Cirrhosis: symptoms and treatment
Cirrhosis is a disease that occurs in chronic form and is caused by the progressive scale of liver damage, as a result of which there is an absolute restructuring in its tissues. Cirrhosis of the liver, the symptoms of which subsequently cause a partial or complete violation of the functions relevant to the body, is mainly observed in men of the middle age and elderly age.
Cirrhosis of the liver is not just an irreversible disease of the liver, but also a serious threat to human life with this disease. The process of cirrhosis of the liver is accompanied by a gradual death of the cells of this organ, as a result of which its dimensions gradually decrease.
In addition, the process under consideration is also accompanied by serious disorders, not only in the functioning of the liver itself, but also in the body as a whole. Her normal tissues with cirrhosis are replaced by nodes formed by abnormal cells, the same, in turn, no important work is not performed. As a result of this increase in connective tissue, the organs of the body are squeezed, which causes necrosis of significant areas of liver tissue.
The liver itself is the largest gland of the digestive system, located in the upper part of the abdominal cavity, on the right side of the diaphragm. The structure of this organ is lobed. Liver cells contain hepatic cells (hepatocytes). Cirrhosis is precisely the changes that occur in this lobule (or rather, its structure), as a result of which its subsequent abnormal degeneration occurs, accompanied by the formation of specific nodes.
It is not superfluous to dwell not only on the peculiarities of the arrangement of this organ, but also on those functions that, in fact, the liver performs. In particular, we can distinguish the following:
- Removal of allergens, poisons and toxins from the body
- Removal of excess hormones from the body, as well as an excess of intermediate elements of metabolism and vitamins.
- Synthesis of carbohydrates, fats and proteins.
- Regulation of the process of the intake of sugar (glucose) into the body.
- Creation of bile involved in digestion processes
- Synthesis of biologically active substances necessary for the body, such as blood coagulation factors, albumins, etc.
To fulfill these functions, liver cells, as you can understand, must work in a normal way, because they are in close connection with the blood (the removed and added substances are transported to it and from it through the blood)
Let us dwell on this, not without exaggeration, unique relationship existing between the blood and the liver. So, for example, the main difference from most of our organs is that only a small amount of blood enters the liver through the arteries. Most blood flow occurs through the intestinal veins, when the blood returns to the heart. The main vein, which provides the return of blood from the intestine, is the portal vein. When passing through the liver, this vein is divided into many smaller veins. The tiniest of them are defined as sinusoids, which is due to the uniqueness of their structure, they also are in direct contact with the liver cells.
Hepatic cells actually line up according to the length of the sinusoid, and it is this close connection that makes it possible for the cells to remove and add substances that enter through the blood. Already after passing through the sinusoids of the blood, its direction to the veins of large sizes occurs, the same, in turn, form the hepatic vein — a single vein that provides a return of blood to the heart.
Considering these processes with the relevance of cirrhosis, we can, first of all, note that such a complex association of liver cells and blood in this disease is destroyed. And although those cells that survived under the influence of the processes that accompany this disease, as well as the newly formed cells can also all remove and produce the required substances in direct connection with the blood, this connection is no longer normal.
In addition, scars formed on the liver, affected by cirrhosis, act as a kind of obstruction to the flow of blood flowing through it to the cells of this organ. As a result of such a barrier to the blood flow, blood returns to the collar vein with simultaneous increase in pressure in it, which is defined as portal hypertension. The high pressure and obstruction that appears for the flow of blood leads to the fact that it begins to search for other veins, by means of which it will be possible to return to the heart, that is, veins with less high pressure, providing a bypass of the liver.
The liver itself is to remove or add blood substances that bypasses it, is incapable. Accordingly, manifestations of cirrhosis are provoked by a combination consisting of a reduced number of hepatic cells, a loss of adequate contact with the blood flow that passes through the liver and the loss of this contact with the blood that bypasses it.
There is also another problem arising on the background of cirrhosis. It is the violation of the connection of the liver cells with the channels through which bile passes. The bile is the liquid produced by the hepatic cells and performs two functions that are important for the body. These include, in particular, the aid provided to the bile system of digestion, as well as the removal of toxic substances from the body.
Bile is excreted into very thin tubules passing through the liver cells located along the sinusoids. These tubules, in turn, flow into small channels, which are later combined to form those channels that have large dimensions. Ultimately, there is a complex integration of all channels into one, it is directly connected with the small intestine. Accordingly, such a scheme indicates the ingress of bile into the intestine, and it is here that it has a definite effect on the processes of digesting food, thereby helping them.
At the same time, the toxic substances in the bile also appear in the intestines, through which they are subsequently removed from the body by natural bowel movement (through the stool). Cirrhosis leads to abnormal processes of these channels, as a result of which there is a communication disorder analogous to the previous case. Thus, the liver loses its ability to eliminate naturally toxic substances from the body, and therefore they begin to accumulate in it. A definite decrease in the activity of digestive functions in the intestine is also noted against this background.
Causes of liver cirrhosis
Considering the reasons that contribute to the appearance of liver cirrhosis, you can formally divide them into frequent, rare and very rare causes. Let’s consider them in some detail.
- viral hepatitis (B, C, D) is the most common cause of cirrhosis; infection with viral hepatitis (of any type) gradually increases in the world, which in turn becomes a suitable background for the subsequent transformation of this disease into cirrhosis;
- causes not to be established (cryptogenic cirrhosis)
- autoimmune hepatitis — appears when there are abnormalities in the immune system, in which the body produces antibodies to its own liver cells
- non-alcoholic steatohepatitis — in this case, liver damage occurs against the background of impaired metabolism (violation of carbohydrate or fat metabolism)
- Biliary (primary) cirrhosis — it is preceded by a prolonged course of cholestasis, accompanied by disturbances in the outflow of bile from the liver to the tubules;
- use of certain medications, hepatotoxic substances — the first group includes, in particular, anticancer drugs and anti-tuberculosis drugs, to the second — lead, gold, mercury.
Very rare reasons:
- Konovalov-Wilson disease — this disease is hereditary, its course is accompanied by the accumulation of copper in the brain and in the liver’s liver tissues
- hemochromatosis is a hereditary type of disease accompanied by accumulation of iron in the tissues and organs of the body
- Antitrypsin deficiency is also a hereditary disease in which chronic liver bronchitis occurs in combination with cirrhosis due to a deficiency in the liver of this protein
- Biliary (secondary) cirrhosis — the development of this form of the disease occurs as a result of squeezing or narrowing the tumor formation or bile duct stone.
The modern classification of the disease under consideration is based on taking into account the etiological, morphogenetic and morphological criteria, as well as the criteria of clinical and functional. Based on the reasons, against the background of the effects of which cirrhosis developed, the following variants of the liver are determined:
- infectious (viral) cirrhosis (hepatitis, biliary tract infections, parasitic liver disease)
- toxic cirrhosis, cirrhosis toxic-allergic (food and industrial poisons, medications, allergens, alcohol)
- biliary cirrhosis (primary, secondary) (cholestasis, cholangitis)
- circulatory cirrhosis (arising from a background of chronic venous congestion)
- metabolic-alimentary cirrhosis (lack of vitamins, proteins, cirrhosis accumulation, resulting from hereditary metabolic disorders)
- cryptogenic cirrhosis
Depending on the clinical and functional characteristics, cirrhosis of the liver is characterized by a number of the following features:
- level of hepatic-cell failure
- the degree of relevance to portal hypertension (bleeding, ascites)
- the general activity of the course of the disease (active cirrhosis, moderately active cirrhosis, as well as inactive cirrhosis)
- the general nature of the course of the disease (progressive, stable or regressive)
The course of the disease, as a rule, is characterized by its own duration, while the following main stages are distinguished:
- Compensation stage. Characterized by the absence of symptoms of cirrhosis, which is due to the increased work of surviving liver cells.
- Stage of subcompensation. At this stage, the first signs of cirrhosis of the liver (in the form of weakness and discomfort of the right hypochondrium, reduce appetite and weight loss). The performance of functions inherent in the work of the liver occurs in an incomplete volume, which is due to the gradual loss of resources of the surviving cells.
- The stage of decompensation. Here we are talking about liver failure, manifested by severe conditions (jaundice, portal hypertension, coma).
The onset of the disease can generally proceed without any symptomatology for the patient, and such a course can be relevant for a period of several years. Moreover, in practice, there are cases of the course of the disease, which in no way manifested itself for 10 or even 15 years. Given this factor, to build on only good health when trying to determine the diagnosis is irrational — even this state of health can only be visible. The most specific symptoms that correspond to this disease are the following:
- Jaundice (i.e., yellowing of the skin). In addition to the skin, yellowing is also noted in the eye proteins, which is generally explained by the high content of bilirubin in the blood.
- Weakness, fatigue.
- Decreased appetite or total loss.
- Bruises, bruises, appearing due to low blood coagulability
- Skin itching.
The rate of the onset of the disease, as well as the rate of its development, is determined by the severity of the disease that provoked it (hepatitis, etc.). The initial stages can be accompanied by moderate soreness and discomfort from the right hypochondrium, which is mainly noted after eating and exercise. Perhaps bloating and bitterness in the mouth, a little later to the pain, nausea and vomiting are added.
In addition, there is a violation of potency in men and menstrual cycle, respectively, in women. Violations of blood clotting lead to frequent nasal bleeding, as well as bleeding gums, any bleeding wounds are characterized by the duration of non-stop blood loss. Also there are so-called vascular sprouts on the skin in the trunk region.
Under the influence of portal hypertension, the essence of which is set out somewhat higher, cirrhosis of the liver is accompanied by a number of complications, among which are the following:
- Ascites, swelling. When cirrhosis develops, excess amounts of water and salt in the body begin to accumulate. As one of the first signs of the considered disease at this stage of its development, it is edemas that initially concentrate in the legs, and later are noted already in the peritoneum. Appear edema mainly in the evening.
- spontaneous bacterial peritonitis type displays. Against ascites (accumulation of fluid that is in the area of the peritoneum) begin to multiply rapidly harmful bacteria, for which this region is becoming an ideal environment. Such a complication is dangerous for the life of the patient, despite the fact that in some cases the course of it is characterized by the absence of symptoms. In some cases, it is supplemented by manifestations in the form of chills and fever, diarrhea, abdominal pain.
- The internal bleeding. Formed in cirrhosis, scar tissue becomes, as we have recovered, an obstacle to the normal blood flow, which is why the pressure rises in the portal vein. This in turn leads to bleeding, is concentrated in the area around the liver and the inner varicose veins in the stomach and / or esophagus. This type of bleeding is no less dangerous threat to the life of the patient, they can be eliminated only in the conditions of specialized medical institutions. Symptoms that indicate internal bleeding vomiting blood (reminiscent of a mixture of coffee grounds and blood consistency), loss of consciousness, fainting, dizziness
- Hepatic encephalopathy. This manifestation is one of the most dangerous complications associated with the course of cirrhosis of the liver. In particular, we are talking about the accumulation of toxic substances in the blood, resulting in a subsequent disruption of brain function. Predominantly patients with hepatic encephalopathy sleep during the day, while awake at night. It is difficult for patients to concentrate on anything, they become irritable. The final phase of this complication is either a coma or a lethal outcome.
- hepatorenal syndrome. With the development of complications of cirrhosis undergo reduction of renal function, which in turn leads to the gradual destruction of.
As a most dangerous complication that can develop with liver cirrhosis, liver cancer can be isolated. It is noteworthy that this type of cancer is second in terms of lethal outcomes among cancer diseases.
Somewhat lower in our article, you will be able to familiarize yourself with the different variants of the course of cirrhosis depending on the type of this disease.
Portal cirrhosis of the liver: symptoms
Portal cirrhosis (and also cirrhosis of Lainek (Laennec), septal cirrhosis, fatty cirrhosis, micronodular or atrophic cirrhosis), is associated primarily with the use of alcohol, as a result of which the general definition of this disease is fixed as an alcoholic cirrhosis.
Alcoholic cirrhosis develops, as one can understand, because of alcohol abuse. In particular, on this account there is information that if a person drinks alcohol daily, then in 2-3 years the considered form of cirrhosis can develop. The development of the process, as a rule, is characterized by its own slowness, the forecasts of this type of cirrhosis, meanwhile, are much more positive than with its other varieties.
Clinical manifestations of the disease in this case are characterized by their own diversity. Often compensated cirrhosis remains asymptomatic or manifests itself in slightly expressed states of weakness, fatigue and nausea.
During the ascitic period of the course of the disease, the symptoms of portal hypertension are in the forefront, which is now very pronounced. Significant weight loss of patients, complete loss of capacity for work, in some cases even the possibility of self-maintenance is excluded, the stomach is significantly enlarged (ie, ascites develops), in addition to this, swollen and sometimes knotty veins can be seen on the skin in this area, which is defined as «The head of the jellyfish.»
The liver increases, which can be determined by palpation, often an increase is noted in the spleen. In addition, anemia begins to increase, the symptoms of hypovitaminosis (A, B) of an endogenous scale become actual, which is manifested in «chicken blindness», skin peeling, peripheral neuritis, etc.
Decompensation of this form of cirrhosis can be characterized by the appearance of jaundice, ascites, in which the stomach of patients acquires already huge sizes, swelling, disorders of consciousness and increased bleeding gums, and nosebleeds. All patients face hepatomegaly, about 25% — with splenomegaly. Insufficiency of the liver gradually intensifies, the hepatic coma with its characteristic symptoms leads to a lethal outcome (the symptoms of the hepatic coma we will consider below).
Characteristic for the disease, liver manifestations can be characterized by a different frequency and intensity. Separately, the symptoms in the form of Dupuytren’s contracture (forming under the skin of the palms of the scar tissue), gynecomastia (increases in men of the breast, one or both, in some cases in accordance with its female type) and «alcohol stigma.» «Alcohol stigmas» in particular imply a characteristic expansion of vessels in the sclera and nose area, as well as an increase in the size of the parotid glands.
The main feature of this type of cirrhosis is that a favorable prognosis, noted initially, is possible with a failure of alcohol, which is accompanied by marked improvements in the general condition of patients.
Post-necrotic cirrhosis of the liver: symptoms
This type of liver cirrhosis can also be defined as cirrhosis toxic, mixed cirrhosis, cirrhosis post-hepatitis or macromodular, about a third of cirrhosis manifests itself in this form. Mostly the development of the disease occurs against the background of the patient’s Botkin disease. As other factors of the appearance of the disease in this form are isolated intoxication of various types of hepatotropic poisons and intolerance of the effect of certain medications.
Post-necrotic cirrhosis progresses rapidly enough, and the clinical picture of its manifestations is very pronounced. In the foreground in this case is a symptomatology, indicating a liver failure. Most often, complaints of pain in the right hypochondrium, as well as pain in the area «under the spoon» are noted. In addition, dyspepsia and asthenovegetative disorders are important. The course of jaundice is undulating.
With this variant of cirrhosis, functional liver failure is noted early, coinciding with the periods of exacerbations of the disease, which include abdominal pain, jaundice, temperature, ascites. Expansion of the esophagus, as well as hemorrhage, occurs at the stage of the already formed disease, and these manifestations do not appear as often as in the case of the portal form of cirrhosis. Meanwhile, late stages of the disease are characterized by the symptoms of portal hypertension and ascites in the expressed form of each patient with postnecrotic cirrhosis.
Primary biliary cirrhosis: symptoms
This type of cirrhosis is a chronic disease of a destructive-inflammatory scale, in which septal and interlobular bile ducts are affected. The disease is autoimmune and subsequently leads to the formation of cholestasis.
Nothing is known about the etiology of the disease, and its main feature is the gradual destruction of the bile intrahepatic ducts. Primary biliary cirrhosis (PBC) can be asymptomatic, slow or, conversely, in a rapidly progressive form. In most cases, women are exposed to this disease (90%), their age varies on average from 35 to 60, but fluctuations within 20-80 years are also possible. If the disease is observed in men, then their course is similar to the «female» variant.
A quarter of cases indicate an asymptomatic course of PBC. In other cases, the onset of the disease is characterized by its own suddenness, often itching and weakness, jaundice is absent. It is noteworthy that the absence of jaundice at the initial stage of the disease does not at all indicate its subsequent absence — it can appear about six months to two years after the onset of itching. 25% of cases indicate simultaneous occurrence of jaundice and itching. Also, patients often complain of pain from the right upper quadrant of the abdomen.
Other symptoms may include steatorrhea (increased fat content in the stool, that is, fatty stools), diarrhea. Often there is an ulcer of the duodenum, complicated later by bleeding. Often PBC is combined with various types of autoimmune diseases (rheumatoid arthritis, red systemic lupus, scleroderma, etc.). In addition to itching, skin manifestations can also be accompanied by red lichen planus or immunocomplex capillaritis. The development of autoimmune thyroiditis occurs in about 20% of cases, and toxic diffuse goiter is also becoming a common phenomenon.
Because of the decrease in the outflow of bile in combination with the immune damage that has arisen from the side of the pancreas, its insufficiency is noted. The respiratory system can be affected by interstitial fibrosis, often the formation of tumor processes in various areas.
The final stage of primary biliary cirrhosis determines a rather detailed clinical picture. The course of jaundice can be accompanied in conjunction with the deposition of melanin in the skin. Xanthoma, xanthelasm, palmar erythema are subject to increase. Ultimately, ascites in combination with bleeding that occurred against the background of varicose veins of the stomach and esophagus, as well as hepatic coma or sepsis — all this leads to a lethal outcome.
Secondary biliary cirrhosis: symptoms
Most often, the development of this type of cirrhosis occurs in patients who have previously undergone surgery (one or several) directly associated with the biliary tract. Symptoms of this disease in its initial stage of the flow largely coincide with the symptoms of the disease, which provoked the actual obstruction (obstruction) of the biliary extrahepatic tracts.
Shortly after the acute form of extrahepatic obstruction occurs development of cholestatic hepatitis, in connection with which focal necrosis is formed in the centers of the lobules, and subsequently an inflammatory reaction is combined with fibrosis. Extrahepatic biliary obstruction over the next 2-7 years leads to the development of septal cirrhosis. As for the specific type of therapy for secondary biliary cirrhosis, it as such does not exist in principle.
Viral cirrhosis: symptoms
Viral cirrhosis, as a rule, occurs in the order of 60% of cases against a background of viral chronic hepatitis, characterized by a significant degree of activity, somewhat less often — low. Within a period of about 5 years, up to 1% of patients who had previously undergone anicteric or symptomatic form of hepatitis B or C, also experienced the development of viral cirrhosis.
In most cases, the disease develops gradually, it is characterized by the appearance of a nonspecific type of complaints of decreased performance, weakness, flatulence and nausea, pain in the right hypochondrium, weight loss. The increase in this symptomatology occurs simultaneously with exacerbation of the disease in combination with moderate development of jaundice. Also, exacerbation can occur with an increase in hemorrhagic syndrome (arthralgia, bleeding, etc.).
Varicose veins of the cardia and esophagus occur in the case of viral cirrhosis much earlier and more often than with alcoholic cirrhosis, ascites here also develops less frequently and later. On average, the life expectancy for patients is defined in 10-15 years from the time of detection of their viral cirrhosis, however, longer periods are also noted for this indicator.
Autoimmune cirrhosis of the liver: symptoms
Cirrhosis as an outcome of autoimmune hepatitis, that is, autoimmune cirrhosis, is usually a disease noted in the vast majority of cases among women (beginning / end of the reproductive period).
The characteristic features of this form of cirrhosis is its combination with various systemic lesions of extrahepatic scale occurring in other systems and organs. In addition, a characteristic feature of the disease is the presence of specific autoantibodies, which are very rare for the same viral cirrhosis. Subjective assessment of patients, in spite of the increased activity of hepatic pathology, often in a long time determines their condition as satisfactory.
Reaching remission with autoimmune cirrhosis is possible with the appointment of large doses of hormones and with an increase in the duration of treatment.
Symptoms of the hepatic coma
Hepatic coma, which is an actual condition of the development of liver cirrhosis, proceeds in the following main stages.
- Precom. The hepatic coma begins at this stage, it can develop gradually. Manifestations are reduced to the appearance of anxiety, apathy or euphoria in the patient. A characteristic feature is a slowdown in patients thinking, disturbances in orientation, as well as sleep disorders.
- Threatening stage of hepatic coma, coma. There is confusion, spatiotemporal disorientation of the patient, change of bouts of depression, drowsiness. There is a tremor (trembling) of the hands. Consciousness with the development of the hepatic coma is absent, the muscles of the occiput and extremities are characterized by their own stiffness (hardening). The person acquires a resemblance to a mask. The terminal period of this condition is accompanied by the dilatation of the pupils and the disappearance of the reaction to light, the corneal reflexes gradually fade, paralysis of sphincters and subsequent respiratory arrest are noted.
There are other signs indicating a general liver damage. This includes jaundice, darkening of urine, discoloration of feces. A dirty plaque appears on the tongue. Also, this manifestation of cirrhosis is accompanied by the appearance of a specific odor from the mouth (it resembles the smell of raw meat).
To date, the most accurate method used in the diagnosis of cirrhosis is a biopsy in conjunction with a detailed questioning of the patient about his lifestyle (alcohol use, the characteristics of professional activity, nutrition, treatment, etc.), transferred earlier and relevant at the time of the survey Diseases (hepatitis, etc.).
Mandatory palpation of the liver is necessary, which is necessary to detect its increase. The possible external manifestations of the disease are also investigated (alcoholic cirrhosis is accompanied, for example, by the appearance of spider veins on the skin). Again, the patient’s mucous membranes and skin are examined for jaundice, which, despite its appearance in other diseases, also develops with cirrhosis.
Diagnosis of cirrhosis of the liver is carried out on the basis of a patient’s ascites (edema of the peritoneum). Endoscopy as a method of investigation makes it possible to identify varicose veins of the esophagus. In addition, ultrasound, CT and MRI of the liver, including a blood test, with whose help is determined by a decrease in blood levels of bilirubin levels and elevated levels of iron, copper and enzymes.
Treatment of liver cirrhosis
The main principles used in the treatment of cirrhosis, are focused on eliminating the direct causes that led to this disease, as well as the development of a specific diet, vitamin therapy and the elimination of complications that accompany cirrhosis. Treatment of cirrhosis with folk remedies can justify itself only as an additional measure that determines some effectiveness only within the initial stages of the course of this disease.
Elimination of causes that provoked cirrhosis
The alcoholic cirrhosis of the liver provides for a complete refusal of the patient to drink alcohol, and also requires the appointment for him of detoxification therapy aimed at removing from the body the products formed during the use of alcohol products of its decay.
If cirrhosis arose against the background of exposure to viral hepatitis, then the treatment is initially focused on it. If the development of cirrhosis was medication ( medicinal hepatitis), then the drug that provoked the disease is excluded from use.
Autoimmune cirrhosis appears due to increased aggressiveness from the immune system, respectively, the treatment involves the use of immunosuppressants (drugs that have an overwhelming effect on the immune system).
Diet for cirrhosis
In any case, with cirrhosis should be abandoned alcohol, in addition, eliminated flavored, fried and fatty foods, as well as canned food, various types of sausages and smoked products. It is recommended to exclude chocolate, tomato juice, garlic, mushrooms and tomatoes.
With the development of ascites in patients, the diet requires the exclusion of table salt from it.
You can eat porridge and vegetable soups, boiled meat (low-fat grades), dairy products (fat-free), green apples, crackers, etc.
Nutrition for cirrhosis is carried out in small portions, 5-6 times a day.
Complication of cirrhosis: treatment
— Ascites . This manifestation is a constituent factor of portal hypertension, characterized, as we have already noted, by an increase in the abdomen due to accumulation of fluid in it. In the treatment of ascites, diuretics are used, that is, those medications with whose help the removal of excess fluid from the body is provided with the urine.
— Hepatic coma. In this case, the brain is affected, which is due to the accumulation of a significant amount of toxic substances in the blood. The development of this type of coma occurs mainly at the stage of decompensated cirrhosis, therefore the treatment is largely hampered and attempts to determine it in each case are strictly individual.
— Bleeding of the esophagus. It occurs because of their expansion and is a serious complication of the course of cirrhosis. Manifestations of bleeding are reduced to blackening of feces or secretion of blood through the mouth (bloody vomiting). Endoscopy or surgery is used in the treatment.
— Liver cancer. The development of this disease occurs, as a rule, as a result of the development of cirrhosis against the background of exposure to viral hepatitis. Treatment in this case is determined by the oncologist.
As a radical method of treatment with an actual for a patient with cirrhosis, organ transplantation, that is, the liver itself, is applied.
Diagnosis of liver cirrhosis is performed by a physician hepatologist.