean the presence of a tumor, growing metastases of cancer or a cyst.
However, liver enlargement is not always caused by any disease. Often such a violation is observed with uncontrolled consumption of medications, as well as with bad habits (and not only with a special love for alcoholic beverages, but also for cigarettes). But this is only possible if, with liver enlargement, the structure of the organ does not change and remains smooth and even.
Enlargement of the organ and detection of fibrous tissue is the most likely sign of a severe inflammatory process. Moreover, it is accompanied by unevenness and heterogeneity of the surface, changes in structure, and the appearance of uncharacteristic spots.
According to statistics from diagnostic centers, the liver is one of the most frequently examined organs using ultrasound. Let's consider the opinions of specialists and patients regarding this procedure:
Elena, St. Petersburg:“The attending physician sent me for an ultrasound, which showed the results of the borders of the liver with very strange indicators. The left lobe is determined to be 54 mm in size, and the right lobe is 98 mm. The surface is homogeneous, smooth, the contour is clear, the bile ducts are not dilated. The only thing is that the echogenicity is slightly increased. The concern was that 3 years ago I had an ultrasound, and the dimensions were much larger - the right lobe was 130 mm!
The first thought is cirrhosis at the progression stage. The doctor sent me for a second examination, reassuring me that errors were possible during the ultrasound. He also prescribed fibroscan diagnostics. As a result, it turned out that in fact the first results were false, but this time they revealed fibrosis of the 1st degree. The doctor noted that the pathology was detected at an early stage and is quite treatable.
My conclusion is this: if the examination results look incorrect, it is better to undergo a re-examination. However, in any case, modern equipment is not capable of producing a global error. If a deviation from the norm is noted (even taking into account the error of the research methodology), there is a high probability of pathologies.”
Harutyunyan K.V., hepatologist:“When performing an ultrasound, it is important to take into account not only the data obtained on the size of the organ, but also compare it with the height, weight and gender of the patient. For example, I had a case in my practice where an ultrasound showed a CVR of 155 mm. If you look at the table indicating normal indicators, then this value is perceived as an excess.
However, the patient’s height was 195 cm. And it is for him that such indicators are normal. Experts have come to the conclusion that for patients with a height of within two meters, values up to 160 mm can be considered normal. Therefore, you should not diagnose yourself when reading the results of a liver ultrasound. This should only be done by a doctor. There is always the possibility of individual deviations from the norm.”
Panfilov K.V., doctor:“Ultrasound diagnostics is a mandatory procedure for identifying liver pathologies. Ultrasound allows you to most accurately determine the boundaries of an organ, its size, and structure. If the results of the study indicate deviations from the norm, this is the first signal of the presence of pathology.
It is important to determine whether the entire liver is enlarged or just one of its lobes. If there is a discrepancy between the size of both lobes, such a violation may be associated with serious diseases, such as hepatitis or cirrhosis. If only one lobe has undergone changes, then the risk of cancer is high. It could be a benign tumor, a cyst or cancer.”
Kondratyeva T.V., doctor:“The norms for liver size are associated with the patient’s gender, weight and height. However, when diagnosing children using ultrasound, it is important to remember that in this case the question of gender and age is not relevant. Children develop differently: one child may weigh 8 kg at one year of age, while another may weigh 13 kg.
In addition, girls often grow more actively than boys. And this clearly contradicts the statement that in the male body the liver is larger than in the female. When it comes to ultrasound diagnostics of children, it is important to compare the obtained research indicators only with the physical development of the young patient. Table standards in this case are not always relevant.”
The size of an organ has a direct bearing on its condition. When it comes to diagnosing the liver, minor deviations from the norm are acceptable due to the individual characteristics of the patient.
However, if the boundaries of the organ go beyond what is acceptable, the problem may be the presence of pathology. This may be due to drug poisoning, cancer, or actively spreading metastases. In any case, only a specialist should diagnose the patient and interpret the results.
A free self-test will help you determine if your liver is damaged. The liver can be damaged by drugs, mushrooms or alcohol. You may also have hepatitis and not know it yet. You will answer 21 clear, simple questions, after which it will become clear whether you need to see a doctor.
Specialist in modeling acute and chronic poisonings, author and co-author of models of the most dangerous of the most common poisonings, created over ten years based on clinical data (more than 400 cases) of the toxicology department of the 1st City Clinical Hospital, Center for Extrarenal Methods of Cleansing the Body (Kazan) and information -consultative toxicological center of the Ministry of Health of the Russian Federation (Moscow).
A gastroenterologist is also an expert in this section. Purgina Daniela Sergeevna.
Daniela Sergeevna works at the medical center of the Pasteur Research Institute of Epidemiology and Microbiology. Engaged in the diagnosis and treatment of patients with a wide range of gastrointestinal diseases.
Education: 2014—2016 — Military Medical Academy named after. S. M. Kirova, residency in Gastroenterology; 2008—2014 — Military Medical Academy named after. S. M. Kirov, specialty “General Medicine”.
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