Means cirrhosis of the liver. What are the main symptoms of cirrhosis of the liver? Exposure to harmful substances

Vivid symptoms of liver cirrhosis are not always initially manifested. But over time, in all patients, a chronic progressive lesion will make itself felt. There are fewer hepatocytes. There are also disturbances in the vascular system, which leads to portal hypertension and liver failure. How much the biochemical and clinical parameters have changed (a characteristic phenomenon for this disease), doctors will find out from blood tests.

Manifestations depending on the type and stage of the disease

While the disease is just beginning, the patient may not even be aware of its presence. The latent stage or course without any symptoms is considered quite dangerous. If the first signs of liver cirrhosis are observed at the stage that is considered advanced, then serious consequences should be expected throughout the year. Indeed, in this case, the cells cannot be restored.

Liver failure and portal hypertension are the main syndromes that can be used to identify the disease and make a further prognosis.

It should be said about the main types of the disease, which are diagnosed depending on how cirrhosis of the liver manifests itself.

It's about cirrhosis.

• Portal.

The patient suffers from nosebleeds, bloating and enlargement (ascites), diarrhea, accompanied by bleeding from the veins of the esophagus and stomach (its lower part). The pathological process can last about two years. There is an increase in ascites and the appearance of an expanded venous network. Nausea and vomiting are more bothersome. Weight is reduced to such an extent that complete exhaustion is diagnosed.

Dryness and flabbiness of the skin is noted. Jaundice is absent. Blood pressure is usually low. Hepatic coma or acute hemorrhage leads to death.

• Biliary hypertrophic.

The first signs of cirrhosis of the liver are manifested in the form of staining of the sclera and skin in an icteric color, flat yellow neoplasms on the eyelids, face and chest, as well as itching. The cause of such manifestations is the stagnation of bile, while bile pigments are observed in the blood.

The disease develops over 5-8 years. Due to bleeding, death is possible.

• Mixed type.

It is characterized by a severe course, since there are simultaneously symptoms indicating both portal and biliary lesions.

Symptoms of cirrhosis of the liver are related to pathological changes.

Therefore, you need to know that there are stages:

• initial (signs and changes in the biochemical nature are not detected);
• subcompensatory (symptoms are pronounced);
• decompensatory (accompanied by portal hypertension, swelling of the feet and legs, ascites, irreversible changes in the body).

The last stage can be recognized by certain symptoms.

Firstly, due to the fact that ammonia compounds, which are extremely toxic, accumulate in the blood, the patient is diagnosed with encephalopathy. In the future, hepatic coma develops. After a short period of euphoria, consciousness is depressed, orientation is completely lost. There are problems with sleep and speech. Then there is a depressive state, the patient loses consciousness.

Secondly, the presence of ascites, in which there is a significant accumulation of fluid, provokes bacterial peritonitis. The eyelids and legs swell.

Thirdly, it is because of heavy bleeding that patients most often die.

The last step is easy to find out. The existing symptoms indicate the futility of any therapeutic measures. Therefore, it is so important to detect external manifestations in order to prevent the situation from aggravating.

General clinical manifestations

How to determine cirrhosis of the liver at the initial stage? The disease begins with increased fatigue and a feeling of weakness. Employability is gradually decreasing.

If the gums bleed and nosebleeds regularly occur, then there are problems with blood clotting. Lack of bile acids and problems with digestion of food causes diarrhea and bloating.

Complete exhaustion occurs due to the fact that fats, proteins and carbohydrates cannot be absorbed. Secondary enzyme deficiency develops in the intestine.

The disease is accompanied by loss of fluid and various trace elements, so the skin becomes dry and flabby.

If the liver is stretched, the patient complains of pain syndromes that are dull in nature or a feeling of heaviness in the side on the right side.

About venous stasis of blood can be recognized by the vascular "asterisks", which are usually found on the face, in the chest and abdomen.

When the concentration of bilirubin exceeds the norm and constantly increases, the sclera and skin become icteric. Characteristic manifestations of the disease are the presence of xanthelasmas (yellow neoplasms) on the eyelids, in the chest area and on the hands.

As a result of the development of anemia, weakness, dizziness and palpitations become stronger. Hypotension may be of concern.

The patient may be tormented by nausea, vomiting, hiccups (the so-called dyspeptic disorders). A negative reaction to food odors is possible.

There is a slight increase in temperature indicators for a long time.

When the skin turns yellow, the urine becomes darker, and the stool, on the contrary, brightens.

If there is internal bleeding, they will be indicated by liquid black stools or the presence of blood in the feces.

The coordinated work of all systems and organs depends on the normal activity of the liver.

And if it is affected, then external signs appear:

1. Human behavior is changing. He becomes irritated. He suffers from insomnia. At the onset of the final stage, consciousness is disturbed to the state of coma.
2. The patient suffers from heartburn and belching.
3. Due to chronic gastritis and duodenitis, “hungry” pains are felt in the epigastric region.
4. If chronic pancreatitis joins the disease, there is an increase in diarrhea and pain in the upper abdomen, as well as in the back.
5. There is pain in the intestines with dysbacteriosis.
6. In the last stage, there are problems with the sensitivity of the skin.

What disease can be accompanied by?

If you are regularly disturbed by pain in the epigastric region and in the right hypochondrium, then you should not hesitate to seek help.

Pain can appear from physical activity, drinking alcohol, fatty or spicy foods. The occurrence of pain syndrome is explained by the fact that with an increase in the body, its capsule is stretched.

Chronic gastritis is very common. In addition, the appearance of biliary dyskinesia, chronic pancreatitis or cholecystitis is not excluded.

If there is a hypokinetic form of biliary tract lesions, then the pain will be weak and pulling. In the right hypochondrium or in the epigastric region, heaviness is felt. With the development of a hyperkinetic form of pain, they will resemble colic. The symptoms are pronounced.

Sometimes the patient may suffer from reflux esophagitis. It is characterized by increased intra-abdominal pressure, due to which the contents of the stomach enter the esophagus. Such violations result in damage to the esophageal mucosa. In other words, the formation of erosions and ulcerations is observed on it, since the gastric contents are acidic.

The use of ultrasound

Ultrasound is a fairly informative technique. It helps with an accurate diagnosis, with the identification of the causes of the disease and with the choice of the most effective method of treatment.

True, ultrasound cannot guarantee an absolute confirmation of the diagnosis. Therefore, the examination is carried out comprehensively.

Diagnosis by ultrasound always causes an ambiguous reaction. This is due to the fact that it is quite difficult to detect the initial stage of the disease using ultrasound. It is very important that the specialist conducting the diagnosis is qualified, and the patient is properly prepared for the upcoming procedure.

During ultrasound, attention is paid to the general characteristics of the affected organ, it is assessed how much its shape, size and location have changed.

The inflammatory process and existing neoplasms are also examined. Vascular and biliary changes are necessarily analyzed.

An organ is considered healthy if ultrasound has shown that it has a homogeneous structure and its edges are even. In addition, it is important that its right and left lobes do not exceed the norm in size. This also applies to the portal vein and the main bile duct, that is, their diameters.

In order for the ultrasound to take place, the patient must carefully prepare. This requirement is explained by the need to obtain reliable results.

It is very important to achieve a reduction in gas formation in the intestines, because of this process, visibility will be poor. Therefore, three days before the ultrasound, you need to abandon products that provoke an increased formation of gases. If constipation occurs regularly, then the doctor prescribes a laxative or the patient is given a cleansing enema.

You can not do without a nutritional regimen. Food is taken several times a day in small portions. No food is allowed 3 hours before bedtime. The recommended amount of liquid per day is no more than one and a half liters.

The ban applies to:

• legumes;
• fatty meat and fish;
• dairy;
• sweet;
• coffee and strong tea;
• carbonated and alcoholic drinks.

The ultrasound procedure is scheduled in the morning on an empty stomach. In extreme cases, after eating, 8 hours should pass. The patient should lie on his back or on his left side. The latter option is better because it is easier to diagnose.

During an ultrasound, a person, taking a deep breath, must hold his breath. So, the sensor has more access to the organ.

Be sure to examine the abdominal cavity for the presence of fluid in it. To do this, the patient must stand. If there are small volumes, then ultrasound will show its accumulation directly near the diseased organ.

As already mentioned, with the help of ultrasound it is difficult to describe the disease if it has just begun to develop. After all, as such, there are no specific signs. But there are certain parameters, thanks to which the disease can be diagnosed. How to determine cirrhosis of the liver in this case?

Due to the death of liver cells under the influence of various damaging factors, normal liver tissue is replaced by fibrous tissue with the formation of nodes and the restructuring of the entire structure of the liver. Violation of the structure of the liver leads to a violation of all its functions.

In economically developed countries, cirrhosis is one of the six main causes of death in patients aged 35 to 60 years, accounting for 14-30 cases per 100,000 population. About 300 thousand people die from cirrhosis of the liver every year in the world, and over the past 10 years, the frequency has increased by 12%. Asymptomatic cirrhosis occurs in 12% of patients suffering from chronic alcoholism.

It is more often observed in men: the ratio of men and women is on average 3:1. The disease can develop in all age groups, but more often after 40 years.

Causes of cirrhosis of the liver

• Viral hepatitis (B, C, delta, G). The most cirrhotic viruses are C and delta, and the virus is called the “gentle killer”, because it leads to cirrhosis of the liver in 97% of cases, while the disease does not have any clinical manifestations for a long time;
• Autoimmune hepatitis (when the body perceives its own cells as foreign);
• Alcohol abuse, the disease develops after 10-15 years from the start of use (60 grams / day for men, 20 g / day for women);
• Metabolic disorders (hemochromatosis, Wilson's disease, Konovalov's disease, alpha-1 antitrypsin deficiency, etc.);
• Chemical toxic substances and medicines;
• Hepatotoxic drugs;
• Diseases of the biliary tract - obstruction (blockage) of the extrahepatic and intrahepatic biliary tract. Cirrhosis of the liver develops 3-18 months after the violation of the patency of the bile duct;
• Prolonged venous congestion of the liver (constrictive pericarditis, veno-occlusive disease, insufficiency).

Unfortunately, it is often impossible to identify the cause that caused cirrhosis, in which case it is called cryptogenic cirrhosis (i.e., with an unknown cause).

Manifestations characteristic of liver cirrhosis

Signs of cirrhosis do not depend on what caused it, but are determined by the stage of the disease.

At the initial stage of cirrhosis (according to the international classification, this is class A), there are still no complications of the disease.

It is at this time that it is very important to eliminate the cause of the disease, which will allow you to save the remaining healthy liver tissue and lead a normal life. The fact is that the liver has a very large capacity for regeneration (recovery), and healthy cells can work for themselves and their affected comrades.

An increase in the volume of the abdomen, the appearance of changes in consciousness and behavior, bleeding gums, nosebleeds indicate complications of the disease (according to the international classification, these are classes B and C).

Complaints made by patients with cirrhosis of the liver: increased fatigue, weight loss, various disorders of consciousness and behavior (decreased concentration, daytime sleepiness, disturbed night sleep, etc.), decreased appetite and abdominal discomfort (bloating, a feeling of rapid satiety while eating ), jaundice (yellow staining of the skin, sclera), lightening or discoloration of feces, darkening of urine, swelling of the legs and (or) an increase in the size of the abdomen due to free fluid in the abdominal cavity (ascites), bleeding: nasal, gastrointestinal, from gums, hemorrhoidal, as well as subcutaneous hemorrhages, frequent bacterial infections (respiratory tract, etc.), decreased sexual desire, in men - often gynecomastia (enlargement of the mammary glands).

Along with an increase or decrease in the size of the liver, its compaction, concomitant splenomegaly (enlargement of the spleen), symptoms of portal hypertension, and jaundice are characteristic. Often dull or aching pain in the region of the liver, aggravated by errors in diet and physical work; dyspeptic symptoms (nausea, vomiting, diarrhea), pruritus due to delayed excretion and accumulation of bile acids in the tissues.

When examining a patient, “liver signs” characteristic of cirrhosis are revealed: vascular telangiectasias (“asterisks”, “spiders”) on the skin of the upper half of the body, erythema of the palms, reddening of the palms (“liver palms”), “lacquered tongue” of crimson color, “hepatic tongue ".

Complications of cirrhosis of the liver

Hepatic encephalopathy

Hepatic encephalopathy is reversible brain damage from toxic products that are not cleared by the liver as a result of liver damage.

Hepatic encephalopathy is characterized by various disorders of consciousness, intelligence, behavior, neuromuscular disorders.

Hepatic encephalopathy is latent (invisible to the patient and others), and then it can only be detected by a doctor during special tests.

The extreme degree of hepatic encephalopathy is coma (unconsciousness), it is based on acute or chronic.

Bleeding from the gastrointestinal tract due to portal hypertension

With cirrhosis of the liver, the passage of blood coming from the lower half of the body through the liver is disrupted, so the blood finds “bypass” paths through the vessels of the anterior abdominal wall, veins of the esophagus, hemorrhoidal veins (veins of the rectum). With the progression of cirrhosis of the liver, at some point, decompensation occurs and bleeding from dilated veins begins. Every patient with cirrhosis of the liver should know that gastrointestinal bleeding is manifested by vomiting, which looks like « coffee grounds » and a chair that looks like « raspberry jelly » ; weakness appears or sharply increases up to loss of consciousness. Possible bleeding from the hemorrhoidal veins of the rectum.

Also a characteristic symptom is « jellyfish head » - overfilling of the veins of the anterior abdominal wall.

Infectious complications of liver cirrhosis

Patients with cirrhosis of the liver are more susceptible to bacterial and viral infections than healthy people. The most common infections in these patients are those of the respiratory tract and urinary tract. Sometimes it happens that the body temperature can rise without a specific reason. This is due to their increased intestinal absorption. « harmful » (toxic) microorganisms. This condition is called endotoxemia.

Cirrhosis of the liver is a chronic disease accompanied by structural changes in the liver with the formation of scar tissue, wrinkling of the organ and a decrease in its functionality.

It can develop against the background of prolonged and systematic alcohol abuse, viral hepatitis with its subsequent transition to a chronic form, or as a result of autoimmune disorders, obstruction of the extrahepatic bile ducts, cholangitis.

What it is?

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

Some historical data

Since ancient times, the liver has been considered as important an organ as the heart. According to Mesopotamians, blood is produced in the liver and the soul lives. Hippocrates also described the relationship between liver diseases and jaundice, as well as ascites. He argued that jaundice and a hard liver were a bad combination of symptoms. This was the first judgment about cirrhosis of the liver and its symptoms.

Cirrhosis of the liver and its causes were described in 1793 by Matthew Bailey in his treatise Morbid Anatomy. In his work, he clearly associated the use of alcoholic beverages with the onset of symptoms of liver cirrhosis. In his opinion, men of middle and older age were sick more often. The British dubbed cirrhosis of the liver "gin plague" or "gin liver".

The term cirrhosis comes from the Greek kirrhos, meaning yellow, and belongs to Rene Theophilus Hyacinthe Laennec, a French physician and anatomist. Many scientists have worked and are working on the study of cirrhosis of the liver to this day. Virchow, Kuehne, Botkin, Tatarinov, Abellov and others have proposed many theories about what cirrhosis of the liver is, its symptoms, causes, methods of diagnosis and treatment.

Reasons for the development of cirrhosis

Among the main reasons leading to the development of the disease, there are:

1. Viral hepatitis, which, according to various estimates, leads to the formation of liver pathology in 10-24% of cases. The disease ends with such varieties of hepatitis as, D and the recently discovered hepatitis G;
2. Various diseases of the biliary tract, including extrahepatic obstruction, and primary sclerosing;
3. Disorders in the work of the immune system. Many autoimmune diseases lead to the development of cirrhosis;
4. portal hypertension;
5. Venous congestion in the liver or Budd-Chiari syndrome;
6. Poisoning by chemicals that have a toxic effect on the body. Among these substances, industrial poisons, salts of heavy metals, aflatoxins and mushroom poisons are especially detrimental to the liver;
7. Hereditary diseases, in particular, genetically determined metabolic disorders (anomalies in the accumulation of glycogen, Wilson-Konovalov's disease, deficiency of a1-antitrypsin and galactose-1-phosphate-uridyltransferase);
8. Long-term use of drugs, including Iprazide, anabolic steroid drugs, Isoniazid, androgens, Methyldopa, Inderal, Methotrexate and some others;
9. Taking large doses of alcohol for 10 years or more. There is no dependence on the specific type of drink, the fundamental factor is the presence of ethyl alcohol in it and its regular intake into the body;
10. The rare Randu-Osler disease can also cause cirrhosis.

In addition, it is worth mentioning separately about cryptogenic cirrhosis, the causes of which remain unclear. It occurs in 12 to 40% of cases. Provoking factors in the formation of scar tissue can be systematic malnutrition, infectious diseases, syphilis (causes cirrhosis in newborns). The combined influence of etiological factors, for example, the combination of hepatitis and alcoholism, significantly increases the risk of developing the disease.

Classification

The modern classification of the disease under consideration is based on the consideration of etiological, morphogenetic and morphological criteria, as well as clinical and functional criteria. Based on the causes, against the background of the impact of which cirrhosis of the liver developed, the following options are determined:

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

• level of hepatocellular insufficiency;
• the general nature of the course of the disease (progressive, stable or regressive);
• the degree of portal hypertension relevant to the disease (bleeding, ascites);
• the overall activity of the disease process (active cirrhosis, moderately active cirrhosis, and inactive cirrhosis).

Portal cirrhosis of the liver

The most common form of the disease, which is characterized by damage to the liver tissues and the death of hepatocytes. Changes occur due to malnutrition and alcohol abuse. In 20%, portal cirrhosis of the liver can cause Botkin's disease. First, the patient complains of disorders of the digestive tract. Then external signs of the disease develop: 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 is a special form of the disease that develops as a result of prolonged cholestasis or damage to the biliary tract. Biliary cirrhosis is an autoimmune pathology that proceeds for a long time without any symptoms. They mostly affect women aged 40-60. The primary degree of the disease is often combined with diabetes mellitus, lupus erythematosus, dermatomyositis, rheumatoid arthritis and drug allergies.

First signs

Among the early symptoms indicating cirrhosis, the following can be noted:

1. and dryness, especially often in the morning hours;
2. The patient loses some weight, becomes irritable, gets tired faster;
3. A person may be disturbed by periodic stool disorders, increased flatulence;
4. Periodically occurring. They tend to increase after increased physical exertion or after taking fatty and fried foods, alcoholic beverages;
5. Some forms of the disease, such as postnecrotic cirrhosis, manifest themselves in the form of jaundice already in the early stages of development.

In some cases, the disease manifests itself acutely and there are no early signs.

Symptoms of cirrhosis

Cirrhosis is characterized by general symptoms: weakness, decreased ability to work, discomfort in the abdomen, dyspeptic disorders, fever, joint pain, flatulence, pain and a feeling of heaviness in the upper abdomen, weight loss, are also noted. On examination, an increase in the liver, compaction and deformation of its surface, sharpening of the edge are revealed. First, there is a uniform moderate increase in both lobes of the liver, later, as a rule, an increase in the left lobe prevails. Portal hypertension is manifested by a moderate enlargement of the spleen.

An extended clinical picture is manifested by syndromes of hepatocellular insufficiency and portal hypertension. There is bloating, poor tolerance to fatty foods and alcohol, nausea, vomiting, diarrhea, a feeling of heaviness or pain in the abdomen (mainly in the right hypochondrium). In 70% of cases, hepatomegaly is detected, the liver is compacted, the edge is pointed. In 30% of patients, palpation reveals a nodular surface of the liver. Splenomegaly in 50% of patients.

Subfebrile temperature may be associated with the passage of intestinal bacterial pyrogens through the liver, which it is not able to neutralize. The fever is resistant to antibiotics and resolves only when liver function improves. There may also be external signs - palmar or plantar erythema, spider veins, scanty hair in the armpit and pubis, white nails, gynecomastia in men due to hyperestrogenemia. In some cases, the fingers take the form of "drum sticks".

In the terminal stage of the disease in 25% of cases there is a decrease in the size of the liver. Jaundice, ascites, peripheral edema due to overhydration (primarily swelling of the legs), external venous collaterals (varicose veins of the esophagus, stomach, intestines) also occur. Bleeding from the veins is often fatal. Hemorrhoidal bleeding occurs less frequently, they are less intense.

Effects

Cirrhosis of the liver, in principle, alone, does not cause death, its complications in the stage of decompensation are deadly. Among them:

1. in cirrhosis, it is an accumulation of fluid in the abdominal cavity. Assign a diet with protein restriction (up to 0.5 grams per kg of body weight) and salts, diuretics, intravenous administration of albumin (protein preparation). If necessary, they resort to paracentesis - the removal of excess fluid from the abdominal cavity.
2. Spontaneous bacterial peritonitis is an inflammation of the peritoneum due to infection of the fluid in the abdominal cavity (ascites). In patients, the temperature rises to 40 degrees, chills, intense pain in the abdomen appears. Prescribe long-term broad-spectrum antibiotics. Treatment is carried out in the intensive care unit.
3. Hepatic encephalopathy. Manifested from minor neurological disorders (headache, fatigue, lethargy) to severe coma. Since it is associated with the accumulation of protein metabolism products (ammonia) in the blood, protein is limited or excluded from the diet, a prebiotic, lactulose, is prescribed. It has a laxative effect and the ability to bind and reduce the formation of ammonia in the intestines. With severe neurological disorders, treatment is carried out in the intensive care unit.
4. Hepatorenal syndrome - the development of acute renal failure in patients with cirrhosis of the liver. Stop the use of diuretics, prescribe intravenous administration of albumin. Treatment is carried out in the intensive care unit.
5. Acute varicose bleeding. It arises from varicose veins of the esophagus and stomach. The patient develops weakness, blood pressure drops, the pulse quickens, vomiting appears with an admixture of blood (the color of coffee grounds). Treatment is carried out in the intensive care unit, in case of ineffectiveness, surgical methods of treatment are used. To stop bleeding, intravenous administration of octropide is used (to reduce pressure in the bloodstream of the abdominal vessels), endoscopic treatment (ligation of varicose veins, sclerotherapy). Carefully carry out the transfusion of solutions and blood components to maintain the required level of hemoglobin.
6. The development of hepatocellular carcinoma is a malignant neoplasm of the liver.

The cardinal treatment of hepatocellular carcinoma and decompensated cirrhosis of the liver is liver transplantation. Replacement of a patient's liver with a donor's liver.

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

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

Ascites in liver cirrhosis - a complication

Edema of the lower extremities in a patient with cirrhosis of the liver with chronic hepatitis

Diagnostics

Determining the diagnosis of cirrhosis of the liver takes place in several stages. The diagnosis itself is made on the basis of data from instrumental studies:

1. Magnetic resonance or computed tomography is the most accurate diagnostic method.
2. Biopsy is a method of histological examination of material taken from the liver, which allows you to establish the type of large- or small-nodular cirrhosis and the cause of the development of the disease.
3. Ultrasound - as a screening. Allows you to establish only a preliminary diagnosis, but is indispensable in the diagnosis of ascites and portal hypertension.

If, at the time of diagnosis, a histological examination did not allow determining the cause of the development of the disease, the search continues. To do this, perform a blood test for the presence of:

• antimitochondrial antibodies;
• RNA of the hepatitis C virus and DNA of the hepatitis B virus using the PCR method;
• alpha-fetoprotein - in order to exclude blood cancer;
• copper and cerruloplasmin levels;
• the level of immunoglobulins A and G, the level of T-lymphocytes.

At the next stage, the degree of damage to the body due to liver damage is determined. For this use:

• liver scintigraphy - a radionuclide study to determine working liver cells;
• biochemical blood test to determine such indicators as sodium and potassium levels, coagulogram, cholesterol, alkaline phosphatase, total and fractional bilirubin, AST, ALT, lipidogram, proteinogram;
• the degree of kidney damage - creatinine, urea.

Absence or presence of complications:

• Ultrasound to exclude ascites;
• exclusion of internal bleeding in the digestive tract by examining feces for the presence of occult blood in it;
• FEGDS - to exclude varicose veins of the stomach and esophagus;
• sigmoidoscopy to exclude varicose veins in the rectum.

The liver with cirrhosis is probed through the anterior wall of the peritoneum. On palpation, tuberosity and density of the organ are noticeable, but this is possible only at the stage of decompensation.

Ultrasound examination clearly defines the foci of fibrosis in the organ, while they are classified into small - less than 3 mm, and large - over 3 mm. With the alcoholic nature of cirrhosis, initially small nodes develop, a biopsy determines specific changes in liver cells and fatty hepatosis. In the later stages of the disease, the nodes enlarge, become mixed, fatty hepatosis disappears. Primary biliary cirrhosis is characterized by an increase in the liver with the preservation of the structure of the bile ducts. In secondary biliary cirrhosis, the liver enlarges due to obstructions in the bile ducts.

Stages of cirrhosis of the liver

The course of the disease, as a rule, is characterized by its own duration, while the following main stages are distinguished:

1. stage of compensation. It is characterized by the absence of symptoms of cirrhosis, which is explained by the increased work of the preserved liver cells.
2. subcompensation stage. At this stage, the first signs of cirrhosis of the liver are noted (in the form of weakness and discomfort in the area of ​​​​the right hypochondrium, decreased appetite and weight loss). The performance of the functions inherent in the work of the liver occurs in an incomplete volume, which occurs due to the gradual loss of resources of the remaining cells.
3. stage of decompensation. Here we are already talking about liver failure, manifested by severe conditions (jaundice, portal hypertension, coma).

How to treat cirrhosis of the liver?

In general, the treatment of cirrhosis of the liver is selected on a strictly individual basis - therapeutic tactics depend on the stage of development of the disease, the type of pathology, the general health of the patient, concomitant diseases. But there are general principles for prescribing treatment.

These include:

1. The compensated stage of liver cirrhosis always begins with the elimination of the cause of the pathology - the liver in this case is still able to function normally.
2. The patient needs to adhere to a strict diet - even a small violation can be an impetus for the progression of liver cirrhosis.
3. It is impossible with the disease in question to carry out physiotherapy, heat treatment. Excluded and physical activity.
4. If the disease is at the stage of decompensation, then the patient is placed in a medical institution. The fact is that with such a course of the disease, the risk of developing severe complications is very high, and only medical workers will be able to timely pay attention to even a slight deterioration in the condition, prevent the development of complications that lead to the death of the patient.
5. Most often, hepatoprotectors, beta-blockers, sodium and ursodeoxycholic acid preparations are prescribed for treatment.

General advice for patients with cirrhosis of the liver:

1. Rest as soon as you feel tired.
2. To improve digestion, patients are prescribed polyenzymatic preparations.
3. Do not lift heavy objects (this can cause gastrointestinal bleeding)
4. Daily measure body weight, the volume of the abdomen at the level of the navel (an increase in the volume of the abdomen and body weight indicates fluid retention);
5. With fluid retention in the body (edema, ascites), it is necessary to limit the intake of table salt to 0.5 g per day, liquids - up to 1000-1500 ml per day.
6. To control the degree of damage to the nervous system, it is recommended to use a simple handwriting test: write down a short phrase every day, for example, "Good morning" in a special notebook. Show your notebook to relatives - if you change your handwriting, contact your doctor.
7. Count daily fluid balance per day (diuresis): count the volume of all fluid taken orally (tea, coffee, water, soup, fruits, etc.) and count all fluid excreted during urination. The amount of liquid released should be approximately 200-300 ml more than the amount of liquid taken.
8. Achieve stool frequency 1-2 times a day. Patients with cirrhosis of the liver to normalize the functioning of the intestines and the composition of the intestinal flora in favor of "beneficial" bacteria are recommended to take lactulose (duphalac). Duphalac is prescribed at a dose that causes soft, semi-formed stools 1-2 times a day. The dose ranges from 1-3 teaspoons to 1-3 tablespoons per day, selected individually. The drug has no contraindications, it can be taken even by young children and pregnant women.

Treatment of pathological manifestations and complications in cirrhosis includes:

1. Reduction of ascites by conservative (diuretic drugs according to the scheme) and surgical (fluid removal through drains) methods.
2. Treatment of encephalopathy (nootropics, sorbents).
3. Removal of manifestations of portal hypertension - from the use of non-selective beta-blockers (propranolol, nadolol) to ligation of dilated veins during surgery.
4. Preventive antibiotic therapy for the prevention of infectious complications during planned visits to the dentist, before instrumental manipulations.
5. Treatment of dyspepsia with the help of nutrition correction and the use of enzyme preparations without bile acids (pancreatin). Perhaps in such cases, the use of eubiotics - bactisubtil, enterol, bifidumbacterin and lactobacterin.
6. To relieve itching, antihistamines are used, as well as drugs containing ursodeoxycholic acid.
7. The appointment of androgens to men with severe manifestations of hypogonadism and the correction of the hormonal background of women to prevent dysfunctional uterine bleeding - under the supervision of an endocrinologist.
8. The use of preparations containing zinc for the prevention of seizures during normal muscle exercise and in the complex treatment of liver failure, to reduce hyperammonemia, is shown.
9. Prevention of osteoporosis in patients with chronic cholestasis and primary biliary cirrhosis, in the presence of autoimmune hepatitis with corticosteroids. For this, calcium is additionally introduced in combination with vitamin D.
10. Surgical correction of portal hypertension for the prevention of gastrointestinal bleeding includes the imposition of vascular anastomoses (mesenteric-caval and splenorenal) as well as sclerotherapy of existing dilated veins.
11. In the presence of single foci of degeneration into hepatocellular carcinoma and the severity of the course of the disease of class A, patients are shown surgical removal of the affected segments of the liver. In clinical class B and C disease and massive lesions, pending transplantation, anticancer treatment is prescribed to prevent progression. To do this, both the effect of currents and temperatures (percutaneous radiofrequency thermal ablation) and chemotherapy by targeted injection of oil solutions of cytostatics into the vessels that feed the corresponding segments of the liver (chemoembolization) are used.

Treatment of such a developed formidable fatal complication as acute massive bleeding from the veins of the esophagus includes:

1. Local application of the Blackmore probe, with the help of which an air cuff inflates in the lumen of the esophagus, compresses the dilated bleeding veins.
2. Targeted chipping of the esophageal wall with sclerosing agents.
3. Blood replacement therapy.

Unfortunately, this condition becomes the main cause of death in patients with cirrhosis of the liver.

Diet for cirrhosis of the liver

Compliance with a diet for cirrhosis of the liver involves, first of all, the rejection of food, which has a high protein content. Indeed, in patients with cirrhosis of the liver, the digestion of protein foods is disturbed, and as a result, the intensity of the processes of decay in the intestine increases. The diet for cirrhosis of the liver provides for periodic fasting days, during which the patient does not eat food containing protein at all. In addition, an important point is to limit the use of table salt along with the main meal.

The diet for cirrhosis of the liver provides for the exclusion of all products that contain baking soda and baking powder. You can not eat pickles, bacon, ham, seafood, corned beef, canned food, sausages, sauces with salt, cheeses, ice cream. To improve the taste of products, you can use spices, lemon juice instead of salt.

The diet for cirrhosis of the liver allows the use of a small amount of dietary meat - rabbit, veal, poultry. One egg per day can be eaten.

Disease prognosis

Liver cirrhosis cannot be cured unless a liver transplant is performed. With the help of the above drugs, you can only maintain a more or less decent quality of life.

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

• with the development of ascites, they live 3-5 years;
• if gastrointestinal bleeding develops for the first time, from 1/3 to half of people will survive it;
• if a hepatic coma has developed, this means almost 100% mortality.

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

Prevention

Cirrhosis of the liver is a rather lengthy process that can be stopped and treated. The main key to success is to go to the doctor on time. However, this is one of those diseases that can be easily avoided by adhering to certain preventive measures, including:

• vaccination against hepatitis B in childhood;
• rational and proper nutrition;
• avoidance of starvation and overeating;
• giving up alcohol and smoking to exclude alcoholic cirrhosis and toxic liver damage;
• annual ultrasound and endoscopic examination;
• timely access to a doctor for medical help;
• adequate intake of vitamin and mineral complexes;
• hard suppression and treatment of drug addiction.

Preventive measures to prevent viral hepatitis will also help to avoid the development of cirrhosis.

The liver filters the blood, neutralizes toxins and harmful metabolic products. In addition, the body regulates the metabolism of fats, carbohydrates, minerals and vitamins. Typical symptoms of liver cirrhosis often appear after cell destruction has begun and active hepatocytes have been replaced by non-functioning scar tissue. It is the progression of fibrosis as a result of chronic inflammation that leads to cirrhosis of the liver. Let us consider how the symptoms of the disease arise and manifest themselves, often eluding attention in the first stages.

The “filter” of the body, as a result of the destruction of the normal structure, can no longer neutralize all toxins, so they enter the organs with the blood. The consequences of fibrosis of the liver tissue are the accumulation of blood in the portal vein and adjacent vessels, varicose veins of the esophagus and stomach. This condition is dangerous with internal bleeding that threatens life. In this case, fluid accumulates in the abdominal cavity, renal failure occurs. Also, with cirrhosis of the liver, a high probability of developing cancer of this organ.

In the ICD-10, such diseases are assigned the code "K74 Fibrosis and cirrhosis of the liver." The replacement of hepatic connective tissue usually occurs within a few years or decades. The disease is chronic, most often its initial stage goes unnoticed. The first symptoms are nonspecific and characteristic of many pathologies.

Signs of chronic inflammation may occur when the process of liver fibrosis is irreversible. Jaundice, pain in the right hypochondrium, venous pattern on the abdomen appear. At home, by a number of symptoms, you can assess how real the danger of cirrhosis of the liver (cirrhosis for short) is. To do this, you need to get an idea about the disease, the ongoing changes in the liver. It is the processes in the body that affect the nature of the symptoms, the time of their appearance. You should also pay attention to the risk factors on which the development of pathology depends.

If there is a suspicion of cirrhosis, then the patient is assigned a complete examination. It is very important to recognize the inflammatory process in a timely manner and begin adequate treatment. As fibrosis progresses, there is less and less chance of restoring organ functions. Sometimes the only option to save a patient's life is transplantation - transplanting a healthy liver from a donor.

Causes

In developed countries, the most common cause of the disease is alcohol abuse for a long time. Toxins in the composition of alcohol and its decomposition products damage liver cells. Fatty hepatosis begins - a partially reversible process in the first stages. If you continue to drink alcohol, then liver cells die, connective tissue develops. The progression of fibrosis leads to cirrhosis.

The next most common cause is chronic viral hepatitis B + D, C. They come out on top in Asia and Africa. In infectious hepatitis, inflammation leads to the death of the liver tissue and the appearance of scars in its place.

The development of cirrhosis can also lead to:

Certain drugs, such as the anticancer drug Methotrexate, can lead to the development of cirrhosis. Cause damage to liver cells and toxic substances: carbon tetrachloride, arsenic.

Risk factors for cirrhosis include smoking, drug use, handling toxic materials, and long-term use of certain other medications. By addressing the causative factor early, further damage to the liver can be avoided.

The likelihood of developing fibrosis increases many times with infectious hepatitis C, B D. You can become infected through a blood transfusion, especially in cases where the procedure was performed before 1992, while traveling to Asia, Africa and Central America. The risk of infection with hepatitis pathogens increases with unprotected sex with frequently changing partners.

What happens to the liver?

Cytokines (protein substances) that provide intercellular interactions provoke local inflammatory reactions in the liver. They are secreted by damaged cells in response to the penetration of hepatitis viruses, the action of toxins, alcohol, drugs. Cytokines are one of the elements of tissue and organ protection. On the other hand, they are also involved in the pathogenesis of fibrosis.

Cytokines most often act at the site where the pathogen enters the organ. The reaction of the liver is to increase the fibrous layers - its own connective tissue. Fibrosis disrupts the original structure of the organ, making it rough and nodular. Scars exert mechanical pressure on the surrounding bile ducts and vessels.

Deterioration of hepatocyte nutrition leads to necrosis of areas of normal liver tissue.

Bile is produced in the liver and flows through the ducts to the gallbladder. This fluid facilitates the breakdown of fats, transfers toxins and metabolites to the intestines, so that they are then excreted in the stool. Scar tissue blocks bile secretion, associated processes of digestion and disposal of toxins.

Violated the most important functions of the liver:

• less fibrinogen and prothrombin (blood clotting factors) are produced;
• decreased production of bile;
• the breakdown of metabolites and toxins worsens;
• bilirubin is not excreted from the body, accumulates in the blood and skin;
• the production of serum albumin (transport protein) decreases.

What does the symptomatology depend on?

In addition, with fibrosis, blood flow is disturbed, which leads to an increase in pressure in the portal vein. Portal hypertension, in turn, causes hypertension in the veins of the stomach, esophagus, and rectum.

The time it takes for fibrosis to develop depends largely on the underlying disease. These can be viral hepatitis C, B, D, fatty liver or other etiological factors. Usually, cirrhosis develops slowly: with alcoholism - within 10-12 years of alcohol abuse, with viral hepatitis - 15-25 years after infection.

It should be borne in mind that piercings, tattoos, drug addiction, and obesity are also risk factors. The likelihood of developing liver fibrosis is higher in autoimmune diseases and heart failure.

Detection of pathology at an early stage

The initial symptoms are unstable, do not always indicate the pathology of the liver. The patient feels tired, sleepy. The appetite worsens, but the weight loss is insignificant. Patients rarely go to the doctor with such complaints, they consider the symptoms that have arisen to be the result of work overload and stress. Gradually, fibrous nodes grow in the liver, and this process takes years.

Cirrhosis is insidious: the characteristic signs of the disease appear late. The first stage is pre-cirrhosis or compensatory. Biochemical changes in the liver are almost not manifested outwardly. If part of the hepatocytes is damaged, the remaining healthy cells work with a double load. It is easier to stop the development of pathology in this latent period.

There may be the following complaints:

• bloating mainly after fatty foods;
• dryness and a feeling of bitterness in the oral cavity;
• nausea, recurrent abdominal pain;
• increased fatigue, weakness;
• loss of appetite, weight loss;
• irritability;
• sleep disorders;
• headache.

Many patients do not notice the onset of cirrhosis, although lesions are already developing in the liver. As a rule, characteristic signs begin to appear in the second stage of the disease.

Fibrosis does not manifest itself for a long time, due to the compensatory capabilities of the liver. After the end of the latent stage, symptoms may appear indirectly or directly indicating damage to hepatocytes. Signs from the proposed list do not appear simultaneously, they manifest themselves and combine with each other in different ways.

List of symptoms to determine the onset of cirrhosis (reminder):

Violation of the liver leads to the accumulation of bilirubin. Normally, this substance is excreted in the bile. With hepatitis and cirrhosis, bilirubin is deposited in the shell of the eyes and in the skin. In everyday life, this condition is called jaundice. At the beginning of cirrhosis, yellowing of the whites of the eyes and skin does not necessarily occur.

How to determine the stage of the disease?

Full recognition of the disease and its severity is possible only with the use of medical diagnostic methods. It is problematic to determine the pre-cirrhosis condition at home. In the pre-cirrhosis period, the load on liver cells increases. Therefore, discomfort may appear in the right hypochondrium. After eating heavy fatty foods, pickles, smoking, alcohol, aching pain occurs in the upper abdomen.

Symptoms are more pronounced at the stage of subcompensation. It is during this period that the patient pays attention to the problems that have arisen with digestion, blood circulation and skin. The stage of subcompensation is characterized by increased discomfort in the liver area. The appearance of paroxysmal pain is not always associated with eating.

There is pain in the right hypochondrium. If the discomfort was earlier, then the discomfort intensifies. Even after taking a small amount of food, there is heaviness and a feeling of fullness in the stomach, nausea. Women note menstrual irregularities, men - erectile dysfunction.

Symptoms of cirrhosis in the second stage (subcompensation):

• vascular "cobwebs" and "stars" on the trunk and arms;
• decrease in muscle mass, strong weight loss;
• swelling of the knee or ankle joints;
• protruding veins on the surface of the abdomen;
• yellowing of the skin and whites of the eyes (jaundice);
• periodic increase in temperature;
• painful cracks in the lips (cheilitis);
• dark urine and light-colored stools;
• depressions and white spots on the nails;
• bleeding gums;
• "varnished" lips;
• redness of the palms;
• an increase in the abdomen;
• bruising (ecchymosis);
• thinning of the skin;
• severe itching;
• dyspnea.

Fibrosis progresses, compression of the liver vessels increases, blood flow and oxygen supply are disturbed. Increasing pain in the right hypochondrium, which is often combined with discomfort in the pancreas. The absorption of fats and fat-soluble vitamins worsens, so the stool is soft, oily. Characterized by severe yellowing of the skin, darkening of the urine.

A specific sign is an increase in the liver - hepatomegaly. The consistency of the organ becomes relatively firm. In 75% of cases, splenomegaly is observed - an enlargement of the spleen. The organ protrudes more strongly on the left under the lower ribs by 2-3 cm.

The third stage is decompensation. The stage of decompensation is characterized by the critical nature of the symptoms. The pain in the right hypochondrium becomes unbearable. It is impossible to remove an attack on your own, without medical help. The patient cannot do without permanent anesthesia. Hepatic encephalopathy develops.

Toxins enter the brain and affect nerve cells. A large amount of fluid accumulates in the abdominal cavity and ascites occurs.

The greatest danger, in addition to hepatic encephalopathy, is gastric and intestinal bleeding. Signs of the condition are anemia, blood in vomit and stool. Decompensated cirrhosis of the liver is irreversible.

The fourth stage of the disease is characterized by an exacerbation of all signs. Complete necrosis of the liver tissue during this period cannot be stopped. Doctors prescribe potent drugs that alleviate the patient's condition. The remaining time before death is measured in months. The fourth stage of cirrhosis is terminal. The patient needs a liver transplant.

Some features of the manifestation of cirrhosis

Cirrhosis of the liver is observed 2 times more often in men over 40 compared to women. The destruction of the structure of the body is accompanied by a violation of the process of utilization of female sex hormones - estrogens (they are also produced in the male body).

The complex of general symptoms of cirrhosis in men is supplemented by the following changes:

• development of the mammary glands (gynecomastia);
• hair loss on the abdomen and armpits;
• testicular atrophy;
• decrease in potency.

Cirrhosis in women is accompanied by menstrual irregularities or the cessation of menstruation. In the body of the fairer sex, there are fewer factors for the utilization of alcohol. Therefore, in women, the stages of cirrhosis proceed faster against the background of prolonged alcohol abuse. In this case, all the symptoms are more pronounced. Women, compared with men, are more susceptible to primary biliary cirrhosis. The disease is more common in the age group from 35 to 70 years.

Damage to the liver and spleen leads to numerous consequences for individual organs and the whole organism. Typical complications of cirrhosis:

Cirrhosis is a severe disease, but it is difficult to predict how many more years of life the patient will have. The prognosis depends on the cause, the stage of the process, the nature of the complications and the effectiveness of the treatment. Already altered liver tissue is not regenerated. You can only stop the further spread of fibrosis.

Every second patient who develops the first stage of cirrhosis has a chance to fully recover, but this happens only in half of the cases, which is associated with the absence or improperly selected therapy.

With progressive fibrosis, the patient dies within the next five years. The life span of a patient with decompensated cirrhosis is about 3 years. The most common causes of death are acute liver failure, internal bleeding, and liver cancer.

Confirmation of the diagnosis and selection of treatment

In the patient's medical history, information about possible infection with the hepatitis virus, alcohol consumption, and travel abroad is especially important for the doctor. To diagnose cirrhosis of the liver, a specialist conducts a physical examination: palpates the liver and spleen, abdomen to determine if there is fluid in the abdominal cavity. The doctor also observes other signs of cirrhosis: yellowing, spider veins on the skin, reddening of the palms.

Examination methods:

With hepatitis and cirrhosis, elevated concentrations of liver enzymes and bilirubin are noted in the blood. Laboratory tests can detect hypersplenism and anemia, leukopenia and thrombocytopenia by reducing the number of red blood cells, white blood cells, and platelets. A professional medical examination and laboratory and instrumental diagnostics will help establish the stage of liver pathology.

Therapy includes drug treatment of the causative disease, such as viral hepatitis or alcoholism. In chronic hepatitis, corticosteroids and antiviral agents are prescribed. This approach can stop fibrosis at the pre-cirrhotic stage and prevent further damage to the liver.

With compensated cirrhosis, moderate physical activity, physiotherapy exercises are not contraindicated. In the later stages of the disease, physical activity is limited. It is necessary to reduce the sodium content in the diet, follow a strict diet.

Patients diagnosed with cirrhosis in the stage of subcompensation and decompensation are prescribed antipruritics, drugs for insomnia, multivitamins. Hepatoprotectors are used to protect liver cells (essential phospholipids). Types of drugs: Essentiale, Phosphogliv, Eslidin, Essentiale Forte N.

The patient is prescribed lyotropic agents: Hepa-Merz, Betargin, Heptral. There is a series of herbal preparations: Allohol, Karsil, Legalon, Gepabene, Silymarin, Galstena. The main components in such products are extracts of spotted thistle, artichoke seeds, birch,.

Ursodeoxycholic acid is prescribed. This is a synthetic analogue of bile, which is contained in the preparations Ursonan, Exhol, Ursodex. To alleviate the symptoms of cirrhosis, you can take the antiemetic Cerucal, a gastrointestinal motility stimulant Motilium. Antihistamines Eslotin, Loratadin, Claritin, Suprastin will help with itching. With insomnia - Tenoten.

Medicines will be required to restore the prevention and treatment of possible complications - ascites, varicose veins of the esophagus. In case of bleeding, beta-blockers are used. Stage 4 cirrhosis requires a liver transplant. Transplantation is complicated by the need to find a donor, the complexity and high cost of the operation.

Patient experience

At specialized forums, patients, as well as their relatives, discuss the problem of the implicit manifestation of symptoms in the first two stages of cirrhosis. Many patients and their relatives confirm that this is most often due to inattention to their body. Often, patients turn when vascular "asterisks" have already appeared on the face, the stomach has increased.

Ivan: “For as long as I can remember, my right side has always hurt: after physical education at school, and after a bottle of beer, and after fried food ... and now it turned out that I had the second stage of cirrhosis. The doctor says that if he had applied earlier, this could have been avoided!”

Konstantin. He recalls that his father developed cirrhosis as a result of an accident in an accident, liver surgery and a craniotomy. After that, more than 6 years passed before the appearance of jaundice. All this time, the man, who underwent two severe operations, worked physically, did not limit himself in food. Then - another accident, treatment, a rapid increase in the symptoms of cirrhosis and death from bleeding in the intestines.

Patient Olga. He writes that he has been sick for 15 years, all this time he has been receiving treatment: hepatoprotectors, herbal and other drugs. In addition, the patient has to go to the clinic regularly to remove fluid from the abdominal cavity. The patient emphasizes that she has been following a strict salt-free diet for a long time. And these procedures allow her to keep the disease under control.

Chronic liver disease develops mainly against the background of viral hepatitis or alcoholism, or a combination of two etiological factors. Less common causes are autoimmune processes in the body, toxic damage, drug poisoning.

Pain with cirrhosis does not appear immediately, like other signs. The initial stage is often asymptomatic. With the development of cirrhosis, it is necessary to eliminate the cause of the disease, for example, completely abandon alcohol or treat viral hepatitis.

Therapy includes, in addition to the use of medications, physiotherapy. It is very important to follow a diet rich in proteins and vitamins, limit the intake of fatty foods, and avoid alcohol.

Prevention of cirrhosis is the timely prevention of conditions leading to liver fibrosis. It is necessary to be vaccinated against viral hepatitis, beware of exposure to toxic substances on the body, and do not take medications without a doctor's prescription. You can use herbal remedies and herbal preparations that support liver function.