Cirrhosis - Causes, symptoms and treatment. MF.

Cirrhosis of the liver is the final stage of all chronic liver diseases associated with a deep irreversible structural rearrangement and with the gradual loss of its function.

The liver - the largest of the digestive glands, occupies the upper abdominal cavity, located on the right under the diaphragm. It has a lobed structure. Its main functions:

1. Removal of toxins, poisons, allergens entering the body from the external environment.
2. Synthesis of proteins, fats, carbohydrates.
3. The formation of bile, involved in digestion.
4. Removal of excess hormones, vitamins, intermediate metabolic products.
5. Synthesis of vital biologically active substances( albumins, coagulation factors).

The lobe of the liver consists of hepatic cells - hepatocytes. It is a violation in the structure of the hepatic lobule, its degeneration into abnormal-structural nodes surrounded by fibrous tissue, and is cirrhosis.

Causes of liver cirrhosis

Most common causes:

1. Viral hepatitis B, C and D are the most frequent and common causes of cirrhosis in the world. Throughout the world, there is an increase in infection with viral hepatitis, which can quickly transform into cirrhosis of the liver.

2. Alcoholic liver disease.
3. Cryptogenic cirrhosis. This is the diagnosis of the exception, it is taken when the cause of the disease can not be established.

Rare causes of cirrhosis:

1. Non-alcoholic steatohepatitis. The defeat of the liver against a background of metabolic disorders( primarily the violation of fat metabolism - with obesity and carbohydrate metabolism - in diabetes).
2. Autoimmune hepatitis. It occurs when there are disorders in the immune system, when the body produces its antibodies to its own hepatic cells - hepatocytes.
3. Primary biliary cirrhosis of the liver. Occurs with prolonged cholestasis - a violation of the outflow of bile along the tubules from the liver.
4. The use of drugs( anti-tuberculosis and anti-cancer drugs) and hepatotoxic substances( mercury, gold and lead).

Very rare causes of cirrhosis:

1. Hemochromatosis. Hereditary disease as a result of accumulation of iron in organs and tissues
2. Konovalov-Wilson's disease. Hereditary disease, leading to the accumulation of copper in the tissues of the liver and brain.
3. Insufficiency of alpha 1 - antitrapepsin. Hereditary disease. The lack of synthesis of this protein in the liver leads to the appearance of chronic bronchitis and cirrhosis of the liver.
4. Secondary biliary cirrhosis of the liver. It develops with obstruction( constriction, compression) of the biliary tract with a stone, a tumor. Syndrome Budd - Chiari. It develops with thrombosis of the hepatic veins.

Symptoms of liver cirrhosis

The rate of onset and development of cirrhosis depends on the severity of the course of the hepatitis that caused it. At the initial stages of the disease there are moderate pains, a feeling of discomfort in the right hypochondrium, usually after eating, exercise. Accompanied by bitterness in the mouth, bloating. In the future, nausea and vomiting, and a decrease in appetite are added to the pain.

Men are violated potency, in women - a menstrual cycle. Skin covers, sclera of the eyes are painted in icteric color because of the increased level of bilirubin and cholesterol in the blood. The skin becomes dry, itching an intense itch. Because of violations of the processes of blood clotting there are nasal bleeding and bleeding from the gums, the bleeding from the wounds does not stop for a long time. Vascular "stars" appear on the skin of the trunk. As cirrhosis develops, swelling on the legs occurs, the abdomen enlarges due to ascites - accumulation of fluid in the abdominal cavity. Because of the accumulation of toxic metabolic products in the blood, there are signs of hepatic encephalopathy( cerebral cortex damage) - intense headaches, memory loss, sleep disturbance, hallucinations, coma development. Sharply reduced appetite, patients weaken, lose weight until exhaustion.

Suspected liver cirrhosis

1. Biochemical methods of investigation show violations of the functional state of the liver( hepatic complex): total protein and protein fractions - reduction of the total protein and protein albumin. The increase in enzymes( AlT - alanine aminotransferase and AsT - aspartate aminotransferase, alkaline phosphatase alkaline phosphatase), bilirubin - indicates the activity of the process.
2. Coagulogram - shows a violation of the blood coagulation system.
3. The general analysis of blood - signs of anemia - a decrease in hemoglobin level, the number of platelets and leukocytes decreases.
4. Serological markers of viral hepatitis B, C, D, G, markers of autoimmune hepatitis( antimitochondrial and antinuclear antibodies) - to establish the cause of the disease.
5. Fecal occult blood test - to detect gastrointestinal bleeding.
6. Determination of the level of creatinine, electrolytes( renal complex) - to detect complications of liver cirrhosis - the development of renal failure.
7. Alpha-fetoprotein of blood - if there is a suspected complication, liver cancer.
8. Ultrasound examination of the organs of the abdominal cavity and vessels of the portal system. Shows the increase and change in the structure of the liver, enlarged spleen. Increase in the diameter of the vessels. The presence of fluid in the abdominal cavity - ascites.
9. Esophagogastroduodenoscopy( PHEGS) - detection of varicose veins of the esophagus and stomach.
10. A liver biopsy. Helps establish an accurate diagnosis and stage of the disease.
11. Computerized tomography and liver scintigraphy - prescribe according to the doctor's indications. They help in more detail and accurately reveal the nature of changes in the liver.

Scintigraphy of the liver

Consultation of specialists, according to indications:

- infectious disease doctor, when establishing the viral nature of liver cirrhosis;
- a hepatologist, for other causes of cirrhosis;
- oncologist - with suspected liver cancer;
- surgeon - if there is a suspicion of complications( bleeding).

The severity of the disease is established by the attending physician using the Child-Pugh( CP) criteria scale. Indicators of the criteria are laboratory data, signs of manifestation of cirrhosis. Patients belonging to class A are compensated, and to class B and C - decompensated.

Treatment of cirrhosis of the

Patients with compensated cirrhosis should be treated for the underlying disease( viral hepatitis, alcoholic or non-alcoholic steatohepatitis) to prevent deterioration in the course of the disease and the development of complications. Patients are recommended a balanced diet, with a sufficient level of protein and fat. Elimination of alcohol, products containing chemical preservatives, extremely careful taking of medications - only vital. Vaccination is carried out only for life indications. Limitation of severe physical exertion. Avoid supercooling, overheating, insolation( sunbathing).Not recommended mineral water, physiotherapy and thermal procedures. It should avoid starvation, the intake of medicinal herbs, treatment with traditional medicine.

Patients with compensated cirrhosis of the liver are observed by the attending physician( therapist or general practitioner), with visits every three months. Pass a complex of examinations( ultrasound examination of the abdominal cavity, a general blood test, studies on the liver complex, kidney complex).

With the development of decompensation, patients are referred for treatment in specialized departments of the hospital, because of the high risk of complications.

The main goal of treatment at this stage is to stop the progression of the disease and treat the complications that have arisen. Medicinal therapy of patients with cirrhosis of the liver should be prescribed only by the attending physician. In each individual case, the necessity of prescribing the drug and the potential danger of its side effect are evaluated.

The use of hepatoprotectors( drugs that improve liver function) is strictly individual and limited, because of their ineffective effectiveness in the treatment of liver cirrhosis.

In the development of cholestasis( violation of the outflow of bile from hepatic cells - hepatocytes), which is manifested by jaundice and pruritus, ursodeoxycholic acid preparations are used to reduce the load and damage to hepatocytes by bile acids. The duration of the drug depends on the patient's condition and the severity of cholestasis.

In the development of portal hypertension( increased pressure in the blood supply system of the abdominal cavity), resulting in ascites and edema, varicose veins of the esophagus, pressure reduction is carried out by the administration of nitrates and b-adrenoblockers( propranololone group).

Complications of liver cirrhosis

1. Acute varicose bleeding. It arises from varicose veins of the esophagus and stomach. The patient develops weakness, blood pressure drops, the pulse becomes faster, vomiting appears with an admixture of blood( the color of the coffee grounds).Treatment is carried out in the intensive care unit, with inefficiency, surgical methods of treatment are used. To stop bleeding, intravenous administration of oktopid( to reduce pressure in the bloodstream of the abdominal vessels), endoscopic treatment( dressing varicose veins, sclerotherapy) is used. Gently transfuse blood solutions and components to maintain the required level of hemoglobin.

2. Spontaneous bacterial peritonitis - inflammation of the peritoneum, due to infection of fluid in the abdominal cavity( ascites).In patients, the temperature rises to 40 degrees, chills, there is intense pain in the abdomen. Prescribe long-acting antibiotics of a wide spectrum of action. Treatment is carried out in the intensive care unit.

3. Ascites - accumulation of fluid in the abdominal cavity. Assign a diet with protein restriction( up to 0.5 grams per kg of body weight) and salt, diuretics, intravenous albumin( protein preparation).If necessary, resort to paracentesis - the removal of excess fluid from the abdominal cavity.

Ascites

4. Hepatorenal syndrome - development of acute renal failure in patients with cirrhosis of the liver. Stop the use of diuretics, appoint intravenous administration of albumin. Treatment is carried out in the intensive care unit.

5. Hepatic encephalopathy. It manifests itself from minor neurological disorders( headache, fatigue, retardation) to severe coma. Since it is associated with the accumulation in the blood of protein metabolism products( ammonia) - restrict or exclude from the diet of the protein, prescribe a prebiotic - lactulose. It has a laxative effect and the ability to bind and reduce the formation of ammonia in the intestine. At the expressed neurologic infringements of treatment spend in branch of an intensive therapy.

6. Development of hepatocellular carcinoma - malignant neoplasm of the liver.

Cardinal treatment of hepatocellular carcinoma and decompensated liver cirrhosis - liver transplant. Replacing the patient's liver with the donor's liver.

Prevention of liver cirrhosis

Timely detection and treatment of diseases that can lead to the development of cirrhosis. Prevention of viral liver damage( vaccination against viral hepatitis B, compliance with personal protective equipment and hygiene).Eliminate the abuse of alcoholic beverages.

Doctor's consultation

Question: Are there any contraindications for liver biopsy?
Answer: Contraindication is the presence of hemorrhagic syndrome( increased risk of bleeding), the presence of ascites, impaired consciousness( hepatic encephalopathy).

Question: Does a patient with cirrhosis be contagious to others?
Answer: No. But for a patient with cirrhosis of the liver, any bacterial, viral infection( cold, pneumonia) that is transferred is a risk of development of decompensation and complications.

Doctor therapist Vostrenkova IN