Liver cirrhosis is a diffuse pathological process with excessive fibrosis and the formation of structurally abnormal regenerative nodes. Clinical manifestations are diverse and are determined mainly by the activity of the pathological process, a decrease in liver function, and the development of portal hypertension.
Symptoms in cirrhosis develops slowly, while its functionality is disturbed. Dangerous disease is that it is difficult to identify in time, a person finds out about him when it is too late and it is almost impossible to save the patient.
In this regard, the most common causes of death for patients with common forms of cirrhosis of the liver are major liver failure, complications of portal hypertension, primary liver cancer, and the addition of a bacterial infection.
Why does cirrhosis develop, and what is it? Liver cirrhosis is a late stage of various inflammatory diseases of the liver (hepatitis) and some other organs (for example, heart failure).
As a result of damage and inflammation of the liver cells, some of them die. In place of the dead liver cells, connective tissue grows. Connective tissue surrounds preserved liver cells, but cannot perform their functions. The remaining liver cells begin to divide vigorously, forming islands of normal liver tissue, which are surrounded by connective tissue. The structure of the liver is disturbed, and its functions are not performed in full. As a result of the loss of liver function, liver failure develops.
All causes of cirrhosis have not been established. But it is proved that most often the death of liver cells occurs as a result of:
- prolonged exposure to such diseases and processes:
- alcohol addiction;
- viral hepatitis (especially B and C);
- autoimmune mechanisms;
- congenital metabolic disorders: Wilson-Konovalov disease, hemochromatosis, alpha-1-antitrypsin deficiency.
- exposure to toxic chemicals and hepatotoxic drugs;
- obstruction of the biliary tract;
- congestion in the liver of venous blood associated with heart disease or veno-occlusive liver disease.
If it is impossible to determine the cause of the disease, they say about cryptogenic cirrhosis. Thus, liver cirrhosis is a multifactorial chronic disease, and there are quite a lot of causal sources from which liver cirrhosis occurs.
The development of cirrhosis occurs gradually and depends on the course of the disease and treatment that caused it. This process can take from a year (in severe forms of viral hepatitis (acute inflammation of the liver caused by viruses B, C, D)) to several decades (in chronic hepatitis (chronic inflammation of the liver)).
Stages of development
There are 3 stages of cirrhosis:
- Compensation (initial). It is characterized by a slight severity of symptoms. Patients can only complain of flatulence, a feeling of heaviness in the right hypochondrium, astenisation, decreased performance. A functional study reveals a small enlargement of the liver, the edge of the liver is dense, pointed. A slight increase in the spleen reflects the initial stage of portal hypertension.
- Subcompensation. Based on the name, it can be understood that a more pronounced decrease in the functional capacity of the organ occurs, which is caused by the increase in the number of dead hepatocytes. At this stage, a person is able to notice that something happens to his body. He begins to suffer from weakness, apathy, decreased performance, nausea, weight loss and other early symptoms of the disease. In men already at this stage, the first signs of gynecomastia appear. As for laboratory parameters, not only bilirubin, but albumin, begins to fall, and the prothrombic index may reach 40. However, if treatment is started promptly, it is still possible to transfer this stage to the compensation stage. That is, with proper medication, the patient organ can function without complications for human health.
- Decompensation. It is characterized by signs of hepatocellular insufficiency and complications of portal hypertension. Hepatocellular failure is a consequence of a decrease in the mass of normally functioning cells and a decrease in the neutralizing function of the liver and is manifested by encephalopathy. Complicated portal hypertension bleeding primarily from varicose veins of the esophagus and stomach, which is the main cause of death. An increase in ascites and peripheral edema, requiring treatment with diuretics in large doses, is characteristic.
In women and men, the initial stage of cirrhosis is almost asymptomatic. In the case of cirrhosis of the liver, the first signs appear as a feeling of heaviness, discomfort in the right hypochondrium, as a rule, similar symptoms appear after eating or exercise. Perhaps the appearance of bitterness in the mouth, nausea. In patients with a decrease in efficiency, weakness, drowsiness.
At this stage of the disease there is a great chance to restore the functional activity of the liver and eliminate the course of the pathological process. After all, it is known that the liver has a great ability to regenerate, therefore, timely access to a doctor with these symptoms will contribute to high chances of a cure.
Symptoms of cirrhosis
Signs of cirrhosis of the liver are caused by damage to all organs and systems of the body. In the initial stages of the disease, a person may not be aware of the disease. Hidden stage or asymptomatic flow is very dangerous.
Symptoms appear already in the advanced phase, when the ability of cells to recover is completely absent. As a result, severe complications occur within a year after detection.
Examination of patients reveals the following characteristic symptoms of cirrhosis as the disease progresses:
- Yellow skin of the face, yellowness can be seen in the whites of the eyes, mucous membranes.
- The redness of the palms, there is also redness at the tips of the fingers, hands, it indicates that the bilirubin in the blood rises.
- Disturbed by severe itching, bile acids are in small vessels that are under the skin.
- There are spider veins, a large number of bruises, bruises, small hemorrhages.
- It seems to a person that the liver interferes with it, its enlargement and compaction is palpable, sometimes the patient is noticed in front of the liver, it protrudes.
- Raising the temperature to 38 degrees for no reason.
- People often suffer from infectious diseases.
- On the stomach visible pattern of vessels that are intertwined.
- In men, the chest may increase.
- The skin has a bright color, due to the fact that a large amount of estrogen, serotonin, has accumulated in the blood.
- Hemorrhoids, varicose veins.
- The tongue is bright pink and smooth.
- Urine is brown and feces are light.
- Bulging belly due to the accumulation of large amounts of water.
- The person loses weight, and the stomach remains.
- The skin is all pigmented, excessively dry.
All the above symptoms cause an extremely characteristic view of patients with cirrhosis of the liver:
- Emaciated face, unhealthy subicteric skin color, bright lips, prominent zygomatic bones, erythema of the zygomatic region, dilated capillaries of the skin of the face; muscular atrophy (limbs thin);
- Enlarged abdomen (due to ascites);
- Dilation of the veins of the abdominal and chest walls, edema of the lower extremities;
- The phenomenon of hemorrhagic diathesis due to liver damage with impaired production of blood clotting factors is found in many patients.
Hemorrhagic rashes of various kinds can be seen on the skin, often nosebleeds, as well as bleeding from other sites (this also contributes to the development of portal hypertension).
The diagnosis of liver cirrhosis is made after a comprehensive examination of the patient. The doctor collects the patient's history, conducts palpation examination for liver enlargement, examines the skin, mucous membranes and sclera.
Endoscopy, gastroscopy, MRI, ultrasound, computed tomography and angiography are performed to assess the condition of the internal organs. In some cases, a liver biopsy is performed. Assign blood tests: biochemical, for markers of viral hepatitis.
Liver cirrhosis at the last stage: photo
In the photo you can see what a person with diagnosed cirrhosis, which is complicated by ascites, looks like.Enlarged abdomen (due to ascites). Jaundice in severe liver failure
As liver cirrhosis progresses, the following effects are possible:
- hepatic coma;
- bleeding from esophageal varicose veins;
- thrombosis in the portal vein system;
- hepatorenal syndrome;
- the formation of liver cancer - hepatocellular carcinoma;
- infectious complications - pneumonia, "spontaneous" peritonitis in ascites, sepsis.
Treatment of cirrhosis
Most men and women, having heard such a terrible diagnosis, quite reasonably ask themselves: is it possible to completely cure liver cirrhosis? Unfortunately, modern medicine does not have such capabilities. The only effective way to get rid of the disease is to transplant a donor organ, that is, to transplant a liver. However, such an option, as a transplant is not for every patient and it costs a lot of money.
In general, the essence of the treatment of liver cirrhosis is to conduct therapeutic interventions:
- taking diuretic drugs;
- dieting: the rejection of fried and fatty foods, alcoholic beverages. In the case of ascites, reducing salt intake;
- with autoimmune disorders - glucocorticoid hormones;
- if viral hepatitis is present, antiviral therapy is used to slow the progression of the disease;
- drugs that protect liver cells (hepatoprotectors), such as, for example, silymarin, ademetionine;
- if the liver stops cleaning the blood of toxins on its own, plasmapheresis is performed;
- drugs that reduce pressure in the portal vein (for example, nitrosorbid, anaprilin).
However, you should not despair, because if the disease was detected in the early stages, then it is quite possible to stop its progression, thanks to adequate therapy. In the event that cirrhosis is detected in the later stages, doctors may be able to somewhat slow down the progression of the disease, and delay the time of onset of complications.
Diet for liver cirrhosis
Patients with liver cirrhosis must follow a diet without fail. First of all, it is recommended to abandon the use of alcoholic beverages, fatty, fried, seasoned dishes, smoked meats, all types of sausages and canned food. It is also recommended to exclude from the diet of mushrooms, garlic, tomatoes, tomato juice, chocolate. Patients with developed ascites (accumulation of fluid in the abdominal cavity) are recommended to exclude table salt from the diet.
Vegetable soups, porridges, low-fat boiled meat, low-fat dairy products (cottage cheese, sour cream), crackers, green apples, etc. are allowed to be consumed.
Sample menu for the day for a patient with liver cirrhosis:
- Breakfast: cereal porridge (semolina, buckwheat, millet, barley, oatmeal) with cream and sugar or baked fruit. 60 g of salt-free bread, or loaves (slices), or salt-free crackers with unsalted butter and marmalade (jelly or honey), 1 egg, tea or coffee with milk.
- Lunch: 60 g of beef or poultry meat or 90 g of white fish, potatoes, greens, fruit (fresh or baked)
- Lunch: 60 g of salt-free bread or bread, unsalted butter, jam or tomato, tea or coffee with milk.
- Dinner: soup without salt, beef, poultry meat or fish (as for lunch), potatoes, greens, fruit or jelly from fruit juice and gelatin, sour cream, tea or coffee with milk.
Option number 2:
- For breakfast: 1 boiled egg, 200 g of buckwheat porridge with baked apple, 100 g of salt-free loaves, 100 ml of oat broth with 1 tsp. Sahara.
- For lunch: 250 g of baked potatoes with greens and tomatoes, 100 g of boiled low-fat fish, fruit jelly 100 ml.
- At lunch: green tea with milk, salt-free crisps with jam.
- For dinner: 200 g of vegetable soup-puree with 1 tbsp. low-fat sour cream, 90 g chicken steamed, 100 g fruit jelly.
Food is carried out 5-6 times a day, in small portions.
How much live with cirrhosis of the liver?
According to world statistics, the life expectancy of patients with compensated liver cirrhosis is more than 10 years. With decompensated cirrhosis, 40% of patients die in the first three years after diagnosis. Patients with hepatic encephalopathy are able to live no more than 1 year.
The most effective method to increase the prognosis for liver cirrhosis is to modify the patient's lifestyle: giving up bad habits, normalizing eating behavior, eating large amounts of fruits and vegetables, maintaining healthy skin, undergoing regular medical examinations and following medical recommendations of the attending physician.