Ultrasound of the abdominal organs of the child. How do ultrasound of the abdominal organs in children - preparation for the study Normal size of the liver in a child of 4 years

Modern methods for diagnosing various liver diseases in children also include ultrasound. This examination has already become routine and is used in a variety of clinical cases. Establishing the size of the liver is included in any clinical protocol for conducting ultrasound.

Features of the structure and functioning of the liver

The liver is an organ that is responsible for a variety of functions in the body. These include: the synthesis of certain hormones, the detoxification of decay products and chemical toxins, participation in hematopoiesis, the formation of bile, the maintenance of immunity, and many others. Determining the size of the liver is very important. Many pathological conditions, including those that are very dangerous for the life and health of children, cause a significant increase in the liver - hepatomegaly.

For quite a long time, only the palpation method was used to determine the boundaries of this organ. It is carried out by doctors and to the present time during a clinical examination of the child. However, palpation of the liver and the definition of boundaries by this method is only indicative. The true dimensions of the organ can be determined only when using special instrumental types of surveys.

Currently, such instrumental tests include ultrasound. It is safe and does not cause any pain in the child during the procedure. Usually the duration of one study is 20-25 minutes. The time of the ultrasound procedure usually depends on the qualifications and experience of the doctor conducting the examination, as well as on the emotional state of the child. If the baby is nervous or starts screaming and crying, then this can significantly complicate the study.

Ultrasound is usually performed in a special darkened room. The baby lies on his back on a couch covered with a diaper. The doctor lubricates the sensor with a special gel and begins to conduct research. During the examination, the doctor can see all the pathological changes in the liver tissue, as well as determine the size of the borders of the liver.

Ultrasound examination is actively carried out for babies from 2 years old. At an earlier age, there are certain clinical indications for ultrasound.

There are special tables that indicate the normal values ​​\u200b\u200bof the size of a healthy liver. They are used by doctors of ultrasound diagnostics working around the world. The tables are compiled taking into account the age of the child. They allow doctors to evaluate the result, and are also necessary to establish clinical signs of hepatomegaly.

The structure of the liver includes several anatomical formations - they are called hepatic lobules. Ultrasound allows you to set the parameters of the right, caudate, left and square lobes of the liver. Also, using this study, you can identify various pathological changes in all 8 segments. Ultrasound is also very effective for diagnosing the detection of various hepatic pathologies in newborns.

In addition to the structure of the liver tissue, the ultrasound doctor also performs visual inspection of all adjacent anatomical organs with the liver. Experienced doctors can also assess the condition of the liver ligamentous system. Usually, the ligaments become visible when free fluid appears in the abdominal cavity.

During the study, the doctor also examines the blood vessels that feed the liver. For this, an additional Doppler mode is used.

Currently, there are a huge variety of very diverse tables that indicate the age parameters of the normal size of the liver. Below is one of them. To assess the state of the organ, the dimensions of the right and left lobes of the liver are mainly used. Options depend on the age of the baby. It is important to note that these indicators are indicative and should be assessed comprehensively when making a clinical diagnosis.

Normal liver size (from upper to lower edge) is presented in the data of the following table:

Preparation

Determining the exact boundaries of the liver and the true size of this organ by ultrasound is quite simple. The high resolution of the devices allows you to get the most clear and reliable images of the internal organs. Hundreds of thousands of ultrasound examinations are performed every day around the world.

To obtain an accurate result when reviewing internal organs, it is very important to conduct preliminary preparation. Many parents often neglect this, which subsequently leads to the fact that ultrasound diagnostic doctors cannot establish an accurate diagnosis. Preparing for an ultrasound scan is not complicated and it is quite easy to do it yourself at home.

The main condition for performing a qualitative study is the release of gas from the intestines. It greatly reduces the reliability of the result.

Gas-inflated intestinal loops do not allow the doctor to fully examine the liver and all its anatomical components. In order to reduce gas filling, a couple of days before the study, all foods that increase gas formation are removed from the baby's diet. These include: fruits and vegetables rich in coarse fiber, bread and pastries, carbonated drinks and kvass, milk, as well as a variety of confectionery.

If the baby has chronic diseases of the digestive system that cause pronounced gas formation, then you should consult with your doctor about which drugs should be used on the eve of the ultrasound procedure to reduce gases in the intestines. Usually, children are prescribed enzyme agents and enterosorbents. Before an ultrasound examination, the baby should not undergo gastro- or fibrocolonoscopy.

The psychological attitude before the study is also very important, especially for the youngest patients. It is better for young children to turn the examination into a real exciting game. With older children and especially teenagers, discuss how the procedure will be performed. During the conversation, it should be noted that this study is absolutely safe and will not cause any pain in the child.

What is it for?

Ultrasound examination of the liver is performed in a wide variety of pathological conditions. This method makes it possible to obtain sufficiently accurate and reliable results that help attending physicians to establish correct diagnoses, and therefore prescribe optimal and effective treatment regimens.

The absence of radiation exposure allows the use of this study both in newborns and in older babies.

An ultrasound examination of the liver is used to diagnose:

• Inflammatory diseases. As a result of severe inflammation, the density and structure of the liver tissue changes. This leads to the fact that the liver increases in size. This symptom may be persistent or disappear after treatment.
• Neoplasms and malignant tumors. To date, it is ultrasound of the liver that is used as a screening for these dangerous diseases. Using this method, it is possible to detect tumors in the liver at a fairly early stage. Also, ultrasound can detect metastases of other neoplasms growing in other organs.
• cystic formations. The presence of cavity contents in the liver tissue is often a sign of a cyst. Such a pathological condition is often recorded in children during an ultrasound examination. The discovery of a cyst should be the reason for seeking a consultation with a doctor.
• Cirrhosis of the liver. This pathological condition practically does not occur in pediatric practice. Pathology is manifested by a pronounced increase in the liver. The prognosis of the course of the disease is extremely unfavorable.
• stagnant processes associated with bile excretion. Pronounced stagnation of bile can contribute to the development of chronic cholecystitis or hepatitis. Stretching of the bile ducts indicates the presence of signs of accumulation of bile.
• vascular pathologies. Hemangiomas of the liver are usually very well detected by ultrasound with additional Doppler imaging. The study allows you to identify these dangerous pathologies at the earliest stages.

For information on how to prepare for an ultrasound of the liver, see the following video.

Ultrasound examination of the liver and other internal organs allows you to identify structural pathology, as well as to measure them. The normal size of the liver in children varies over a wide range, depending on height, body weight and type of constitution. Increased indicators of the length or width of the organ testify in favor of the presence of pathology.

Features of the structure and functioning of the liver in children

The liver is an unpaired parenchymal organ, which is located mainly in the right hypochondrium and occupies a small part of the left. In a newborn baby, this organ makes up to 4.5% of the total body area and weighs about 120-140 grams on average. This is due to the fact that in the prenatal period, he performed a hematopoietic function, which ceases after birth.

By about 10 months of life, the weight of the "digestive gland" doubles, and by the age of 3 it triples, which is 360-400 grams. It is also important to remember that in infants and preschool children, the lower edge of the organ normally protrudes somewhat (by 2-3 cm) from under the costal arch, so the doctor can easily palpate it during the examination.

In adults and children, the liver consists of 4 lobes:

• tailed, square.
• right, left;

They are separated from each other by ligaments, grooves and gates - that place in the body where the vessels enter and exit from (portal, hollow, hepatic veins, arteries). On the visceral surface "lies" the gallbladder, the main duct of which flows into the lumen of the duodenum 12. The liver itself consists of hepatocytes that form hepatic beams surrounded by small capillaries and bile ducts.

The main functions of the parenchymal organ in childhood:

• synthesis of bile, which is an important component of the digestion process;
• participation in carbohydrate, protein and fat metabolism;
• neutralization of poisonous, toxic substances;
• production of proteins, some factors of the blood coagulation system;
• the formation of reserves of vitamins, glucose in the form of glycogen;
• participation in hormonal metabolism.

The size of the liver in a child correlates with his height, body weight and, to a lesser extent, with age. They can increase with congenital anomalies in the development of the hepatobiliary tract, against the background of an acute infectious pathology, as a result of a tumor lesion.

The children's liver is more rich in small vessels, and its cells are just finishing differentiation, which leads to the easy development of congestion in it against the background of a banal ARVI or acute intestinal infection.

Body sizes in children of different ages

Age-related changes in the liver mainly relate to its size, the structure and location of the organ does not change. To do this, measure the length, width of the left and right lobes. There are several options for normal liver size tables in children: by age, height.

The right lobe of a one-year-old baby is within 60 mm, after which it increases by an average of 5-6 mm every year. The anteroposterior size of a child at 12 months normally does not exceed 40 mm, and each subsequent year increases by 2 mm.

Approximate indicators of the liver depending on age:

• 3-4 years: right lobe - 70-75 mm, left - 44-46 mm.
• 6-7 years: right lobe - 85-90 mm, left - 50-54 mm.
• 9-10 years: right lobe - 100-110 mm, left - 60-62 mm.
• 14-15 years: right lobe - 110-115 mm, left - 65-67 mm.
• 18 years old: right lobe - 120 mm, left - 70 mm.

Table of norms of ultrasound of the abdominal cavity in children by age

Normal ultrasound readings

Modern domestic sonologists in their practice use special tables according to Dvoryakovsky or Pykov, which reflect the normal size of the shares, help determine the increase or vice versa - a pathological decrease in the organ.

Norms of the size of the liver in children according to ultrasound:

When measuring this organ, one should not forget about the influence of body mass index and body morphotype on its size. So, in tall thin children, the length of both lobes may exceed the average values ​​in the norm. In hypersthenics, it can be elongated in an oblique size.

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You can determine the presence of problems with the liver with conventional ultrasound diagnostics. This study allows you to assess the nature of the disease, obtain information about its course, as well as prescribe and adjust treatment.

Every doctor who specializes in ultrasound knows what to pay attention to in the first place. So, the diagnostician evaluates the density, structure of the organ, checks for pathological inclusions. In addition, be sure to look at the size of the liver on ultrasound. The norm in adults is set for each of its shares. Its oblique transverse size is also estimated. During the study, the doctor looks at the condition of the biliary tract and large vessels passing inside the liver.

Such an examination allows you to clarify the diagnosis if you suspect several different diseases. And the established norm for the size of the liver by ultrasound makes it possible to determine the presence or absence of pathological changes in the specified organ or deviations from its physiological development at different ages in children.

indicative figures

Specialists know what data to focus on when examining and diagnosing. But if you yourself want to find out if you have problems, then you need to know the normal size of the liver by ultrasound. It is also important to understand where this organ is located.

The lower edge of the right lobe is located in the region of the right costal arch. But in the presence of inflammatory diseases of the lungs, lower respiratory tract, its slight downward displacement is possible. But after resection of the lungs, with flatulence or tumors in the kidneys, it can rise.

In order to assess whether everything is in order with this organ, you need to know what is the norm of an ultrasound scan of the liver, what are the normal indicators of the liver. It should be of a homogeneous structure, without seals, large veins should be easily visualized. Its contours should be clear and even. The gallbladder and ducts should also be visible. Throughout the entire length, the inferior vena cava should be visualized, its diameter can be from 9 to 15 mm. But the intrahepatic ducts should normally be traced with difficulty.

Normal sizes

In addition to assessing the structure and location of the largest gland in the body, it is important to determine its other parameters. So, the size of the liver is normal according to ultrasound should be as follows:

- left lobe - 6-8 cm;

- diameter - from 20 cm, an increase of up to 22.5 cm is permissible;

- right lobe - up to 12.5 cm;

- organ width (measurement is carried out from right to left) 23-27 cm;

- length (from the posterior blunt edge to the anterior sharp edge) varies from 14 to 20 cm.

Also, the doctor should evaluate the diameter of the hepatic common duct: normally it is 3-5 mm.

The doctor should know not only the norms for ultrasound of the liver. In addition, the gallbladder is also evaluated. Its length in an adult is 7-10 cm, its width is 3-5, and its diameter is 3-3.5 cm. - up to 3 mm. Normally, it should not have any formations.

Diagnosis in children

You can also assess the health of the child's liver with the help of ultrasound. It is important to understand that the size of this organ directly depends on the age of the child. So, the right lobe in babies up to a year should be 60 mm, it increases annually by 6 mm. At 15 years old, its size is 10 cm, and at 18 - about 12 cm. The right lobe in children under one year old should be 32-40 mm, it grows by 2 mm every year. At the age of 15-18, the size of this area should be about 5 cm. You should not try to establish a diagnosis for the baby, even if you know what the normal size of the liver should be according to ultrasound. The transcript of the protocol must be carried out by a doctor. He will evaluate all the indicators in the aggregate and, if there are deviations, will prescribe the appropriate treatment.

It is also important to know that, regardless of age, it should be of a homogeneous structure and be interrupted only by the portal vein and its branches. The bile ducts should also be visualized normally.

Conducting a survey

If you want the diagnosis to be performed as accurately as possible, then you need to prepare for an ultrasound scan. It is advisable to follow a certain diet for the three days preceding the study. It is better to exclude high-calorie foods, foods that cause increased gas formation. With excess weight, prolonged constipation, bloating, it is better to do an enema before an ultrasound scan.

Also, before the diagnosis, it is advisable to drink an adsorbent. It can be smectite, activated charcoal or chamomile infusion.

The examination is usually carried out on an empty stomach. It is advisable not to eat for at least 8 hours before the ultrasound. When feeling thirsty, it is allowed to drink ordinary clean water.

For the diagnosis, the patient must lie on his back. The doctor applies a special gel to the area of ​​the right hypochondrium and moves the device's sensor along it. The procedure is absolutely painless. Children can be examined not only in the supine position, but also on the right or left side, sometimes the doctor asks the child to sit down to better visualize the picture.

Indications for examination

There are a number of problems in which ultrasound of the liver is one of the mandatory examinations. It is necessary to carry out such a diagnosis if you or your child has:

- icteric coloration of the whites of the eyes and skin appeared;

- there are pains in the right hypochondrium;

- the doctor suspects the presence of neoplasms in the liver;

- deviations in blood tests, indicating the pathology of the specified organ;

- there was an injury, and damage to the abdominal organs is possible.

It is also recommended to periodically examine the liver when taking certain drugs or alcohol abuse, with chronic problems with this organ, gallbladder or pancreas.

If you know what the normal size of the liver should be according to ultrasound, you can even understand for yourself what is written in the examination protocol.

Possible problems

Any deviations from the norm are the reason that the doctor can establish a definite diagnosis depending on the condition of the organ being examined. After an ultrasound, you can determine the helminthic invasion (giardiasis in the liver), fatty degeneration of the gland, see tumors, cysts. Also, with the help of this examination, diagnoses such as cirrhosis, hepatitis can be established. Each of these problems causes certain characteristic changes in the organ.

Diagnosis of diseases

With hepatitis, the liver begins to display waves worse, on the screen it looks quite dark. In addition, the disease is characterized by the fact that the edges of the organ are rounded, one or both of its lobes increase in size. Its structure becomes heterogeneous, dilated portal and splenic veins are also visualized.

For example, knowing what the normal size of the liver should be according to ultrasound, one can establish a diagnosis such as cirrhosis. With this disease, the left lobe or the entire organ as a whole increases. In the later stages, on the contrary, it decreases due to the fact that cells begin to die. In addition, the density of tissues increases, their structure is heterogeneous. The ultrasound shows that the liver looks like a mosaic. This picture appears due to the presence of areas where tissues are restored. The edges of the liver become not even, but bumpy, the diameter of the portal vein increases.

The helminthic invasion caused by Giardia is indicated by dark spots on the liver - these are the places where the worms are concentrated, and the light areas are calcifications that appear in the later stages of the disease.

Tumors appear as dark (hypoechoic) or light (hyperechoic) spots. Also, with malignant tumors, a dark rim is visible around them. Also, with tumors, the gallbladder is displaced, lymph nodes increase.

With fatty degeneration of the liver, increased echogenicity is noted, the picture on the monitor of the ultrasound machine is bright, the structure of the organ is mottled. There is also an increase in the size of the organ, fuzzy contours, rounded edges.

The liver is a huge gland, without which almost no process in the body can do. For this reason, the condition of the organ is of vital importance. As soon as any pathological process begins to develop in it, the size of the liver also changes. In the initial stages, such changes can only be traced using special diagnostic methods, and when the pathology reaches a more serious stage, the changes are visualized.

Liver size: normal

To begin with, let's figure out together what the normal size of an organ should be. In its natural state, the lower edge of the right lobe of the liver is at the level of the right costal arch, protruding up to 6 cm along the midline, and 1-2 cm along the midclavicular line. Even if the organ is not enlarged, some omission is allowed. It is observed in bronchial asthma, massive pleurisy or asthmatic bronchitis.

If there is a resection of the lungs or flatulence, then the liver may be located high. Normally, the angle of the lower edge of the left lobe is about 30 degrees (maximum up to 45 degrees), and the right lobe is 75 degrees or more. To date, experts say that in healthy people, the vertical oblique size of the right side of the liver is within 15 cm, and the height (craniocaudal size) is 8.5-12.5 cm. But the height of the left hepatic lobe is up to 10 cm. Thickness the right lobe is about 11-12.5 cm, the left - up to 8 cm.

During the echogram, you can count on the following sizes of the liver:

• Length in the transverse plane - 14 - 19 cm (average - 17 cm);
• The length of the right lobe is 11-15 cm (average 13 cm).

This difference in rates is due to the difference in data in the medical literature itself. The indicators differ against the background of the use of differential methods. Also, the size of the liver is directly affected by height, age, human constitution and the depth of inspiration at which the echogram was made. For this reason, in situations where the study fixes borderline dimensions, the conclusion cannot be categorical. It indicates a numerical value (usually this is the vertical size of one of the lobes of the organ).

The structure of the liver parenchyma is normally homogeneous, fine-grained, weakly intense. It visualizes the vascular network and bile ducts. The size of the veins of the organ is also of great importance. Normally, the diameter of the portal vein, according to various sources, ranges from 8 to 14 mm, and its branches - up to 1 mm.

Liver vein size

Of course, the correct parameters of the organ itself are of great importance, but you need to pay attention to the condition of the veins. Very often, specialists have to conduct a general analysis of the state of the portal system. To do this, evaluate the splenic vein and mesenteric superior vein. The first is located behind the pancreas, located ventrally from large vessels. The splenic vein has a lumen of about 8-10 mm on inhalation, and on exhalation it decreases to 4-6 mm. The diameter of the mesenteric superior vein during inspiration is 8-11 mm, and during expiration - 4-6 mm.

It is especially important to correctly analyze the diameter of each of the portal vessels with a deep and relaxed breath. The veins of this gland consist of main trunks - left right and middle, as well as small branches. All of them have a smooth internal contour. At a distance of 2 cm from the mouths, the diameter of such vessels is from 6 to 10 mm. The structure of the inferior vena cava has a tubular character, its diameter changes during breathing and is 2-2.5 cm.

Body sizes in children of different ages

The norm of the parameters of this huge gland in children is determined using numerous formulas, including volumetric ones. They should be used by professionals in specialized medical centers. The fact is that the size of the liver at different ages in children can vary. The right lobe can be located up to the lower pole of the kidney, it can be lowered even lower if there is a Riedel lobule. In one-year-olds, the left lobe most often extends beyond the midline on a transverse scan, and in older children to the aorta.

With hepatomegaly, the left lobe of the organ in children reaches the spleen, slightly shifting it down. At the same time, the organ itself is divided into three lobes: right, left, caudate. Each share has its segments. The right lobe of the liver has posterior and anterior segments. The boundary between them is the right hepatic vein. The left lobe is divided by the left hepatic vein into lateral and medial segments. Each of these areas has a separate blood circulation.

The size of the liver in young children can vary under the influence of a large number of factors. The table will help you get acquainted with the average statistics.

About ultrasound of the liver for a child

The liver is one of the most important organs in a child's body. The liver neutralizes and removes almost all toxic substances, synthesizes biologically active substances and controls the energy balance. To obtain all the necessary data or to obtain reliable information about its condition and work, it is necessary to do an ultrasound examination.

Ultrasound of the liver allows you to accurately determine the structure of the organ, the diameter, the size of the existing changes, as well as analyze all deviations from the norm. Ultrasound of the liver is the safest, painless and informative research method. Most often, this is the only way to diagnose any disease.

Indications for ultrasound of the liver in children:

Preparation for ultrasound examination of the liver in children:

• Three days before the procedure, follow a certain diet;
• Do not eat foods rich in fiber;
• If overweight, it is necessary to give the child an enema on the evening before the procedure;
• For two days, exclude from the diet all foods that promote gas formation, as well as exclude high-calorie foods;
• It is necessary to carry out the procedure on an empty stomach;
• Do not eat 6 hours before the procedure;
• When thirsty, give only clean water to drink.

The procedure for ultrasound of the liver is as follows: the child lies on his back, the doctor applies a special gel to the area under study, which helps the sensor slide over the skin and begins to diagnose.

If necessary, the procedure for ultrasound of the liver of the child can be performed not only on the back, but also on the right or left side or in a sitting position.

Norms of ultrasound of the liver in children

During the ultrasound of the liver in children, the doctor pays special attention to the structure and homogeneity of the liver, draws attention to large vessels, small branches and bile ducts. The norm of ultrasound of the liver for children is:

• Parenchyma of a homogeneous structure, which is interrupted by a portal vein with branches;
• All veins are well traced;
• The bile ducts are clearly visible.

• 1 year - 60 mm, each subsequent year + 6 mm;
• 15 years - 100 mm;
• 18 years - 120 mm.

• 1 year - 33-40 mm, each subsequent year 2 mm;
• 15 years - 50 + 1.5 mm;
• 18 years old - 50 + 1.5 mm.

Decoding ultrasound of the liver in a child

After receiving all the evidence, the doctor proceeds to decipher the ultrasound of the child's liver. Ultrasound is the most important method for examining children who have diseases or suspicions of their presence in the digestive organs. Ultrasound for children is the most informative diagnostic method that is widely used in outpatient practice, in specialized gastroenterological clinics and has no restrictions on its use.

After deciphering the indications of an ultrasound examination, a large number of hidden diseases of the digestive system can be detected (ultrasound of the abdominal cavity is used for this) or any other diseases of the child's body. Deciphering the ultrasound and the doctor's testimony helps to formulate the exact treatment tactics. This allows you to start treating existing pathologies as soon as possible.

Make an ultrasound of the liver in our center

The equipment in our center "Cradle of Health" for ultrasound of the liver is constantly being improved, this allows us to make this method very informative and completely safe for a small patient. The liver is a very important organ that is responsible for the entire digestive system of the body. Keeping your liver healthy is the key to your baby's health. and guaranteed successful later life. If your child has indications for an ultrasound procedure, contact our Cradle of Health center and experienced specialists will help you.

We have a large staff of highly qualified workers who are fluent in the technique of performing an ultrasound procedure. After receiving the conclusion, our doctors will draw up a comprehensive plan for the treatment of existing diseases and give recommendations on changing the baby's lifestyle. It is important to remember that the human digestive system is one of the most important systems in the body. Therefore, you should not postpone a visit to a consulting pediatrician (pediatrician) and the very procedure for ultrasound of the liver.

Benefits of an ultrasound of the child's liver in our center "Cradle of Health":

1. The procedure is carried out by highly qualified doctors with extensive practical experience;
2. The procedure is carried out on modern equipment;
3. The procedure has no contraindications;
4. The procedure is easy to carry out, which is a huge plus for a small child;
5. The procedure provides research data in dynamics;
6. The procedure is completely safe for the baby.

In our center, you can easily and quickly undergo an ultrasound of a child’s liver, an ultrasound of a child’s head, with us you will receive high-quality ultrasound diagnostics and consultation with an experienced pediatrician.

Doctors of ultrasound diagnostics of our center

Kazantseva Marina Anatolievna

Doctor of functional diagnostics. Candidate of Medical Sciences. Assistant professor.

She graduated from the Kemerovo State Medical Institute with a degree in Pediatrics. He has valid certificates in ultrasound diagnostics and functional diagnostics.

With vast experience and the highest qualifications, he never ceases to improve his professional knowledge.

Menzelintseva Svetlana Konstantinovna

Ultrasound doctor. Total work experience 24 years

She graduated from the Karaganda State Medical Institute in 1992 with a degree in pediatrics.

She is a highly qualified specialist, attentive, quickly finds an approach to children, enjoys great respect among her colleagues.

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The liver is a huge biochemical laboratory in the human body. It neutralizes toxins (performs a detoxifying function), synthesizes proteins, enzymes, vitamins, controls the energy balance.

For an objective assessment of the detoxification and synthesizing function of the liver, ultrasound diagnostics is performed.

Diagnostic procedure Ultrasound of the liver

allows to assess the homogeneity of the tissue structure, the size of the organ, helps to determine the presence of pathological formations.

Study preparation

Preparation for the study begins in advance: normally, 4 days before the procedure. The main purpose of the preparation is to get rid of gases in the intestines.

Ultrasound is performed on an empty stomach, with strict adherence to the recommendations for preparing for the procedure. Recommendations for dieting 3-4 days before the procedure are as follows:

refuse food rich in fiber (vegetables, fruits); for constipation and flatulence, make an enema as an intestinal preparation; products that promote increased gas formation, exclude from the diet of children for 2 days (cabbage, milk, white bread, rice, legumes); exclude high-calorie foods; normally, you can’t eat food 7 hours before the study. The main obstacle to normal imaging of the liver on ultrasound is intestinal distension. Therefore, the diet in preparation for the study is aimed at reducing the amount of gases.

Ultrasound procedure

To prepare the “research field”, the doctor applies a gel on it, which helps to better visualize the structures of the organ. Next comes the diagnosis.

Baby position options:

on the back; on the right or left side; in a sitting position.

Before scanning, the child is offered to take a deep breath, the doctor immerses the sensor in the hypochondrium. In this way, better visualization of the organ is achieved by reducing the distance between the sensor and the liver. Then the results of the study are deciphered. The degree of reliability of the results is directly proportional to the quality of preparation for the procedure.

Normal ultrasound readings

the parenchyma has a homogeneous structure, interrupted by the portal vein; the veins and bile ducts are clearly visualized.

In children, quantitative indicators depend on age. Normal dimensions of the right lobe of the liver from upper to lower edge:

1 year of life - 6 cm, 6 mm are added for each subsequent year; 15 years of life - 10 cm; 18 years of life - 12 cm.

Dimensions of the left lobe of the liver from upper to lower edge:

1 year of life - up to 4 cm, for each subsequent year of life, 2 mm are added; 15 years of life - up to 5.5 cm; 18 years of life - up to 5 cm.
The liver is an organ that is perfectly visualized with an echogram. This feature allows the doctor to obtain the characteristics of the child's organ, and then compare them with the norm.

Interpretation of diagnostic results

Hepatomegaly- the most common pathology, which is an increase in the liver of a child. The indicator is inversely proportional to age. In children under 7 years old, there may be an unexpressed enlargement of the organ, which is recognized as a variant of the norm. Usually, the liver comes out from under the costal margin up to 2 cm. When the organ increases by more than 2 cm at school and adolescence, this indicates the presence of pathological changes. In this case, the main task of the doctor is to find out the causes of the pathology.

The cause of hepatomegaly may be the presence of an inflammatory process:

The causes of the disease can also be metabolic disorders:

mucopolysaccharide metabolism; deposition of abnormal amyloid protein in tissues (amyloidosis); porphyrin metabolism (a substance that forms red blood cells); fat metabolism; protein metabolism (insufficient amount of alpha-antitrypsin).
Hepatomegaly (enlarged liver) is one of the most common pathologies in children. It may be associated with toxic effects on the liver, viral hepatitis, TORCH infections, and metabolic disorders.

Obstruction of the flow of bile and blood can also be the cause of hepatomegaly, due to diseases such as:

Wilson-Konovalov disease; cirrhosis (ultrasound signs of cirrhosis are well visualized in the diagnosis); thrombosis of the hepatic veins; congenital malformation - atresia (absence) of the bile ducts.

The cause of the development of the disease may be infiltrative damage to the liver tissue, resulting from the following pathologies:

blood cancer; hemolytic disease of the newborn (with Rh-incompatibility of the fetus and mother); metastases of tumors of other organs; lymphoma (tumor of the lymphatic system); hepatoma (neoplasm of the liver tissue); hemochromatosis (improper exchange of iron in the blood); histiocytosis (increased division of immunity cells) the emergence of a focus of hematopoiesis (production of blood cells).

Primary damage to the liver tissue is also a factor in the development of hepatomegaly:

cirrhosis (replacement of the hepatic parenchyma with connective tissue); polycystic disease is a congenital disease characterized by the appearance of many cysts in the tissue of the organ; fibrosis (replacement of normal hepatic tissue with scar tissue); hemorrhagic telangiectasia is the expansion of the hepatic vessels and the occurrence of bleeding.

In addition, hepatomegaly can develop due to:

hyperplasia (increased number) of Kupffer cells - macrophages that utilize dying hepatocytes and foreign agents; sepsis; a large amount of vitamin A in the child's body.

There is also the concept - "false hepatomegaly". Its cause is the pathology of the respiratory system, namely the lungs. It is characterized by the fact that the increased volume of the lungs “presses” on the liver from above and “forces” it out from under the ribs. For example, with emphysema (increased airiness) of the lungs.

Features of the symptoms of hepatomegaly

Signs of hepatomegaly on examination:

signs of enlargement of the organ when palpating its edge and tapping (exit from under the costal margin by more than 2 cm); increased circumference of the child's abdomen; the symptom of "jellyfish head" is the venous network around the child's navel, indicating portal hypertension; pain and feeling heaviness in the right hypochondrium; symptoms of intoxication; increased skin pigmentation; icterus of the sclera and skin (icteric color, due to an increase in the level of bilirubin in the blood).

If the organ is moderately enlarged, then the symptoms are not pronounced or absent. In addition, poor preparation for the procedure, which can distort the result, is not ruled out. Reliable signs of the onset of pathology are changes in the ultrasound picture.

To establish the cause of hepatomegaly in children, auxiliary methods are used:

Ultrasound picture in other liver diseases

Direct indicators of cirrhosis:

parameters exceed the norm; unevenness of the edge and contours (on the ultrasound picture looks like tuberosity); increased echogenicity of the tissue structure on ultrasound, which indicates the appearance of connective and scar tissue in its parenchyma; the lower edge becomes rounded.

Indirect indicators of portal hypertension:

the lumen of the portal vein is enlarged; the parameters of the spleen exceed the norm; the expansion of the esophageal veins, with the threat of bleeding from them; ascites (free fluid in the abdominal cavity); liver failure.

Heart failure:

there is an expansion of the lumen of the hepatic veins on the ultrasound picture; the diameter of the lumen of the inferior vena cava does not change during breathing; the presence of free fluid in the pleural cavity.

Acute hepatitis: parameters are above normal. Ultrasound is not a specific sign; laboratory research methods are carried out for accurate diagnosis.

Metastases of malignant neoplasms:

hyperechogenicity or hypoechogenicity of formations; contours are clear or fuzzy; reduced echogenicity of areas of the liver tissue; contours are blurred; blurring of contours; increased echogenicity with the appearance of blood clots.
Malignant liver tumors ultrasound diagnoses very well. They are usually hyper- or hypoechoic.

Treatment of diseases

Both conservative and operative methods are used. The choice of method depends on:

nosological unit; disease severity; involvement of other internal organs in the pathological process; timeliness of diagnosis.

For example, diseases such as an abscess or a cyst are treated exclusively by the surgical method. And hepatitis or poisoning with toxic substances will respond well to drug treatment.

In conclusion, we recall that you must pay special attention to the child. Be interested in his well-being, pay attention to behavior, appetite, activity. At the slightest suspicion of a disease, you need to urgently contact a specialist, and not self-medicate! And when preparing for the prescribed study, follow all the recommendations of the doctor impeccably. Remember that any disease is easier to treat in the early stages of development.

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One of the most common abdominal (abdominal) studies is ultrasound. It is often prescribed to examine the liver. The size of the liver is normal according to ultrasound is different, and depends on age, gender, physique. As for the results, their correct interpretation will help to correctly diagnose and prescribe competent treatment in a timely manner.

The results of an ultrasound examination help to ascertain the health or progress of liver disease.

Characteristics determined by ultrasound

The liver is the largest gland in the body. Its weight in an adult is 1.5 kg (in women it is slightly less - 1.2 kg), and in children it depends on age. In a healthy liver, the structure is dense, the color is red-brown. The organ consists of four lobes: right, left, caudate, square. Consider the factors that the sonologist focuses on when writing a description or test protocol.

The location of the liver is the right upper quadrant of the abdomen. Normally, it does not protrude from under the costal arch, it is held by the abdominal press. Structure, contours. Normally, the organ is smooth, even, the contours are clear, the structure is homogeneous, the edges are sharp, the angle of the left lobe is 45 degrees, the right lobe is 75 degrees, the tissue structure is homogeneous. If there are bumps or foreign formations on the surface, we can talk about the development of oncological processes or echinococcosis (helminth damage). Echogenicity. These are the acoustic properties of the organ (absorption of sound waves and sound conductivity). The higher the fluid content in the organ, the lower the echogenicity, which means that we can talk about cirrhosis, endocrine diseases, impaired metabolism, or that the patient took a large amount of medication. Color. A light shade of the liver can show the initial stage of hepatitis. Graininess. It is given by the structural units of the organ - the hepatic lobes (lobules), between which the bile and blood ducts are located. In a healthy liver, the structure is fine-grained, its change indicates an inflammatory process. Ultrasound of the liver allows you to consider the structure of tissues, blood vessels, the shape of the organ. Dimensions. One of the important indicators of the state of the body. Also measure KVR - oblique internal size; a large proportion of the liver is of particular importance for measuring CVR. Below is a table that shows the normal size of the liver. Blood vessels. They consider the portal (another name is the portal), inferior vena cava and splenic veins (attached to the portal vein, accounting for 30% of its blood flow). Since the main function of the liver is detoxification, the blood circulation in this organ is specific. Blood with toxic substances enters the liver through the portal vein, where it enters the interlobular veins, where it is neutralized from toxins. Arterial and venous blood is ejected into the sinusoids, then drained through the vessels into the inferior vena cava. Changes in the diameter of the vessels can lead to serious consequences. The gallbladder and its ducts. The liver is pierced by the bile ducts, their normal diameter is 6.5–9 mm; the gallbladder itself looks like a sac with a volume of 40-70 cm³, length - 8-14 cm, width - 3-5 cm. A decrease in size indicates dyskinesia, an increase indicates an excess of bile. If there is sediment in the bag, this indicates the onset of gallstone disease. Expanded biliary tract indicates stagnation of bile. There are narrowed ducts, with cysts, constrictions, but these anomalies are usually congenital, and if they do not interfere with the work of the organ, they are not treated.

Table of normal liver sizes in adults on ultrasound

Ultrasound of the liver in children

Sometimes children also need an examination of this organ. The parameters do not change, just the norms will be somewhat less than in adults, since the child's liver is smaller. We should expect the variability of the results, because the body is still developing. The tables give the norms of ultrasound parameters for children, including blood vessels.

How to prepare for an ultrasound

Proper preparation of the patient for the study of the liver contributes to the accuracy of indicators that affect the description.

In the study of the abdominal organs, the main task is to reduce gas formation in the intestine so that its loops do not create shadows and do not interfere with the specialist to decipher the ultrasound images. First, a week before the study, you need to follow a diet. It includes the following aspects:

it is recommended to eat in small portions 4-5 times a day, dinner - no later than 2-3 hours before bedtime; consume no more than 1.5 liters of liquid per day; exclude legumes, fatty, dairy, sweet foods, rich products from the diet , strong tea / coffee, alcoholic drinks and soda.

Secondly, patients who have reduced motor-evacuation function of the intestine are given a cleansing enema. In order for the ultrasound probe to show a clear image, the study is carried out on an empty stomach. If the patient followed the doctor's instructions, deciphering the test will give accurate results about the state of the body's main filter. The test has no contraindications, it can be prescribed to children, adults, the elderly, pregnant women.

The procedure is carried out for awareness of the functioning of this organ in a child. Violations of the liver can be triggered by the penetration of viruses, chemicals and toxic substances into the body. With liver pathologies, the entire human body suffers, since harmful substances are not fully excreted from the body.

To eliminate complications that may arise in the future, it is necessary to contact a specialist who will refer the child for ultrasound diagnostics of the liver.

Sometimes an ultrasound of the liver and spleen is also prescribed for children. To conduct such a study, there must be additional evidence. This is, as a rule, leukemia and inflammatory processes occurring in the body.

What can an ultrasound of the liver reveal in a child?

Hepatomas, hypertension and steatosis; Hepatic cirrhosis at various stages of its development; Stagnation of bile in the ducts; Metastases; Liver calcifications and hemangiomas; Hepatitis, the appearance of which is associated with the penetration of viruses; Cysts and other neoplasms.

Enlargement of the liver in a child by ultrasound

Ultrasound (liver size in children, table) can sometimes show that the size of a child's liver is increased compared to the norm. On ultrasound, the liver (child) is enlarged: what does this mean? With ultrasound diagnosis of newborns, an increase in the size of the liver indicates jaundice. It is not necessary to carry out therapy for this disease, since it passes in about a month. The main causes of jaundice in a newborn are considered to be diabetes or birth trauma.

If the liver is slightly enlarged in a child under seven years old, do not worry about this. This is a completely natural phenomenon for this age period. As the child grows, the organ begins to acquire normal size. An increase of 1-2 cm should not be considered a deviation from the norm.

However, if the liver in young children is enlarged, this may also indicate pathologies such as:

Blocked bile ducts; Development of tumors and metastases; The course of inflammatory processes in the child's body; Congenital infections; metabolic disorders in the body.

What symptoms does a child face if the liver is enlarged?

With hepatomegaly (enlargement of the liver), no symptoms may be observed. It is especially difficult with newborns or young children who cannot tell exactly what and where they hurt. Parents should beware of the following:

The child has constant problems with the stool; There are spider veins on the skin and the child often complains of itching; Low appetite in the baby; Yellowing of the skin, eye proteins, mucous membranes of the eyes; Drowsiness, lethargy, tearfulness and rapid fatigue of the child.

Diagnosis includes not only the passage of ultrasound, but also a medical consultation along with an examination. It is also necessary to pass a blood test, urine and feces. If necessary, magnetic resonance imaging and genetic analysis can be shown to detect congenital developmental anomalies.

Norms of the size of the liver according to ultrasound in children

Ultrasound of the liver in children: decoding - what can be said about the results of an ultrasound examination? Only a competent doctor can interpret them. The doctor during the procedure draws attention to deviations in the work of the body, its structure and size.

In children, the liver is conditionally divided into three parts: left, right and tail. These shares are also divided into segments, each of which contains a vein.

The normal size of the liver in children according to ultrasound at the age of up to a year will be as follows:

The size of the right hepatic lobe should normally be 6 cm; The size of the liver lobe on the left should not exceed 4 cm; The wall of the organ in thickness should be no more than 1 mm; The collar vein should not exceed 5 mm in diameter.

The norm of the liver on ultrasound in a child provides that the left hepatic lobe should be localized to the midline, and in children older than a year - to the aorta. As the child grows, the liver also enlarges by a few mm. That is why the results are in close relationship with the age of the child.

Ultrasound of the liver (normal in children, table) will be able to provide reliable information on the tangential size of the liver at different childhood ages.

Ultrasound picture in hepatic diseases

Cirrhosis of the liver. In this case, the edges and contours of the liver will be uneven, which will look like tuberosity on the monitor during the study. In addition, the lower edge of the liver will be rounded. It should also be noted that the echogenicity of the liver structure will be increased, since connective and scar tissue will be observed in the hepatic parenchyma; Heart failure. In this case, free fluid will be found in the pleural cavity, the lumen of the hepatic veins will be clearly increased compared to the norm. In addition, when inhaling and exhaling, the diameter of the lumen of the inferior vena cava will not change; portal hypertension. In the abdominal cavity, free fluid will be visualized (otherwise called ascites), the esophageal veins will be greatly enlarged. They are at risk of bleeding. The lumen of the portal vein is also noticeably enlarged; Abscesses. In this case, the contours will be smoothed out, and echogenicity will increase; Hematomas. Echogenicity increases, blood clots are visible in places. The contours are not clearly visualized.

Make an ultrasound of the liver for a child: preparation

The first point to consider is the following: it is necessary to eliminate the increased gas formation in the baby's abdomen, if any. To do this, you need to remove fresh vegetables, high-calorie confectionery and whole milk from the diet. If the child's body has a tendency to accumulate gases, the doctor will prescribe the intake of enzyme medications or enterosorbents.

If the child is being treated with any medications, you need to warn the doctor about this, who will carry out liver diagnostics.