Cirrhosis is a diffuse pathological process that occurs with excessive fibrosis and the formation of structural abnormal regenerative nodes. Clinical manifestations are diverse and determined mainly by the activity of the pathological process, a decrease in liver function, and the development of portal hypertension.
Symptomatic for cirrhosis develops slowly, while its functionality is impaired. Disease is dangerous because it is difficult to identify in time, a person learns about it when it is too late and it is almost impossible to save the patient.
In this regard, the most frequent causes of death of patients with common forms of cirrhosis are hepatic insufficiency, complications of portal hypertension, primary liver cancer and attachment of bacterial infection.
Why does cirrhosis develop and what is it? Cirrhosis of the liver is a late stage of various inflammatory liver diseases( hepatitis) and some other organs( for example, heart failure - heart failure).
As a result of damage and inflammation of the liver cells, some of them die. In place of dead cells of the liver, connective tissue grows. The connective tissue surrounds the preserved liver cells, but can not perform their functions. The remaining liver cells begin to be intensively divided, forming islets of normal liver tissue that are surrounded by connective tissue. The structure of the liver is disturbed, and its functions are not performed in full. As a result of loss of liver function, hepatic failure develops.
All causes of cirrhosis are not established. But it is proved that most often the death of liver cells occurs as a result of :
- prolonged exposure to such diseases and processes:
- alcohol dependence;
- of viral hepatitis( especially B and C);
- autoimmune mechanisms;
- of congenital metabolic disorders: Wilson-Konovalov's disease, hemochromatosis, alpha-1-antitrypsin insufficiency.
- exposure to toxic chemistry and hepatotoxic drugs;
- occlusion of the biliary tract;
- stagnation in the liver of venous blood, associated with heart disease or veno-occlusive disease of the liver.
If it is impossible to establish the cause of the disease, they speak of cryptogenic cirrhosis. Thus, cirrhosis of the liver is a multifactorial chronic disease, and causative sources, from which there is quite a lot of cirrhosis of the liver.
The development of cirrhosis occurs gradually and depends on the course of the disease that caused it and treatment. This process can take from a year( in severe forms of viral hepatitis( acute inflammation of the liver caused by viruses B, C, D)) up to several decades( with chronic hepatitis( chronic inflammation of the liver)).
Stages of development of
There are 3 stages of development of cirrhosis:
- Compensation( initial) .It is characterized by a slight severity of symptoms. Patients can complain only about flatulence, a feeling of heaviness in the right hypochondrium, asthenia, decreased efficiency. With functional examination, a slight increase in the liver is revealed, the edge of the liver is dense, pointed. A slight increase in the spleen reflects the initial stage of portal hypertension.
- Subcompensation of .Based on the name, you can understand that there is a more pronounced decrease in the functional capacity of the organ, which is due to an increase in the number of dead hepatocytes. At this stage, a person is able to notice that something is going on with his body. He begins to suffer from weakness, apathy, decreased efficiency, nausea, weight loss and other early symptoms of the disease. At men already at this stage there are the first signs of gynecomastia. As for the laboratory indicators, not only bilirubin, but albumin, begins to fall, and the prothrombic index can reach 40. However, if the treatment is started in time, it is still possible to transfer this stage to the stage of compensation. That is, with the proper intake of medicines, the sick body will be able to function without complications for human health.
- Decompensation of .Characterized by signs of hepatic-cell insufficiency and complications of portal hypertension. Hepatic-cell failure is a consequence of a decrease in the mass of normally functioning cells and a decrease in the detoxifying function of the liver and is manifested by encephalopathy. Complicated portal hypertension with bleeding primarily from varicose veins of the esophagus and stomach, which is the main cause of death. Characteristic increase in ascites and peripheral edema, requiring therapy with diuretics in large doses.
First signs of
In women and men, the initial stage of cirrhosis passes almost asymptomatically. In the case of cirrhosis of the liver, the first signs manifest themselves in the form of a feeling of heaviness, discomfort in the right hypochondrium, as a rule, such a symptomatology appears after eating or exercise. There may be bitterness in the mouth, nausea. In patients, there is a decrease in working capacity, weakness, drowsiness.
At this stage of the disease there is a great chance to restore the functional activity of the liver and eliminate the course of the pathological process. After all, it is known that the liver has great ability to regenerate, so the timely access to a doctor with these symptoms will contribute to a high chance of recovery.
Symptoms of liver cirrhosis
Symptoms of liver cirrhosis are caused by damage to all organs and body systems. At the initial stages of the disease a person can not guess about the disease. The latent stage or asymptomatic course is very dangerous.
Symptoms are manifested already in the neglected phase, when the ability of cells to restore is completely absent. As a result, severe complications occur within a year after detection.
Patient examination reveals the following characteristic symptoms of liver cirrhosis as the disease progresses:
- Yellow facial skin, you can notice yellow in the eyes, mucous membranes.
- Redness of the palms, also the redness at the fingertips, brushes, this indicates that bilirubin in the blood rises.
- Disturbing a strong itch, bile acids find themselves in small vessels that are under the skin.
- There are vascular asterisks, a large number of bruises, bruises, small hemorrhages.
- It seems to a person that the liver interferes with it, its enlargement and compaction is felt, sometimes the patient is noticed before the liver, it protrudes.
- Temperature rise up to 38 degrees without a reason.
- A person is often ill with infectious diseases.
- On the abdomen there is a pattern of vessels that intertwine.
- In men, the breast can increase.
- The skin has a bright color, due to the fact that a large amount of estrogen, serotonin has accumulated in the blood.
- Hemorrhoids, varicose veins.
- The language is bright pink, smooth.
- Urine is brown in color, and feces are light.
- Bulging stomach due to the accumulation of large amounts of water.
- A person loses weight, but the stomach stays.
- Skin all pigmented, excessively dry.
All of the above symptoms cause an extremely characteristic type of patients with cirrhosis of the liver:
- Skinny face, unhealthy sub-bacterial skin color, bright lips, prominent cheekbones, erythema of the zygomatic area, widening of facial capillaries;muscular atrophy( limbs thin);
- An enlarged abdomen( due to ascites);
- Extension of veins of the abdominal and thoracic walls, edema of the lower limbs;
- Many patients exhibit hemorrhagic diathesis, caused by liver damage with impaired production of blood coagulation factors.
On the skin you can see hemorrhagic rashes of various types, often there are nosebleeds, as well as bleeding of other localizations( this is also promoted by the development of portal hypertension).
Diagnosis "Cirrhosis of the liver" is put after a comprehensive examination of the patient. The doctor collects an anamnesis of the patient, conducts a palpation examination for the increase of the liver, examines the skin, mucous membranes and sclera.
The endoscopy, gastroscopy, MRI, ultrasound, computed tomography, angiography is performed to assess the condition of internal organs. In some cases, a liver biopsy is performed. Assign blood tests: biochemical, on the markers of viral hepatitis.
Cirrhosis of the liver at the last stage: photo
In the photo you can see what a person looks like with diagnosed liver cirrhosis, which is complicated by ascites.
As liver cirrhosis progresses, the following consequences are possible:
- of the hepatic coma;
- bleeding from esophageal varices;
- thrombosis in the portal vein system;
- hepatorenal syndrome;
- formation of liver cancer - hepatocellular carcinoma;
- infectious complications - pneumonia, "spontaneous" peritonitis in ascites, sepsis.
Treatment of liver cirrhosis
Most men and women, after hearing such a terrible diagnosis, reasonably wonder - is there any way to completely cure liver cirrhosis? Unfortunately, modern medicine does not have such possibilities. The only effective way to get rid of the disease is to transplant the donor organ, that is, transplant the liver. However, such an option as transplantation is not suitable for every patient and costs a lot of money.
In general, the essence of the treatment of cirrhosis of the liver lies in carrying out therapeutic measures of :
- taking diuretics;
- compliance with the diet: the rejection of fried and fatty foods, alcoholic beverages. In the case of ascites, a decrease in salt intake;
- for autoimmune disorders - glucocorticoid hormones;
- if there is viral hepatitis, antiviral therapy is used to slow the progression of the disease;
- drugs that protect liver cells( hepatoprotectors), such as, for example, silymarin, ademethionine;
- if the liver ceases to purify the blood of toxins by itself, plasmapheresis is performed;
- drugs that reduce pressure in the portal vein( for example, nitrosorbide, anaprilin).
Nevertheless, do not despair, because if the disease was detected in the early stages, then stop its progression is quite possible, thanks to adequate therapy. In the event that cirrhosis is found in the late stages, doctors may be able to somewhat slow the progression of the disease, and delay the onset of complications.
Diet for cirrhosis of the liver
Patients with cirrhosis need to follow the diet. First of all, it is recommended to stop using alcoholic beverages, fatty, fried, seasoned dishes, smoked products, all kinds of sausages and canned food. It is also recommended to exclude from the diet of mushrooms, garlic, tomatoes, tomato juice, chocolate. Patients with developed ascites( accumulation of fluid in the abdominal cavity) is recommended to exclude from the diet table salt.
Vegetable soups, porridges, low-fat types of meat in boiled form, low-fat dairy products( cottage cheese, sour cream), crackers, green apples, etc. are allowed.
Sample menu for day for a patient with cirrhosis of the liver:
- Breakfast: cereal cereal, buckwheat, millet, barley, oatmeal) with cream and sugar or baked fruit.60 g of salt-free bread, or loaf( slices), or salt-free rusks with unsalted butter and marmalade( jelly or honey), 1 egg, tea or coffee with milk.
- Lunch: 60 g of beef or poultry meat or 90 g of white fish, potatoes, greens, fruit( fresh or baked)
- Snack: 60 g of salt-free bread or loaves, unsalted butter, jam or tomato, tea or coffee with milk.
- Dinner: soup without salt, beef, poultry or fish( as for lunch), potatoes, greens, fruit or jelly from fruit juice and gelatin, sour cream, tea or coffee with milk.
Option number 2:
- For breakfast: 1 boiled egg, 200 g of buckwheat porridge with baked apple, 100 g of salt-free bread, 100 ml of oat broth with 1 tsp. Sahara.
- For lunch: 250 g of baked potatoes with greens and tomatoes, 100 g of boiled fish of low-fat varieties, fruit jelly 100 ml.
- For a snack: green tea with milk, salt-free bread with jam.
- For dinner: 200 g vegetable soup puree with 1 tbsp.low-fat sour cream, 90 g of chicken fillet, steamed, 100 g of fruit jelly.
Food is provided 5-6 times a day, in small portions.
How many live with cirrhosis of the liver?
According to the world statistics, the life expectancy of patients with compensated cirrhosis of the liver exceeds 10 years. With decompensated cirrhosis, 40% of patients die in the first three years from the date of diagnosis. Patients with hepatic encephalopathy are able to live no more than 1 year.
The most effective method for increasing the prognosis for liver cirrhosis is to modify the patient's lifestyle: avoiding bad habits, normalizing eating habits, eating large amounts of vegetables and fruits, maintaining skin health, passing regular medical examinations, and observing the medical recommendations of the treating doctor.