Cirrhosis: symptoms, treatment. How many live with cirrhosis

Liver cirrhosis - chronic disease accompanied by structural changes in the liver with the formation of scar tissue, organ shrinkage and reduction of its functionality.

It can develop on the background of a long and systematic alcohol abuse, viral hepatitis with subsequent transition in its chronic form, or as a consequence of autoimmune disorders nature, extrahepatic biliary obstruction, cholangitis.

Science known cases where this disease leads to prolonged heart failure, parasitic liver disease, hemochromatosis, etc.

What it is?

Liver cirrhosis - chronic liver disease accompanied by irreversible substitution parenchymal liver tissue by fibrous connective tissue, or stroma. Liver cirrhosis is increased or reduced in size, unusually dense, bumpy, rough. Death occurs depending on the various types of cases within two to four years, with severe pain and suffering of the patient in the terminal stage of the disease.

A bit of historical data

Since ancient times, the liver is considered to be as important organs like the heart. According to the beliefs of residents Mesopotamia, is produced in the liver and blood living soul. Hippocrates described relationship between liver disease and obstructive jaundice, and ascites. He argued that the jaundice and solid liver - a bad combination traits. It was the first judgment of liver cirrhosis and its symptoms.

Cirrhosis of the liver and its causes have been described in 1793. Matthew Baillie in his treatise "morbid anatomy". In his work he clearly linked consumption of alcoholic beverages with the emergence of the symptoms of liver cirrhosis. According to him, sick more often than men middle-aged and older. British cirrhosis dubbed "dzhinovoy plague" or "dzhinovoy liver."

The term derives from the Greek cirrhosis «kirrhos», which means that a yellow color and belongs Raney Theophilus Hyacinthe Laennec - French doctor and anatomist. On the study of liver cirrhosis work and work until our time many scientists. Virchow, Kuehne, Botkin, Tatarinov, Abella and others have proposed many theories about what cirrhosis, its symptoms, causes, methods of diagnosis and treatment.

The causes of cirrhosis

Among the main reasons that lead to the development of disease, distinguished:

1. Viral hepatitis, which is different estimates leads to the formation of liver disease in 10-24% of cases. Disease hepatitis end such varieties as AT, FROM, D, and the newly discovered hepatitis G;
2. Various diseases of the biliary tract, including extrahepatic obstruction, cholelithiasis and primary sclerosing cholangitis;
3. Abnormalities in the immune system. To lead the development of cirrhosis, many autoimmune diseases;
4. Portal hypertension;
5. Venous stasis in liver or Budd-Chiari syndrome;
6. Poisoning by chemicals have toxic effects on the body. Among those substances particularly harmful to the liver, industrial toxins, heavy metals, aflatoxins and fungal toxins;
7. Transmitted Diseases inherited, in particular, genetically determined metabolic disorders (anomalies glycogen storage, Wilson's disease, deficiency of a1-antitrypsin galactose-1-phosphate uridiltransferazy);
8. Prolonged reception drugs, among which Iprazid, anabolic steroid agents, Isoniazid, androgens, Methyldopa, Inderal, Methotrexate and some others;
9. Taking large doses of alcohol for 10 years or more. Depending on the specific type of beverage no fundamental factor - the presence of the ethyl alcohol and regular flow of the body;
10. Rare Disease Rendu-Osler disease can also cause cirrhosis.

In addition, should also be said of cryptogenic cirrhosis, the causes of which remain unclear. It occurs in the range of from 12 to 40% of cases. Aggravating factors in the formation of scar tissue can become systematic malnutrition, infectious diseases, syphilis (is cause of cirrhosis in infants). Significantly increases the risk of the combined effects of the disease etiological factors, e.g., a combination of hepatitis and alcoholism.

Classification

Modern classification of the disease in question is based on the account of etiological, morphogenetic and morphological criteria, as well as clinical and functional criteria. Based on the reasons for the background exposure who develop cirrhosis, defined by the following variants:

• biliary cirrhosis (Primary or secondary) (cholestasis, cholangitis);
• circulatory cirrhosis (arising on a background of chronic venous stasis);
• metabolic and nutritional cirrhosis (lack of vitamins, proteins, cirrhosis accumulation resulting from hereditary metabolic disorders);
• infectious (viral) cirrhosis (hepatitis, biliary tract infections, liver disease, parasitic scale);
• toxic cirrhosis, cirrhosis, toxic and allergic (food and industrial poisons Medications, allergens, alcohol);
• cryptogenic cirrhosis.

Depending on the clinical and functional characteristics, cirrhosis is characterized by several of the following features:

• level of hepatocellular insufficiency;
• general nature of the disease (progressive, stable or retrogressive);
• the degree of relevance to disease portal hypertension (bleeding, ascites);
• The total activity of the disease course of a process (active cirrhosis, cirrhosis moderately active and inactive cirrhosis).

Portal cirrhosis

The most common form of the disease, which is characterized by lesions of the liver tissue and the loss of hepatocytes. The changes are due to poor nutrition and alcohol abuse. In 20% of portal cirrhosis can cause an infectious disease. First, the patient complains of a violation on the part of the digestive tract. Then develop the outward signs of the disease: yellowing of the skin, the appearance of spider veins on the face. The last stage is characterized by the development of ascites (abdominal dropsy).

biliary cirrhosis

This particular form of the disease that develops due to the long cholestasis or biliary tract lesions. Biliary cirrhosis is an autoimmune pathology which takes a long time without any symptoms. Sick they are mainly women of 40-60 years. Initial degree of disease is often associated with diabetes mellitus, lupus erythematosus, dermatomyositis, rheumatoid arthritis and drug allergy.

The first signs

Additional early symptoms indicating cirrhosis, are the following:

1. In the mouth there is a feeling of bitterness and dryness, especially often in the morning;
2. The patient loses some weight, becomes irritable, gets tired quickly;
3. Man can disturb the periodic stool disorders, increased flatulence;
4. recurring pain localized in the right upper quadrant. They have a tendency to increase after intensive physical exercise or after taking fatty and fried foods, alcoholic beverages;
5. Some forms of the disease, such as cirrhosis Postnecrotic, manifest themselves in the form of jaundice in the early stages of development.

In some cases, the disease manifests itself is sharp and there are no early warning signs.

symptoms of cirrhosis

Cirrhosis is characterized by common symptoms: fatigue, reduced work capacity, abdominal discomfort, dyspepsia disorder, fever, joint pain, also marked flatulence, pain and feeling of heaviness in the upper half abdomen, weight loss, asthenia. On examination revealed an increase in the liver, the seal and the deformation of its surface, the edge sharpening. First noted even a moderate increase in both lobes of the liver, usually predominates later increase in the left lobe. Portal hypertension is shown a moderate increase in the spleen.

Unfolded clinical picture manifested syndromes of liver cell failure and portal hypertension. There are bloating, poor tolerance of alcohol and fatty foods, nausea, vomiting, diarrhea, a feeling of heaviness or pain in the abdomen (mainly in the right upper quadrant). In 70% of cases revealed hepatomegaly, liver sealed, sharpened edge. In 30% of patients revealed nodosum palpation the liver surface. Splenomegaly in 50% of patients.

Low-grade fever may be associated with the passage through the liver, intestinal bacterial pyrogens, which it is unable to neutralize. Fever is resistant to antibiotics and only passes with improved liver function. There may also be external signs - palmar or plantar erythema, spider veins, lean scalp underarm and pubic hair, white nails, gynecomastia in men due hyperestrogenemia. In some cases, the fingers take the form of "drumsticks."

In the terminal stages of the disease in 25% of cases there is a reduction in liver size. Also, there are jaundice, ascites, peripheral edema due to fluid overload (especially swelling of the feet), external venous collaterals (varicose veins of the esophagus, stomach, intestines). Bleeding from the veins often ends in death. Less commonly, bleeding hemorrhoids occur, they are less intense.

Effects

Cirrhosis of the liver, in principle, alone, does not cause death, it is deadly complication in the stage of decompensation. Among them:

1. ascites with cirrhosis - is fluid accumulation in the abdominal cavity. Assign diet with protein-restricted (up to 0.5 gram per kg body weight) and salts, diuretics, intravenous administration of albumin (a protein preparation). If necessary, resorting to paracentesis - removal of excess liquid from the abdominal cavity.
2. Spontaneous bacterial peritonitis - peritonitis, infections due to fluid in the abdomen (ascites). In patients with fever to 40 degrees, chills, an intense abdominal pain. Designate long-term broad-spectrum antibiotics. Treatment is carried out in an intensive care unit.
3. Hepatic encephalopathy. Manifested by minor neurological disorders (headache, fatigue, lethargy) to severe coma. Since it is associated with the accumulation of protein metabolism in blood products (ammonia) - limited, or excluded from the diet protein administered prebiotic - lactulose. It has a laxative effect and the ability to bind and reduce the formation of ammonia in the gut. When expressed neurological disorders treatment is carried out in an intensive care unit.
4. Hepatorenal syndrome - the development of acute renal failure in patients with cirrhosis. Cease use of diuretic drugs, administered intravenous albumin. Treatment is carried out in an intensive care unit.
5. Acute variceal bleeding. It arises from varicose veins 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 the NICU, the ineffectiveness, surgical treatment is used. To stop bleeding oktropida apply intravenous (to reduce pressure in the circulating abdominal vessels), endoscopic treatment (variceal ligation nodes sclerotherapy). Carefully carried solutions and transfusions of blood components, to maintain the desired level of hemoglobin.
6. The development of hepatocellular carcinoma - liver cancers.

A radical treatment of hepatocellular carcinoma and decompensated liver cirrhosis - liver transplantation. Substitution patient liver liver donor.

Cirrhosis of the liver at the last stage: the photo of people

The photo below shows how the disease manifests itself in humans.

Diagnostics

Determination cirrhosis diagnosis takes place in several stages. Self diagnosis is based on the data of instrumental studies:

1. Magnetic resonance imaging or computerized tomography - the most accurate method of diagnosis.
2. Biopsy - a method of histological examination of material taken from the liver, which allows you to set the kind of large-cirrhosis or CKD and cause disease.
3. US - as screening. It allows you to install only the preliminary diagnosis, but it is indispensable for the diagnosis of ascites and portal hypertension.

If the diagnosis of histological study could not determine the cause of the disease, continues its search. To do this, perform a blood test for the presence of:

• mitochondrial antibodies;
• RNA of hepatitis C virus and hepatitis B virus DNA using a PCR method;
• AFP - in order to prevent cancer of the blood;
• the level of copper and tserruloplazmina;
• level of immunoglobulins A and G, the level of T-lymphocytes.

At the next stage the extent of damage to the body due to liver destruction. For this purpose:

• liver scintigraphy - radionuclide study to determine the working of the liver cells;
• Biochemical analysis of blood for determination of indicators such as sodium and potassium, coagulation, cholesterol, alkaline phosphatase, total bilirubin and fractional, AST, ALT, lipidogram, proteinogramma;
• the degree of kidney damage - creatinine, urea.

The presence or absence of complications:

• Ultrasound to eliminate ascites;
• exception of internal bleeding in the digestive tract by the presence of fecal occult blood in it;
• FEGDS - to eliminate varicose veins of the esophagus and stomach;
• sigmoidoscopy to eliminate varicose veins in the rectum extensions.

Liver cirrhosis is felt through the front wall of the peritoneum. On palpation palpable roughness and density of the body, but it is only possible to decompensation stage.

When ultrasound foci of fibrosis clearly defined in the body, and they are classified into small - less than 3 mm and larger - more than 3 mm. When developing cirrhosis of alcoholic nature initially small nodes biopsy defines specific changes in liver cells, and steatosis. In the later stages of the disease components become larger, become mixed, steatosis disappears. Primary biliary cirrhosis is characterized by an increase in liver bile ducts retaining structure. In secondary biliary liver cirrhosis increases due to obstacles in the bile ducts.

Step cirrhosis

The disease is usually characterized by its length, with the following basic stages of his:

1. compensation stage. Characterized by the absence of cirrhosis symptoms, due to intensification of work remaining liver cells.
2. Step subcompensation. At this stage, the first signs of liver cirrhosis (as weakness and the right hypochondrium discomfort, loss of appetite and weight loss). To perform the functions inherent in the liver, occurs in an incomplete, that is due to the gradual utrachivaniya resources remaining cells.
3. Step decompensation. Here the case of liver failure, exhibited severe conditions (jaundice, portal hypertension, coma).

How to treat cirrhosis of the liver?

In general, the treatment of liver cirrhosis is chosen strictly individual - therapeutic tactics depends on the stage of the disease, the type of pathology, the general health of the patient, concomitant diseases. But there are general principles for the appointment of treatment.

These include:

1. Compensated cirrhosis step always starts with removing the cause of the pathology - in this case the liver is still able to operate normally.
2. The patient must adhere to a strict diet - even a slight breach can be the impetus for the progression of cirrhosis.
3. It is impossible at present to carry out fizioprotsedury disease, treatment with heat. Excluded and exercise.
4. If the disease is in the stage of decompensation, the patient is placed in a medical institution. The fact is that in this disease the risk of serious complications is very high and only medical professionals can timely pay attention even to a slight deterioration, prevent complications that lead to death patient.
5. In most cases, the treatment prescribed hepatoprotectors, beta-blockers, sodium and ursodeoxycholic acid preparations.

General advice to patients with liver cirrhosis:

1. Rest when you feel tired.
2. To improve digestion polyenzyme patients prescribed drugs.
3. Do not lift (it can provoke gastrointestinal bleeding)
4. Daily measure the body weight, the volume of the abdomen at the level of the umbilicus (belly increase in volume and weight indicates fluid retention);
5. When fluid retention (edema, ascites) necessary to restrict sodium chloride intake to 0.5 g per day, fluid - up 1000-1500ml per day.
6. To control the degree of damage to the nervous system is recommended to use a simple test with hand: each day write down a short phrase such as "Good morning" in a special notebook. Show your notebook families - a change of handwriting, contact your doctor.
7. Daily fluid balance count per day (diuresis): count the volume of all received inside liquid (tea, coffee, water, soup, fruit, etc.) and counting all liquid discharged at urinating. The amount of liquid should be released approximately 200-300 ml more than the number of the received fluid.
8. Achieve stool frequency 1-2 times a day. Patients with liver cirrhosis for the normalization of the bowel and the composition of the intestinal flora in favor of "useful" bacteria are encouraged to take lactulose (Duphalac). Duphalac appointed to the dose that causes a mild, poluoformlenny stool 1-2 times a day. The dose ranges from 1-3 teaspoons adjusted individually to 1-3 tablespoons per day. There are no contraindications of the drug, it can take even the young children and pregnant women.

Treatment with cirrhosis and complications of pathological manifestations is meant by:

1. Reducing ascites conservative (diuretics scheme) and surgical (removal of liquid through the drainage) methods.
2. Treatment encephalopathy (nootropics, sorbents).
3. Removal manifestations portal hypertension - application of nonselective beta-blockers (propranolol, nadolol) before ligation of varicose veins during surgery.
4. Preventive antibiotics for the prevention of infectious complications in planned visits to the dentist before the instrumental manipulation.
5. dyspepsia treatment with Correction supply and application of enzyme preparations without bile acids (pancreatin). Perhaps in such cases and the use of eubiotics - baktisubtil, enterol, bifidumbacterin and laktobakterin.
6. For removal of pruritus isporlzuyut antihistaminic agents, and preparations containing ursodeoxycholic acid.
7. Appointment of androgens in men with severe manifestations of hypogonadism and female hormonal correction for the prevention of dysfunctional uterine bleeding - under the supervision of an endocrinologist.
8. It shows the use of preparations containing zinc to prevent seizures at the usual muscle load and in the complex treatment of liver failure, for reducing hyperammonemia.
9. Prevention of osteoporosis in patients with chronic cholestasis and in primary biliary cirrhosis, in the presence of autoimmune hepatitis with taking corticosteroids. For this additionally introduced calcium in combination with vitamin D.
10. Surgical correction of portal hypertension for the prevention of gastrointestinal bleeding include imposition of vascular anastomoses (mesocaval and splenorenal) as well as sclerotherapy with extensions veins.
11. In the presence of single foci of degeneration in hepatocellular carcinoma and severity of the disease class, patients show operational removal of affected liver segments. In a clinical disease class B and C, and a massive defeat, waiting for transplantation, cancer chemotherapy is prescribed to impede progression. For this purpose, as the effect of currents and temperatures (Percutaneous radiofrequency thermal ablation) or chemotherapy administration by the impact of cytostatics oily solutions into vessels supplying the liver corresponding segments (Chemoembolization).

Treatment of established such a terrible fatal complications such as acute massive bleeding from esophageal varices include:

1. Topical application probe Blackmore, through which inflating airbag in the esophageal lumen cuff compresses the expanded vein bleeding.
2. The sighting obkalyvanie esophageal wall sclerosing substances.
3. Krovezamestitelnaya therapy.

Unfortunately, this state and it becomes the main cause of death in patients with liver cirrhosis.

Diet liver cirrhosis

Dieting with cirrhosis of the liver involves, first of all, denial of food, in which there is a high protein content. After all, in patients with liver cirrhosis digestion breaks down protein foods, and as a result the intensity of the rotting processes in the intestine increases. Diet for cirrhosis provides periodic fasting days, during which the patient did not consume foods containing protein. Furthermore, another important issue is the restriction of use together with the main meal salt.

Diet in cirrhosis involves eliminating all foods that contain baking soda and baking powder. Can not eat pickles, bacon, ham, seafood, corned beef, canned, sausages, sauces, salt, cheese, ice cream. To improve the taste of the products, can be used instead of salt spices, lemon juice.

Diet for cirrhosis of the liver allows the use of a small amount of dietary meat - rabbit, veal, poultry. Once a day, you can eat one egg.

prognosis of the disease

Cirrhosis of the liver is incurable, but if not carried out a liver transplant. Using the above drugs can only maintain a more or less decent quality of life.

How many people live with cirrhosis of the liver depends on the cause of the disease, the stage at which it was discovered, and the complications that had to appear at the start of treatment:

• the development of ascites live 3-5 years;
• if developing gastrointestinal bleeding for the first time, will outlive him from 1/3 to half of the people;
• if developed hepatic coma, that means nearly 100% lethality.

There is also a scale which allows to predict life expectancy. It takes into account the results of the analyzes and the degree of encephalopathy:

Parameter	points
1	2	3
ascites	No	The abdomen was soft, it goes by the diuretic	Abdomen tense, its volume is reduced bad when taking diuretics
Personality change, memory, sleepiness	No	mild	strongly expressed
total bilirubin	Less than 34 mmol / l	31-51 mmol / l	More than 51 mmol / l
Albumen	3.5 g / l and more	2.8-3.5 g / l	Less than 2.8 g / l
prothrombin index	More than 60%	40-60%	Less than 40%
score	5-6	7-9	10-15
how many live	15-20 years	It is necessary to transplant the liver, but postoperative mortality - 30%	1-3 years. If conduct transplantation of this step, the probability of dying after operation 82 of 100

prevention

Cirrhosis of the liver - it's quite a long process that lends itself to a halt and treatment. The main key to success - on time to go to the doctor. Nevertheless, this is one of those diseases which can be easily avoided by adhering to certain preventive measures, which include:

• Vaccination against hepatitis B in childhood;
• rational and proper nutrition;
• golodovaniya and preventing overeating;
• avoiding alcohol and smoking, to avoid alcoholic cirrhosis and liver toxicity;
• annual ultrasound and endoscopy;
• timely access to a doctor for medical advice;
• adequate intake of vitamin and mineral complexes;
• harsh suppression and treatment of drug addiction.

Also help prevent the development of cirrhosis of the preventive measures for the prevention of viral hepatitis.