Cirrhosis - a pathological condition of the liver, which is a consequence of impaired blood flow in the hepatic vessels and dysfunction of the bile duct, usually occurs on the background of chronic hepatitis and is characterized by full violation architectonic hepatic parenchyma.
risk for the disease are the representatives of the male half of the population over the age of 45 years.The incidence of cirrhosis among all entities that according to the world statistics, is 2 - 8%.Through the introduction of effective methods of treatment and prevention of this disease, mortality is not more than 50 diagnoses per 100,000 people.
The liver is one of the largest endocrine glands, has several important functions:
- the main function of the liver is the detoxification, that is, the ability to destroy harmful substances and excrete toxins;
- in the process of formation of liver bile containing bile acids involved in the process of digestion;
- synthetic organ function is to participat
- liver in the formation of the most important factors of blood coagulation;
- the liver is involved in the formation of the protective functions of the body by the formation of antibodies;
- liver contains a large supply of nutrients, which, if necessary, supplies all the cells and organs.
structural unit of the liver tissue is a liver lobule.Cirrhosis of the liver is characterized by a significant decrease in the functioning of liver cells and the restructuring of the hepatic parenchyma with a predominance of connective tissue component.In cirrhosis of the liver develops changes that can not be correct, and the task of the physician is to keep the liver and maintain the status of the vital organs of the patient to a compensated level.
Among the etiological factors causing the formation of cirrhosis of the liver, cirrhosis of the share, arising on a background of suffering any form of chronic hepatitis (viral, toxic, autoimmune) account for over 70% of cases.
most dangerous viral hepatitis, which in 97% of cases provokes the development of cirrhosis, hepatitis C is an insidious and unpredictability of this disease is that it has a hidden symptoms and recognized during specific laboratory tests.Viral hepatitis is characterized by the massive destruction of hepatocytes, and then grows connective tissue and formed scarring of the liver.This form is called cirrhosis postnecrotic.
Autoimmune hepatitis is also complicated by the development of cirrhosis, but its frequency is quite low.
Long term effects on the body of toxic substances and stimulates the development of toxic hepatitis, which is then transformed into cirrhosis.Toxic medical drugs are antibacterial agents, antiviral drugs, provided their long-term use.
in recent years have increasingly become diagnosed cirrhosis arising on a background of non-alcoholic steatohepatitis.Fatty liver disease affects people with obesity and diabetes, and in the initial stage of the disease does not cause significant changes in the structure of the hepatic parenchyma.Upon accession, the inflammatory component of the pathogenetic mechanisms are triggered proliferation of connective tissue and in the structure of the liver are formed scarring, ie cirrhosis is formed.
Chronic heart failure is accompanied by long-term venous congestion of the liver, thus creating conditions for the regeneration of cirrhotic liver.
important factor for the occurrence of liver cirrhosis is a condition of the vascular system of the liver, so blood circulation disorder in the hepatic arteries and veins leads to fibrosis of the liver tissue.For example, many patients with congestive heart failure, cirrhosis of the liver sick afterwards.
Diseases accompanied by deep metabolic disorders (hemochromatosis, cystic fibrosis, thalassemia, Wilson's disease) provoke the development of cirrhosis.
significant factor in the development of biliary cirrhosis is the state of the bile duct, as in violation of the outflow of bile, the conditions for toxic damage to the liver cells of bile acids.Thus, the final stage of diseases such as calculous cholecystitis and cholangitis, primary sclerosing cholangitis, in the absence of treatment, is the development of cirrhosis.If
reliably determine the cause of cirrhosis is not possible, then it is a form of cryptogenic cirrhosis, which is 20% of the overall structure of morbidity.
There are two main groups of cirrhosis depending on the etiological factor of occurrence: true (primary) and symptomatic (secondary), resulting in chronic heart failure or chronic calculous cholecystitis.
Symptoms of liver cirrhosis is quite diverse.The degree of clinical manifestations depends on the stage of the disease and the availability of other chronic pathologies of the patient.When the disease is marked not only the pathological processes in the liver, but also affects all the organs and systems of the human body.
Cirrhosis is characterized by sluggish progression with a gradual increase in clinical manifestations.Very often, there is a hidden (latent) for sickness, dangerous by the fact that there are no patient complaints and patient care in the process of appeals has the appearance of complications of cirrhosis.The average course of the disease is 5-6 years, but in severe comorbidity death can occur after only a year after the diagnosis.
main clinical types of cirrhosis are:
- portal liver cirrhosis, which is characterized by severe symptoms of portal hypertension in the absence of express cholestatic syndrome.In the period of the disease is marked predastsiticheskom pronounced flatulence, dyspeptic syndrome, asthenovegetative symptoms and frequent nosebleeds.Ascetic period is characterized by the appearance of abdominal pain of various localization, weakness, vomiting, and onset of symptoms, "the head of Medusa."Later stages of this form of cirrhosis is cachexia.The transition from the ascitic period to cachectic takes an average of 6-24 months.Cachexia is manifested in the form of drastic weight loss, skin becomes flabby and pale, the patient noted a tendency to hypotension, gastric bleeding.Death occurs as a result of hepatic coma or joining intercurrent diseases;
- hypertrophic biliary cirrhosis is characterized by a prolonged course, and slow growth of the clinical picture.Among the symptoms and complaints of the patient in the first place are the signs of cholestasis - pronounced yellowing of the mucous membranes of the mouth, sclera and skin, itching and scratching of the skin appearance, xanthelasma and trophic skin damage.Lethal outcome comes as a result of the massive hemorrhagic syndrome;
- mixed cirrhosis, accompanied by a rapid clinical symptoms and signs of a progressive increase in portal hypertension.
All forms of cirrhosis accompanied asthenovegetative symptoms (unmotivated weakness, decreased performance, decreased appetite, feeling heart palpitations).
pain in the projection of the right hypochondrium is aching character and worse after physical activity.The occurrence of pain due to increase in liver and stimulation of nerve endings, which are located in the capsule.
frequent early symptom of cirrhosis of the liver is a hemorrhagic syndrome, which manifests itself in bleeding gums and minor nosebleeds.Hemorrhagic syndrome is caused by insufficient production of major clotting factors in the liver.
Patients complain of swelling and pain during bowel, nausea and heartburn.The projection of the right hypochondrium there is a feeling of heaviness and arching pain.
frequent symptom of cirrhosis of the liver is a long rise in body temperature to 37 ° C, and in the final stage of the disease may be a short-term fever, caused by the addition of infectious complications and intestinal endotoxemia.
Cirrhosis of the liver is often associated with other disorders of the digestive system, so join the symptoms of intestinal dysbiosis (disorder stool, pain during bowel) reblyuks esophagitis (nausea, belching stomach contents), chronic pancreatitis (girdle pain upper abdomen, diarrhea,vomiting) and chronic gastroduodenitis ("hungry" epigastric pain, heartburn).
Patients with severe hepatic cirrhosis note the loss of all kinds of sensitivity (tactile, temperature, pain), which shows the development of polyneuropathy.
At the final stage of liver cirrhosis, symptoms indicating the joining of complications of the underlying disease, since the accession of portal hypertension affects not only the organs of the digestive system, and hormonal, circulatory, nervous.
Thus, when long-term accumulation in the intestine of metabolic products, especially ammonia, which is toxic to brain cells are damaged nervous tissue cell structure and the appearance of symptoms of hepatic encephalopathy.Signs of hepatic encephalopathy include: euphoric mood, which quickly gives way to deep depression, sleep disorder, speech disorder, disorientation in place and identity, as well as varying degrees of impaired consciousness.Hepatic coma is the extreme degree of damage to the brain, is the main cause of death in patients with liver cirrhosis.
Prolonged accumulation of ascites fluid in the abdominal cavity, the conditions for inflammatory changes, which leads to spontaneous bacterial peritonitis.
patients with significant impairment of the functional state of the liver increases the risk of gastric and esophageal bleeding, manifested as vomiting thick mass of dark brown or fresh venous blood is dark red.
Frequently cirrhosis complicated by hepatorenal syndrome, which should be suspected if the patient is severe fatigue, anorexia, thirst, decreased skin turgor, swelling of the face.
Signs of cirrhosis
diagnosis of cirrhosis is not too difficult, and often even at the initial examination of the patient can identify a number of specific features that characterize this disease.
Cirrhosis is always accompanied by an enlarged spleen and liver, which can be determined by palpation of the abdomen.Increasing the size occurs due to progressive overgrowth of connective tissue.The surface of the liver is uneven, bumpy, and the edges sharpened.
cirrhotic patients have typical skin changes in the form of appearance of earthy hue of the skin and mucous membranes and the appearance of telangiectasia in the upper body.
due to dysfunction of the liver there is a lack of protein in the blood that is accompanied by anemic syndrome.In addition, any pathology of the gastrointestinal tract leads to vitamin B12 deficiency, resulting in anemia.
specific signs of the transition to the stage of cirrhosis decompensation is the accumulation of fluid in the abdominal cavity, confirmed by objective methods of examination of the patient.If you have a large amount of fluid can not stomach palpation, percussion and marked dullness.
On examination, plain film of the abdominal cavity can define an indirect sign of ascites - high position of the diaphragm.The most reliable diagnostic method is considered to be in this situation ultrasound of the abdominal cavity with the definition of the scope of ascites.
There are a number of specific and general laboratory signs of liver cirrhosis, the priorities of which are changes in hematological (anemia, thrombocytopenia and leukopenia).Upon accession of infection in the blood increase performance leukocytes, erythrocyte sedimentation rate and leukocyte marked shift to the left.Changes in the biochemical analysis of blood can be combined into a cytolytic syndrome (increased levels of AST and ALT) and cholestatic syndrome (increased levels of bilirubin, alkaline phosphatase and LDH).As a result, the synthetic function of the liver failure has been a sharp reduction in the albumin fraction of protein in the blood, reduced blood clotting parameters in the analysis of coagulation and hypocholesterolemia.
signs of cirrhosis, arising on a background of viral hepatitis is to define specific markers of a virus in the blood.
Among the instrumental methods of diagnosis, contributing to the diagnosis, the most effective are: ultrasound, radionuclide study, EFGDS, laparoscopic examination of the liver needle biopsy and histology of biopsy specimens.
specific changes in liver cirrhosis in the US are: enlarged liver and spleen at the initial stage and the dramatic hardening of the liver in the stage of decompensation, heterogeneity of hepatic parenchyma with the emergence of areas of high density and echogenicity, increase lumen of the portal vein and splenic.
When Radionuclide studies observed an uneven distribution of colloidal agents in the liver tissue, and in areas with excessive proliferation of connective tissue indicated a complete lack of accumulation of drug with a radioactive label.
EFGDS and contrast radiological techniques are used to study the state of the walls and the lumen of the esophagus and stomach.In cirrhosis patients often can detect varicose veins in the esophagus and cardia projection.
To determine the morphological variant of cirrhosis should be performed laparoscopic examination of the liver.For micronodular cirrhosis is characterized by such signs: gray-brown color, the entire surface of the liver consists of small uniform tubercles, disconnected connective tissue, the size of the liver increased.
Makronodulyarny cirrhosis is characterized by the changes: uneven surface of the liver due to the formation of large deformations with node situated between kollabirovannogo interstitial liver.For biliary cirrhosis characterized by a significant increase in the size of the liver and its grained surface.
most accurate method of diagnosis of cirrhosis is a needle biopsy.Histological examination of the seized material found large areas of necrotic tissue and a significant proliferation of connective tissue components between kollabirovannoy organ stroma.Liver biopsy can reliably establish the diagnosis and determine the cause of the disease, the degree of destruction of liver tissue to determine the method of treatment, and even allows you to make projections for the life and health of the patient.
There are two main methods of biopsy: transcutaneous and transvenous.The absolute contraindication to percutaneous biopsy is bleeding tendency, expressed ascites and obesity.
cirrhosis of any etiology develops on a single mechanism, which includes 3 stages of the disease:
Stage 1 (initial or latent), which is not accompanied by biochemical abnormalities;
subcompensation Stage 2, in which there are all clinical manifestations showing functional disorders of the liver;per day.per day.per day.sugar.