Cirrhosis of the liver – a disease characterized by a violation of the structure of the liver due to the proliferation of connective tissue; manifested by functional liver failure.
The main risk factors for cirrhosis are considered to be:
- chronic alcoholism
- viral hepatitis
- toxic effects of industrial poisons, drugs (methotrexate, isoniazid, etc.), mycotoxins , etc.
- venous congestion in the liver associated with prolonged and severe heart failure
- hereditary diseases – hemochromatosis , hepatocerebral dystrophy, deficiency of alpha- single- antitrypsin , galactosemia , glycogenosis, etc.
- prolonged damage to the biliary tract
In about 50% of patients with cirrhosis of the liver, the disease develops due to the action of several causal factors (more often the hepatitis B virus and alcohol).
Complaints of weakness, fatigue, decreased performance and appetite, dyspeptic disorders (nausea, vomiting, bitter taste in the mouth, belching, intolerance to fatty foods, alcohol).
Characterized by a feeling of heaviness or pain in the abdomen, mainly in the right hypochondrium and the epigastric region. Among the signs of cirrhosis of the liver, so-called “liver signs” in the form of reddening of the palms, vascular “asterisks” (mainly on the skin of the upper half of the body) are important. Often there are hemorrhages in the skin, as well as increased bleeding of the mucous membranes.
Marked itching, pain in the joints, reduce hair in the armpits and pubis, reduce sexual desire. Body temperature rises moderately or remains within the normal range.
Often there is asthenic syndrome, manifested by weakness, increased fatigue, irritability, tearfulness, instability of mood. Patients are impressionable, often touchy, picky, suspicious, prone to hysterical reactions. Characterized by sleep disturbance – insomnia at night, sleepiness during the day.
For cirrhosis of the liver are caused by colds, a violation of the regime, the use of alcohol.
The diagnosis of cirrhosis in the early stages presents significant difficulties, since the disease develops gradually and at first has no pronounced manifestations.
Ultrasound, X-ray and radionuclide methods of investigation are essential in recognizing cirrhosis . Quite accurate information about the state of the liver in cirrhosis can be obtained using computed tomography .
Radionuclide study of the liver – scintigraphy is inferior in its information content to ultrasound and computed tomography, but unlike them, it also makes it possible to evaluate the function of the organ.
Crucial in the diagnosis of cirrhosis is the study of liver tissue obtained by puncture biopsy – blind or targeted, carried out under the control of ultrasound or during laparoscopy.
Limit mental and physical stress. With an overall good condition, therapeutic walking and therapeutic exercises are recommended. Women with active liver cirrhosis should avoid pregnancy.
Compensated inactive liver cirrhosis, as a rule, does not require medical treatment. In addition, you should generally limit the intake of medicines, especially soothing.
With sub – and decompensated forms, the choice of drug therapy is determined by the nature of the main manifestations of the disease. In the case of a low protein content in the blood, anabolic steroids are prescribed, transfusions of albumin and plasma. The presence of anemia is an indication for prescribing iron supplements. When edema and ascites limit fluid intake, exclude from the diet table salt, prescribe diuretics (hypothiazide, furosemide) in combination with aldosterone antagonists ( spironolactone ). Paracentesis is produced for health reasons, simultaneously releasing no more than 3 liters of liquid.
The so-called hepatoprotectors are also used – vitamins of group B, orotic acid, extracts and hydrolysates of the liver, silibinin (legal), Essentiale , etc.
In the case of process activity, the same agents are used as with chronic active hepatitis, the main ones being hormones (prednisone) and immunosuppressants ( azathioprine , etc.). Their effectiveness is inversely related to the depth of the structural reorganization of the liver tissue and in far advanced stages of cirrhosis of the liver is close to zero.
To prevent infections in all patients with cirrhosis of the liver during any interventions (tooth extraction, rectoromanoscopy , paracentesis , etc.) prophylactically prescribed antibiotics. Antibacterial therapy is also indicated even in light infectious processes.
General advice for patients with cirrhosis of the liver:
- Rest as soon as you feel tired.
- Do not lift weights (this can cause gastrointestinal bleeding)
- Achieve stool frequency 1-2 times a day. Patients with cirrhosis of the liver to normalize the work of the intestine and the composition of the intestinal flora in favor of “beneficial” bacteria are encouraged to take lactulose ( duphalac ). Duphalac is prescribed in the dose that causes soft, half-shaped chair 1-2 times a day. The dose ranges from 1-3 teaspoons to 1-3 tablespoons per day, is selected individually. The drug has no contraindications, it can be taken even for small children and pregnant women.
- To improve the digestion of patients
prescribed multienzyme preparations.
With fluid retention (edema, ascites), it is necessary to limit the intake of salt to 0.5 g per day, fluids – up to 1000-1500 ml per day.
- Daily measure body weight, the volume of the abdomen at the navel (an increase in the volume of the abdomen and body weight indicates fluid retention);
- Daily read the fluid balance per day (diuresis): count the volume of all ingested fluid (tea, coffee, water, soup, fruit, etc.) and count all the fluid released during urination. The amount of released fluid should be about 200-300 ml more than the amount of fluid taken.
- To control the degree of damage to the nervous system, it is recommended to use a simple handwriting test: write 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.
Excluded from nutrition:
- mineral waters containing sodium;
- salt, food must be prepared without adding salt (salt-free bread, crackers, cookies and bread are used, as well as salt-free oil);
- products containing baking powder and baking soda (cakes, biscuit cookies, cakes, pastries and plain bread);
- pickles, olives, ham, bacon, corned beef, tongues, oysters, mussels, herring, fish and canned meat, fish and meat pate, sausage, mayonnaise, various canned sauces and all kinds of cheeses, ice cream.
It is recommended to use seasonings in cooking: lemon juice, orange zest, onion, garlic, salt-free ketchup and mayonnaise, pepper, mustard, sage, cumin, parsley, marjoram, bay leaf, cloves.
100 g of beef or poultry, rabbit or fish and one egg per day are allowed (one egg can replace 50 g of meat). Milk is limited to 1 cup per day. You can eat low-fat sour cream. You can eat boiled rice (without salt). Allowed any vegetables and fruits in fresh form or in the form of dishes prepared at home.
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.
Life expectancy in liver cirrhosis depends on the degree of compensation process. Approximately half of patients with compensated cirrhosis (at the time of diagnosis) live more than 7 years.
With decompensated cirrhosis, after 3 years, 11–41% remain alive. With the development of ascites, only a quarter of patients experience 3 years. Even more unfavorable prognosis has cirrhosis, accompanied by damage to the nervous system, in which patients in most cases die within a year.
The main causes of death are hepatic coma and bleeding from the upper gastrointestinal tract. Patients with cirrhosis of the liver are partially able-bodied (group III disability), and with decompensated cirrhosis, the active forms of the disease and when joining complications are disabled (disability groups II and I).
Prevention consists in the prevention and timely treatment of diseases leading to cirrhosis of the liver (primarily alcoholism and viral hepatitis ).