Cirrhosis - Causes, Symptoms and Treatment .MF .
Cirrhosis of the liver - this is the final stage of chronic liver diseases associated with irreversible deep restructuring and the gradual loss of its function.
liver - the largest of the digestive glands, takes upper abdomen, lying right below the diaphragm.It has a lobed structure.Its main functions:
1. Removing the toxins, poisons, allergens enter the body from the external environment.
2. Synthesis of proteins, fats, carbohydrates.
3. Education bile involved in digestion.
4. Removal of excess hormones, vitamins, metabolic intermediate products.
5. The synthesis of biologically active vitally important substances (albumin, clotting factors).
liver slice is composed of liver cells - hepatocytes.It is in violation of the structure of hepatic lobules, its rebirth in abnormally structural units, surrounded by fibrous tissue and a cirrhosis.
Causes of cirrhosis
most common causes:
1. Viral hepatitis "B", "C" and "D" are the most frequent and common causes of cirrhosis in the world.In the world th
2. Alcoholic liver disease.
3. Cryptogenic cirrhosis.It is a diagnosis of exclusion, its stand when the cause of the disease can not be established.
Rare causes of cirrhosis:
1. Non-alcoholic steatohepatitis.Liver damage on the background of metabolic disorders (especially violation of lipid metabolism - obesity and carbohydrate metabolism - diabetes).
2. Autoimmune hepatitis.Occurs when irregularities in the immune system, when your body produces antibodies to its own liver cells - hepatocytes.
3. Primary biliary cirrhosis.Occurs when the long flowing cholestasis - a violation of the outflow of bile from the liver by the tubules.
4. The use of drugs (anti-tuberculosis and anti-cancer drugs) and hepatotoxic substances (mercury, gold and lead).
extremely rare causes of cirrhosis:
1. Hemochromatosis.Hereditary diseases resulting from accumulation of iron in tissues and organs
2. disease Konovalov - Wilson.The hereditary disease that leads to an accumulation of copper in the tissues of the liver and the brain.
3. The lack of alpha 1 - antitrepsina.Hereditary diseases.Lack of protein synthesis in the liver, leads to chronic bronchitis and liver cirrhosis.
4. The secondary biliary cirrhosis.Developed with obstruction (narrowing, compression), biliary tract stones, tumors.Chiari - Budd syndrome.Developed in thrombosis of the hepatic veins.
Symptoms of liver cirrhosis
rate of occurrence and development of cirrhosis depends on the severity of hepatitis caused it.In the initial stages of the disease there moderate pains, discomfort in the right hypochondrium, usually after meals, exercise.Accompanied by a bitter taste in the mouth, abdominal distention.In the future, to join pains nausea and vomiting, loss of appetite.
Men disturbed potency in women - menstrual cycle.Skin, eye sclera icteric painted in color due to increased levels of bilirubin and cholesterol in the blood.The skin becomes dry, worried about intense itching.Due to violations of the processes of blood coagulation occur nosebleeds and bleeding gums, long time did not stop bleeding from wounds.On the skin of the trunk appear vascular "asterisks".With the development of cirrhosis occur swelling in the legs, abdomen increases due to ascites - fluid accumulation in the abdominal cavity.Due to the accumulation of toxic products of metabolism in the blood there are signs of hepatic encephalopathy (lesion of the cerebral cortex) - intense headaches, memory loss, sleep disturbances, hallucinations, coma development.Sharply reduced appetite, weakened patients lose weight to exhaustion.
surveys in suspected cirrhosis
1. Biochemical methods of investigation, indicate a violation of the functional state of the liver (hepatic complex): total protein and protein fractions - reduction of total protein and albumin protein.Increase in enzymes (ALT - alanine aminotransferase and aspartate - aspartate aminotransferase, alkaline phosphatase - ALP), bilirubin - says about the activity of the process.
2. Coagulation - shows the violation of the blood coagulation system.
3. Complete blood count - signs of anemia - a decrease in hemoglobin levels, reduces the number of platelets and white blood cells.
4. Serological markers of viral hepatitis B, C, D, G, markers of autoimmune hepatitis (mitochondrial and antinuclear antibody) - to determine the cause of the disease.
5. Fecal occult blood test - to detect gastrointestinal bleeding.
6. Determination of serum creatinine, electrolytes (kidney complex) - to identify complications of cirrhosis of the liver - the development of renal failure.
7. Alpha-fetoprotein blood - in cases of suspected development of complications - liver cancer.
8. ultrasound study of abdominal organs and vessels of the portal system.It shows an increase and change in the structure of the liver, enlarged spleen.The increase in vessel diameter.The presence of fluid in the abdomen - ascites.
9. Esophagogastroduodenoscopy (FEGDS) - Identification of varicose veins of the esophagus and stomach.
10. A liver biopsy.It helps establish an accurate diagnosis and the stage of the disease.
11. Computed tomography and scintigraphy of the liver - is prescribed by the physician.They help in more detail and identify the exact nature of the changes in the liver.
consultation of experts, according to testimony:
- an infectious disease physician at the establishment of viral liver cirrhosis;
- doctor hepatologist, with other causes of cirrhosis of the liver;
- oncologist - in cases of suspected development of liver cancer;
- surgeon - for suspected complications (bleeding).
severity of the disease sets the physician, using a scale of criteria for Child - Pugh (CP).Indicators criteria are research data, recognize the signs of cirrhosis.Patients belonging to class A are compensated, and the class B and C - decompensated.
Treatment of cirrhosis
Patients with compensated cirrhosis is necessary to treat the underlying disease (viral hepatitis, alcoholic or non-alcoholic steatohepatitis) to prevent the deterioration of the disease and the development of complications.Patients recommend a balanced diet with sufficient protein and fat content.Excluding alcohol, foods containing chemical preservatives, very careful medication - only vital.Vaccination is carried out only for health reasons.Limit heavy physical load.Avoid hypothermia, overheating, insolation (sun).Not recommended for mineral water, physiotherapy and thermal procedures.Avoid fasting, receiving medicinal herbs, traditional medicine treatment facilities.
Patients with compensated cirrhosis observed the doctor (internist or general practitioner) with periodicity of visits to once every three months.Pass the complex examinations (ultrasound study of abdominal organs, blood tests, studies on hepatic complex, kidney complex).
With the development of decompensation, patients are sent for treatment in specialized departments of the hospital, because of the high risk of complications.
main goal of treatment in this step is to stop the progression of the disease and treatment of any complications.Drug therapy of patients with liver cirrhosis should be administered only by the attending physician.In each individual case, the need for drug administration evaluated and potential danger of side effects.
Application hepatic (drugs improve liver function) - strictly limited and individually, due to their unproven efficacy in the treatment of cirrhosis of the liver.
With the development of cholestasis (disturbance of outflow of bile from the liver cells - hepatocytes), which is a manifestation of jaundice and itching, to reduce stress and damage to the hepatocyte bile acids ursodeoxycholic acid used drugs.The duration of the drug depends on the patient and the degree of severity of cholestasis.
With the development of portal hypertension (increased pressure in the blood supply to the abdominal organs system), causing swelling and ascites, esophageal varices, pressure reduction is carried out by assigning nitrates and b-blockers (group propranolona).
complications of cirrhosis
1. acute variceal bleeding.It arises from varices of the esophagus and stomach.The patient grows weak, falling blood pressure, pulse quickens, there is vomiting with blood (the color of coffee grounds).Treatment is carried out in an intensive care unit, with inefficiency, used surgical treatments.To stop bleeding apply intravenous oktropida (to reduce the pressure in the blood vessels of the abdominal), endoscopic treatment (variceal ligation sites, sclerotherapy).Carefully carry out a transfusion of blood components and fluids, to maintain adequate levels of hemoglobin.
2. Spontaneous bacterial peritonitis - an inflammation of the peritoneum by infection of fluid in the abdomen (ascites).Patients temperature rises to 40 degrees, chills, there is intense pain in the abdomen.Assign long-term broad-spectrum antibiotics.Treatment is carried out in an intensive care unit.
3. Ascites - accumulation of fluid in the abdominal cavity.Assign restricted diet with protein (up to 0.5 grams per kilogram of body weight) and salts, diuretics, intravenous administration of albumin (a protein preparation).If necessary, resort to paracentesis - removal of excess fluid from the abdominal cavity.
4. hepatorenal syndrome - the development of acute renal failure in patients with cirrhosis.Discontinue the use of diuretic drugs, prescribed intravenous albumin.Treatment is carried out in an intensive care unit.
5. Hepatic encephalopathy.Manifested by minor neurological disorders (headache, fatigue, lethargy) to severe coma.Since it is associated with the accumulation of blood products of protein metabolism (ammonia) - restrict or exclude from the diet of protein administered prebiotic - lactulose.It has a laxative effect and the ability to bind and reduce the formation of ammonia in the intestine.When expressed neurological disorders treatment is carried out in an intensive care unit.
6. The development of hepatocellular carcinoma - malignant liver tumors.
cardinal treatment of hepatocellular carcinoma and decompensated cirrhosis of the liver - liver transplant.Substitution patient liver liver donor.
Timely detection and treatment of diseases, which can lead to cirrhosis.Prevention of viral liver disease (vaccination against hepatitis B, the observance of personal protection and hygiene).Delete the abuse of alcoholic beverages.
Question: Are there any contraindications to liver biopsy?
answer is contraindicated in the presence of hemorrhagic syndrome (increased risk of bleeding), the presence of ascites, impaired consciousness (hepatic encephalopathy).
Q: patients with liver cirrhosis is contagious to others?
Answer: No.But for patients with liver cirrhosis, any transferred bacterial, viral infection (common cold, pneumonia) - is the risk of decompensation and complications.
therapists Vostrenkova IN