Cirrhosis : causes, symptoms , diagnosis, treatment
Gastroenterology / / May 12, 2016
Cirrhosis of the liver caused by various diseases, which over time damage the liver cells healthy.In the end, defeat leads to disruption of the normal structure and function of the liver.Cirrhosis of the liver - a chronic disease caused by damage to healthy liver tissue.
disease leads to unfavorable consequences:
- progressive decrease in liver function
- Chrezmernoeu accumulation of fluid in the abdomen (ascites)
- bleeding disorders (coagulopathy)
- Increased blood pressure
- Disorders of brain function (hepatic encephalopathy) andblood vessels (portal hypertension).
That excessive use of alcohol is a major cause of liver cirrhosis.In addition to alcohol increasing fibrosis is caused by viruses, and many other diseases.Is replaced to healthy tissue scar, however cirrhosis leads to significant changes of blood flow and bile from the liver.
Such changes in the blood and bile, in turn, lead to serious consequences:
- In the liver, there are small blood vessels and bile
- Gradually, the blood vessels constrict in other organs, including the
kidneys - The flow of blood comingfrom the intestine to the liver, it is also reduced and through the portal vein seeks other ways
- The stomach and lower esophagus is formed, so-called varicose veins, due to which the flow of blood and does not reach
liver - in the blood begins to accumulatebilirubin (yellow-green pigment), resulting in jaundice, the main features of which is a yellowish tinge to the skin and eyeballs, as well as dark color
urine - fluid begins to accumulate in the abdomen (ascites), and on the legs appear swelling
Causes of cirrhosis
liver Cirrhosis - a disease which is characterized by permanent scarring of the liver, which directly affects its normal functionality.The processes that can lead to cirrhosis of the liver:
- Alcoholism. Alcoholism threatens the healthy functioning of the liver, causing liver disease alcoholic.This disease contributes to the development of fatty liver disease, alcoholic hepatitis (inflammation of the liver caused by alcoholism) and alcoholic cirrhosis.
it is known that in the US alcoholic cirrhosis of the liver is the main kind of cirrhosis of the liver and is found in 10-20% of heavy drinkers, after 10-15 years of excessive alcohol consumption.Particularly at risk are people who not only drink a lot, but at the same time suffer from hepatitis C to cirrhosis of the liver leads directly to the alcohol itself, which is converted to a chemical damaging healthy tissue.
- Chronic hepatitis B and C. Such chronic viral hepatitis, such as hepatitis B and hepatitis C - are the second leading cause of cirrhosis of the liver.For example, chronic hepatitis C is the most common in developed countries, while hepatitis B - all over the world, especially in sub-Saharan Africa and parts of Asia.
main risk group consists of people who are suffering from chronic hepatitis D. And, as a rule, the longer a person suffers from chronic hepatitis B, the higher the risk of developing cirrhosis of the liver.
Viral hepatitis leads to inflammation of the liver cells, which promotes its degradation.Gradually progressive destruction of the cells and leads to the appearance of scar tissue.In the later stages of liver even shrinks in size, this condition has been called postnecrotic posthepatic or cirrhosis.
Hepatitis C also causes inflammation of the liver, which can lead to jaundice, fever and liver cirrhosis.For the main risk group includes people who inject drugs through a needle, including health care workers and emergency workers.
- Autoimmune hepatitis. Autoimmune hepatitis, as well as other autoimmune diseases, developed in violation of the immune system, that is, when the system attacks the body's own cells and organs.For people who suffer from autoimmune hepatitis is characterized spetsefichesky condition: lupus erythematosus, rheumatoid arthritis, Sjogren's syndrome, scleroderma, inflammatory bowel disease, glomerulonephritis, and hemolytic anemia.
autoimmune hepatitis usually occurs in women aged 15 - 40 years.
- diseases of the bile ducts. Disorders damaging or blocking the bile ducts, such as primary biliary cirrhosis and primary sclerosing cholangitis, ultimately contribute to inflammation, and finally lead to cirrhosis.Primary biliary cirrhosis (PZHTSP) to 95% of cases occur in women under the age of 50 years.People with PZHTSP, the immune system weakens and destroys cells in the bile ducts of the liver.As with many other autoimmune diseases, the causes are unknown PZHTSP.
Primary sclerosing cholangitis (PSC) is a chronic disease that primarily affects males, usually around the age of 40 years.It is considered a very rare disease, the cause of the disease is also unknown, the immune system is affected and there is great role of genetic factors.
- Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Non-alcoholic fatty liver disease (NAFLD) resembles alcoholic liver disease, but occurs more often it is the people who do not drink alcohol in large quantities.Especially a disease common in the United States.
Furthermore, NAFLD includes a spectrum of progressive liver disease.Moreover, non-alcoholic fatty liver is the earliest stage of NAFLD.The disease is characterized by the presence of fat in the liver (steatosis), the destruction of which has not yet occurred.Fatty liver is not yet considered a serious disease.
Nonalcoholic steatohepatitis (NASH) is the next stage of cirrhosis.This disease is characterized by inflammation of the liver and signs of fatty liver.NASH is dangerous because it can lead to scarring of the liver.In addition, it NASH is one of the main causes of cirrhosis of the liver.In other words, liver cirrhosis is an irreversible final stage of non-alcoholic fatty liver disease.
Obesity and diabetes are the two main causes of NAFLD.Another important factor in the metabolic syndrome is considered, comprising a plurality of risk factors: abdominal obesity, unhealthy blood lipids, high blood pressure and insulin resistance.
non-alcoholic fatty liver disease refers to benign tumors that are very slow progress.In some patients, this condition may lead to liver cirrhosis and eventually to liver failure.NAFLD also increases the risk of cardiovascular diseases, which are the main cause of death.
- Metabolic disorders. Such diseases, first of all, need to include hemochromatosis or disorder of iron metabolism in the body.This disease leads to the fact that iron from food is absorbed and excessively accumulated in the organs and tissues.An excess amount of iron in the liver and causes just the same cirrhosis.
- Heredity. to hereditary diseases that can cause cirrhosis of the liver include:
- Wilson (causes an accumulation of copper in the body)
- Alpha-1-antitrypsin deficiency (a genetic disorder caused by a defect in a specific enzyme)
- Diseases of glycogen (a group of diseases that resultto an abnormal accumulation of glycogen in the liver).
- veschestav Chemicals and Pharmaceuticals. Prolonged exposure to drugs or chemicals with a strong impact, including arsenic, the drug methotrexate, toxic doses of vitamin A and certain medications issued on prescription.
- Parasites. schistosomiasis - a disease caused by a parasite.Mostly found in Asia, Africa and South America.Among the risk factors are cirrhosis and opistarhi, the parasites that cause opistorhoz.
Symptoms of liver cirrhosis
Basic common liver cirrhosis symptoms include:
- Weight Loss
- abdomen Increased
- Nausea and vomiting
- skin yellowness and eye
- Reduction or complete lossappetite
- bruising and bruising
- Discoloration stool
urine - dull or aching pain in the liver area
The clinic cirrhosis distinguish two stages of the disease: the compensated and decompensated.
1. Compensated cirrhosis furnace. body function is still quite good, there is no pronounced symptoms, despite the defeat, and scarring of the liver tissue.
2. Decompensated cirrhosis of the liver. observed the appearance of scars, and violated the most important functions of the body.Patients developing many serious and life-threatening symptoms and complications.
Early symptoms in compensated cirrhosis include:
- Fatigue and
energy loss - loss of appetite and weight reduction
- Nausea and pain
stomach - Outbreaks angiomas on the skin (red spots the size of a pinhead, "spider veins").
In the transition from compensated to decompensated stage of the disease the following symptoms may develop in patients:
- Ascites .Accumulation of fluid in the legs (edema) in the abdomen.
- Jaundice. This staining of the skin and eye sclera in yellow color, which is due to the fact that bilirubin due to liver damage poorly excreted from the body.Consequently, excessive amounts of bilirubin in the blood circulates dissolved in the subcutaneous fat (fat layer just under the skin), resulting in a yellowish color appears and the whites of the eyes.Except for neonatal jaundice in the first week of life, all other types of the disease indicate a surplus of bilirubin, liver damage, or the inability to transport the bilirubin from the liver through the bile ducts into the intestines.
- Itching. It appears due to the accumulation of bile acids in the defeat of the biliary tract.
- Palmar erythema - reddish and blotchy palms.
- Sexual dysfunction. Men may experience breast swelling or shrinkage of the testicles.
- Bruising. Minor bruising and bruising.
- Physical examination . At this stage revealed the following abnormalities in patients with liver cirrhosis:
The liver is often enlarged and compacted in the early stages of the disease.(In the later stages of cirrhosis, the liver may be reduced in size and shrivel.)
bloating doctor checks for the presence of ascites, palpating and listening to the wave movements of liquid.
The doctor will also check for signs of jaundice, muscle wasting;men - breast enlargement.
Patient history is another indicator of the risk of liver cirrhosis.Basically it patients afflicted with alcoholism, hepatitis B or C and some other diseases.
- Blood tests. Blood tests are also conducted to measure the activity of liver enzymes associated with liver function.Enzymes known as transaminases, including aspartate (AST) and alanine (ALT), released when the liver is damaged.Blood tests can also reveal:
- The concentration of serum albumin.The content of serum albumin in the blood (low level indicates poor liver function).
- Prothrombin time.This is the time required for clotting of blood plasma of the patient (the longer, the greater the risk of bleeding).
- Alkaline phosphatase.High levels of ALP may indicate a blockage of the bile ducts.
- Bilirubin.One of the most striking evidence of liver damage is bilirubin, a yellow-red pigment that is usually metabolised by the liver and then excreted in the bile.Patients with hepatitis liver can not process bilirubin, and blood has been an increase in this material, sometimes causing jaundice.
- Imaging. Magnetic resonance imaging (MRI), computed tomography (CT), ultrasound can be useful in identifying and defining complications of the disease, such as ascites and hepatocellular carcinoma.These methods can also provide inspection information concerning the extent of liver damage.
- biopsy. Liver biopsy is the only productive method to confirm the diagnosis of liver cirrhosis.It also helps to identify its causes, treatment methods, the extent of damage and to make predictions.For example, biopsies of patients with chronic hepatitis C who have minor scarring of the liver, showed a low risk of cirrhosis.
biopsy procedure takes about 20 minutes.It is performed under local anesthesia, and the patient may feel pressure and some dull pain.Guided by ultrasound data, a physician with a fine needle takes a small sample of liver tissue for testing.A biopsy may be performed using a variety of approaches, including:
1.Chreskozhnaya liver biopsy.In this method, to obtain a sample of liver tissue needle is inserted through the skin into the liver.Various forms of the needle, which allows to absorb or cut the tissue.This method is contraindicated in patients with bleeding, and it should be used with caution in patients with ascites or obesity.
2. transvenous liver biopsy.This method uses a catheter (a thin tube), which is inserted into the jugular vein in the neck and is passed via the hepatic vein to the liver.The catheter together with the needle, with a suction device, collects liver function tests.This procedure is quite risky, but it can be used for patients with severe ascites.
- Laparoscopy. procedure is effective enough to detect liver cancer, ascites and other pathologies.During the laparoscopy is a small abdominal incision through which the doctor inserts a thin tube containing a small surgical instruments and a tiny camera to see the surface of the liver.
- Endoscopy. Some doctors recommend endoscopy in patients with the presence of early symptoms of cirrhosis of the liver to detect varikozno- esophageal varices and preventing bleeding risk.In carrying out this procedure, a fiber-optic tube is inserted into the throat.The tube contains a tiny camera that allows to explore the esophagus, to identify areas of possible development of varicose veins.
- paracentesis. This procedure is carried out to determine the causes of existing ascites.For its use of fine needle through which the fluid is taken from the abdomen and is tested for a variety of factors to determine the cause of ascites:
- Seeding of bacteria and white blood cells.(They are used to diagnose the infection.)
- protein level.Low level of protein in the liquid, and low white blood cell count gives grounds to assume that it was the cause of cirrhosis ascites.
- Tests for liver cancer. Some doctors recommend patients to carry out repeated surveys, cirrhosis affected every 6 months for the detection of hepatocellular carcinoma cancer.For this purpose, as the blood tests to check the levels of alpha-fetoprotein and imaging techniques (ultrasound, MRI or CT scan).
Treatment of cirrhosis
Cirrhosis of the liver - an incurable disease.Treatment is carried out in order to slow the progression of liver injury and reduce the risk for further complications.Currently, there are no drugs to treat scarring of the liver, but at the same time, scientists are studying different types of antifibrotic drugs.
Treatment of cirrhosis depends on the cause of the disease.