Cirrhosis - a disease characterized by abnormal liver structure due to proliferation of connective tissue; manifested functional liver failure.
Causes
The main risk factors for cirrhosis is considered to be:
- Saint Martin's evil
- viral hepatitis
- toxic effects of industrial poisons, drugs (methotrexate, isoniazid, etc.), and other mycotoxins.
- venous stasis in the liver that is associated with prolonged and severe heart failure
- hereditary diseases - hemochromatosis, Hepatolenticular degeneration, a failure alfa-antitrypsin, galactosemia, glycogen and others.
- prolonged biliary tract lesion
Approximately 50% of patients with cirrhosis of the liver disease develops due to the actions of a few causal factors (usually hepatitis B and alcohol).
Manifestations cirrhosis
Complaints of weakness, fatigue, decreased performance and appetite, dyspeptic disorders (nausea, vomiting, bitter taste in the mouth, belching, intolerance to fatty foods, alcohol).
Characterized by a feeling of heaviness or pain in the abdomen, especially in the right upper quadrant and epigastric region. Among cirrhosis importance are so-called "hepatic signs" as redness of palms, vascular "Stars" (mainly on the skin of the upper half of the trunk). Often there are hemorrhages in the skin, as well as increased bleeding of mucous membranes.
There have itchy skin, joint pain, reduce hair in the armpits and pubic area, lower sex drive. Body temperature rises moderately or remains within the normal range.
observed asthenic syndrome frequently show weakness, fatigue, irritability, tearfulness, mood instability. Patients impressionable, often resentful, picky, suspicious, prone to hysterical reactions. Characterized by sleep disorder - insomnia at night, sleepiness during the day.
During cirrhosis are caused by colds, violation of the regime, the use of alcohol.
Diagnostics
The diagnosis of cirrhosis in the early stages is quite difficult because the disease develops gradually and at first does not express symptoms.
Essential in the recognition of liver cirrhosis have ultrasound, X-ray and radionuclide methods. Fairly accurate information about the condition of the liver with cirrhosis may be obtained by CT.
Radionuclide studies of the liver - scintigraphy to its informational content inferior to ultrasound Research and computed tomography, but unlike them, it also allows you to evaluate the function authority.
The decisive importance in the diagnosis of cirrhosis of the liver tissue is obtained by needle biopsy - blind or sighting conducted under ultrasound or laparoscopy.
Treatment of cirrhosis
Limit the mental and physical stress. With the general good condition are recommended medical walking, therapeutic exercises. Women with active liver cirrhosis should avoid pregnancy.
Compensated cirrhosis inactive drug treatment is usually not required. Furthermore, it should do as much as possible to limit the use of drugs, especially sedatives.
When sub- and decompensated forms to drug therapy is determined by the nature of the main manifestations of the disease. In the case of the low protein content in the blood administered anabolic steroids and plasma albumin transfusion solution. The presence of anemia is an indication for iron supplementation. Swelling and ascites restrict fluid intake, exclude sodium chloride in the diet, administered diuretics (hydrochlorothiazide, furosemide) in combination with an aldosterone antagonist (spironolactone). Paracentesis produce for health reasons, simultaneously releasing not more than 3 liters.
Applied also called gepatoprotektory - vitamins, orotic acid, extracts and hydrolysates liver, silibinin (is legal), Essentiale et al.
In the case of process activity using the same means as in chronic active hepatitis, the main of which are hormones (prednisolone) and immunosuppressants (azathioprine, etc.). Their efficiency is inversely related to the depth of adjustment of the liver tissue and in advanced stages of cirrhosis is close to zero.
To prevent infection, all patients with cirrhosis of the liver in all interventions (tooth extraction, sigmoidoscopy, Paracentesis et al.) Prophylactically administered antibiotics. Antibacterial therapy is also even in mild infectious processes.
General advice to patients with liver cirrhosis:
- Rest when you feel tired.
- Do not lift (it can provoke gastrointestinal bleeding)
- Achieve stool frequency 1-2 times a day. Patients with cirrhosis of the liver for the normalization of the bowel and the composition of the intestinal flora in favor of "good" bacteria is recommended 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.
- To improve digestion polyenzyme patients prescribed drugs.
When fluid retention (edema, ascites) necessary to restrict sodium chloride intake to 0.5 g per day, fluid - up 1000-1500ml per day. - 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);
- 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.
- 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.
Diet liver cirrhosis
Excluded from the diet:
- mineral water containing sodium;
- alcohol;
- Salt, food must be cooked without the addition of salt (used salt-free bread, crackers, biscuits and bread, butter and salt-free);
- products containing baking powder and baking soda (cakes, biscuits, cakes, pastries, and the usual bread);
- pickles, olives, ham, bacon, corned beef, languages, oysters, mussels, herring, canned fish and meat, fish and meat pate, sausage, mayonnaise, various sauces and canned all kinds of cheeses, ice cream.
It is recommended to use in cooking seasonings: lemon juice, orange zest, onion, garlic, salt-free mayonnaise and ketchup, pepper, mustard, sage, thyme, parsley, oregano, bay leaf, clove.
Allowed 100 grams of beef or poultry meat or fish and rabbits one egg a day (one egg can replace 50 g of meat). Milk is limited to 1 cup per day. You can eat low-fat sour cream. You can eat steamed rice (without salt). Resolve any fruits and vegetables in the open or in the form of dishes prepared at home.
Sample menu for the day for a patient with liver cirrhosis:
- Breakfast: cereal porridge (semolina, buckwheat, millet, barley, oats) with cream and sugar, or baked fruit. 60 g of salt-free bread loaves or (slices), or salt-free crackers with unsalted butter and jelly (jelly or honey), 1 egg, tea or coffee with milk.
- Lunch: 60 grams of beef or poultry meat or 90 g white fish, potatoes, greens, fruits (fresh or baked)
- Snack: 60 g of salt-free bread or breads, unsalted butter, jam or tomato, tea or coffee with milk.
- Dinner: soup without salt, beef, poultry, meat or fish (for lunch), potatoes, greens, fruit or jelly from fruit juice and gelatin, cream, tea or coffee with milk.
For more information on nutrition in liver cirrhosis - in our separate article
Forecast
Lifespan liver cirrhosis depends on the degree of compensation process. Approximately half of the patients with compensated (at diagnosis), cirrhosis of the lives of more than 7 years.
Patients with decompensated cirrhosis remains alive 11-41% in 3 years. only a quarter of patients undergoing 3 years during the development of ascites. Even more unfavorable prognosis has cirrhosis, accompanied by damage to the nervous system in which most of the patients die within a year.
Leading causes of death - hepatic coma and bleeding from the upper gastrointestinal tract. Patients with cirrhosis disabilities (disability group III), and with decompensated cirrhosis, active forms of the disease and complications accession - are disabled (disability I and II group).
prevention
Prevention is timely treatment and prevention of diseases, leading to cirrhosis (primarily alcohol and viral hepatitis).
