Cirrhosis of the liver is a serious progressive disease. In a he althy state, this organ has a red-brown color. During illness, it acquires a yellowish tint. With cirrhosis, the liver is rebuilt. As a result, he althy cells become damaged and are replaced by scar tissue. As a result, the work of this organ is disrupted, liver failure and portal hypertension develop.
Types of liver cirrhosis
Classification of cirrhosis occurs according to etiology (causes of the disease) and morphology (external signs). Depending on the size of the nodes, it happens:
- small-knot (diameter up to 3 mm);
- SKD (over 3 mm);
- mixed (with knots of different diameters).
Depending on the etiology and morphology, cirrhosis is divided into:
- alcoholic;
- biliary (with stagnation of bile in the liver);
- compensated;
- postnecrotic;
- decompensated;
- portal;
- pigmented.
Common signs of liver cirrhosis
The symptoms of cirrhosis depend on the stage of the disease. At the elementary level (class A), there are no complications yet. This is the ideal time to eliminate the cause of the disease. During this period, you can save the liver and continue to lead a normal life, since this organ has great regeneration capabilities.
Complications begin with progressive cirrhosis (grades B and C). The abdomen increases in volume, there are changes in behavior and consciousness. The gums and nose begin to bleed. Symptoms of cirrhosis in women are breast enlargement (gynecomastia) and cessation of menstruation.
There is increased fatigue, weight loss, absent-mindedness, daytime sleepiness, insomnia. Appetite disappears. There is a feeling of bloating in the abdomen. Jaundice develops. Feces and urine change their normal color. Legs swell and abdominal pain begins.
Fluid accumulates in the abdominal cavity. Bacterial infections appear. Suffer from frequent headaches. Symptoms of cirrhosis in men: sexual desire partially or completely disappears and the mammary glands increase. Armpit and pubic hair begin to fall out.
With cirrhosis, the liver increases or, conversely, decreases. In any case, it becomes more dense. The size of the spleen increases. There are signs of jaundice and portal hypertension. Often there is a dull and aching pain in the region of the liver. It gets stronger after physical work or when the diet is broken.
Itchy skin, nausea and vomiting appear. Violated stool (constipation or diarrhea). External signs are vascular "asterisks", reddening of the palms. Tongue turns crimson.
Cirrhosis treatment
Cirrhosis cannot be completely cured, but it can be slowed down in the early stages of the disease. With a progressive and advanced case, the efforts of doctors are aimed at relieving unpleasant symptoms and complications.
Therapeutic measures are the basis of the treatment of cirrhosis:
- diet;
- diuretics;
- antiviral therapy;
- glucocorticoid hormones;
- drugs that reduce pressure in the portal zone ("Nitrosorbid", "Inderal");
- hepatoprotectors protecting liver cells ("Ademetionin", "Silymarin");
- plasmapheresis;
- hospitalization is needed for exacerbations of cirrhosis.
In surgical treatment, punctures are performed in the abdominal region to remove accumulated fluid. Bypass operations are done (creation of new pathways for blood flow). Or a liver transplant.
Treatment of liver cirrhosis with leeches
Treatment of cirrhosis with leeches is recommended, but only used under medical supervision. Since it is necessary to constantly monitor the patient's blood condition and symptoms of cirrhosis. The sooner such treatment is started, the more effective the result will be.
One procedure requires 4 to 8 leeches. Basically, they are divided into several prefixes. howas soon as the leeches begin free sucking, they are removed. Such procedures are carried out twice a week. Then one session every 7 days. A total of 12 procedures are scheduled.
Repeated course is carried out with an interval of 2-3 months. The general course of treatment is quite long. Therefore, the patient's diet should include foods high in iron (except meat).
Portal cirrhosis
Portal cirrhosis is the most common form of the disease. Causes can be hepatitis, poor circulation, alcohol, and poor digestion. Almost the entire liver is affected. Most often, this disease affects men after 40 years.
The first symptoms of cirrhosis are weakness, nausea. Unpleasant sensations arise in the region of the stomach. Constipation or diarrhea may occur. If cirrhosis is due to alcoholism, sexual desire decreases. Some have yellow mucous membranes and skin.
The most characteristic symptom is the appearance of spider veins in the upper part of the body and on the abdomen, red coloration of the fingers and palms. At the same time, fluid begins to accumulate in the abdominal cavity. Gastritis often develops.
Symptoms of liver cirrhosis at the initial stage are heaviness and pain in the right hypochondrium, loss of appetite, constant nausea. There are insomnia, increased fatigue and impaired stool. Gradually, the liver thickens, increases in size. Legs swell, cracks and white coating may appear on the tongue.
There are three stages of cirrhosis of the liver. Symptoms at the first are its increase. On the second it, on the contrary, decreases. And onthe third becomes very small and dense to the touch.
Treatment of portal cirrhosis
In the treatment of portal cirrhosis, the patient needs bed rest. Any physical activity should be excluded. Treatment of cirrhosis of the liver is aimed primarily at eliminating the causes of the disease. And also to prevent complications that may appear.
In the treatment of portal cirrhosis, it is necessary to completely abandon alcohol. This is one of the main reasons for the development of the disease. Need a liver cleanse.
If portal cirrhosis is caused by hepatitis, treatment should be aimed primarily at combating it. Be sure to exclude drugs that give complications to the liver.
A strict diet is required. Spicy, fatty and fried foods are excluded from the diet. Seasonings should be kept to a minimum. It is forbidden to use canned food, smoked products and sausages. From the diet it is necessary to exclude chocolate, garlic, tomatoes and their juice, mushrooms. S alt intake is desirable to minimize.
Recommended for use are various vegetable soups without frying. Any cereals, legumes and cereals. Low-fat dairy products, boiled poultry, turkey and rabbit meat. You need to eat apples and crackers.
Meals should be 5-6 times a day. But in small portions. At the same time, during the diet, you need to drink decoctions of herbs, liver fees. In the treatment of drugs, hepatoprotectors of plant origin are prescribed. They areprotect liver tissue and restore its functions.
In addition, diuretics are prescribed, which remove swelling and remove excess accumulated fluid from the body. As well as drugs that relieve the symptoms of cirrhosis.
If that doesn't work, surgery is done. And a liver transplant is performed. Stem cell treatments are now being developed to treat portal cirrhosis.
Post-necrotic cirrhosis
Postnecrotic cirrhosis is also a fairly common form of the disease. Most often appears after viral hepatitis and alcohol abuse. Less often - after poisoning with poisons, taking certain drugs, acute infectious diseases. With postnecrotic cirrhosis, liver tissue begins to die. Internal scars appear that disrupt the function and shape of the organ.
Symptoms of liver cirrhosis at the initial stage appear sharply. Suddenly, the stomach begins to hurt, diarrhea and vomiting appear. Mucous membranes and skin turn yellow. The liver increases in size. When touched, there is pain. There is nausea, loss of appetite and weight.
When exacerbated, skin itching begins, the temperature rises greatly. The stool becomes pale and the urine dark. Appears ascites, anemia, heart failure. Employability is drastically reduced. This is a very dangerous form of cirrhosis, as it causes liver cancer. Death can occur at any stage of the disease.
Treatment of postnecrotic cirrhosis
Treatment of postnecrotic cirrhosis is aimed at complications arising from portalhypertension. Primarily ascites. The protein content in the diet is reduced. Avoid drugs that provoke hepatic coma. If necessary, antimicrobial therapy is carried out.
If no complications are observed, then periodic examinations and observations of the patient are sufficient. If cirrhosis develops from a disease, then it is that disease that is treated (if it can be treated).
Alcoholic cirrhosis
Another very common form of the disease is alcoholic cirrhosis. Its symptoms can be pronounced, and sometimes they are not at all for a long time. They appear depending on the degree of liver damage. There are three stages:
- Compensation. There are almost no signs of cirrhosis, except for an enlarged liver. Sometimes mild nausea may occur. There is a general weakness in the body and fatigue.
- Subcompensation. Appetite worsens, body weight drops sharply, nausea and vomiting appear.
- Decompensation. Complete exhaustion of the body, liver failure and jaundice begin. All the complications of cirrhosis and portal hypertension appear. Fluid builds up in the abdomen (ascites). It is difficult to treat. There is increased bleeding. There may be bouts of disorder of consciousness. Often there is an additional bacterial infection. All patients develop hepatomegaly, and a quarter develop splenomegaly.
When alcoholic cirrhosis of the liver progresses, the signs and symptoms are clearly manifested externally. Nasal vasodilation is observed. The parotid glands are prominentincrease in size. Facial features become puffy.
Ethanol exposure causes internal organ damage. Neuritis, pancreatitis, mastopathy, encephalopathy and other diseases may appear. Muscle atrophy is observed, in particular in the shoulder girdle.
Treatment of alcoholic cirrhosis
Symptoms of liver cirrhosis are more common in men than in women. Since alcohol is consumed more by the “strong half”. With alcoholic cirrhosis, first of all, conversations are held, during which the patient is set up to get rid of harmful addiction.
Then a special diet is prescribed. Destroyed liver cells that have already been replaced by fibrous tissue cannot be restored. Therefore, treatment is aimed at those who are still functioning to some extent. Antiviral treatment is applied as needed.
If withdrawal is present, sedatives are used and fluid and electrolyte balance is restored. When alcoholic cirrhosis is complicated by hepatic encephalopathy, glucocorticosteroids are prescribed for a course of 30 days. And ursodeoxycholic acid, which prevents cell death and has an anti-inflammatory effect.
Bile acids and vitamin E are used as antioxidants. They are needed to utilize ethanol, which accumulates in excess in the liver in alcoholic cirrhosis.
Biliary cirrhosis
Biliary cirrhosis of the liver is less common than the above forms. This is a disease in whichits functions and structure are violated. A consequence of the cessation of the bile outflow, and a change in the structure of its ducts.
In a disease of such a form as biliary cirrhosis, the symptoms and causes of occurrence have not yet been fully studied. It is believed that it may begin due to a genetic predisposition. And also in violation of immunity or infection. Biliary cirrhosis is divided into primary and secondary.
Primary Biliary Cirrhosis
In a form such as primary biliary cirrhosis, symptoms and signs increase gradually. A person often does not even suspect about the disease for a long time. And his condition does not even worsen for a long time. There are two stages.
Itchy skin starts early. Moreover, this symptom appears long before jaundice. This symptom precedes her from six months to 1.5 years. But sometimes itching and jaundice occur at the same time. Fatigue, severe weakness, depression, drowsiness appear.
In the late stage of a disease such as primary cirrhosis, the symptoms are obvious. There is ascites. And this is the first sign of liver failure. Vascular "asterisks", encephalopathy appear. Some have xanthomas and xanthelasmas (plaques around the eyes). A quarter of patients show skin hyperpigmentation.
Treatment of primary biliary cirrhosis
Treatment of biliary cirrhosis is based on reducing the intensity of symptoms and slowing the progression of the disease. Complications are being treated and their occurrence is being prevented.
First of allthe patient must give up all bad habits and taking drugs that destroy the liver. A strict diet is required and physical activity is prohibited. During the treatment of cirrhosis, all concomitant infectious chronic diseases are simultaneously treated.
If instrumental intervention is performed (dental procedures, etc.), then antibiotics are prescribed to prevent infection. Primary biliary cirrhosis, the symptoms of which signal a transition to the decompensation stage, requires bed rest and inpatient treatment. Physiotherapy, stress testing and balneological procedures are contraindicated.
During the compensation period, rational nutrition and diet No. 5 are necessary. If encephalopathy occurs, protein levels should be reduced. If ascites appears, eliminate s alt from the diet. Physical activity and work at low temperatures are excluded. Walking and some physical exercise are recommended.
Some drugs are excluded: some types of antibiotics, aminoglycosides and nonsteroidal anti-inflammatory drugs. Apply:
- immunosuppressors;
- glucocorticoids (in minimal doses);
- ursodeoxycholic acid;
- D-penicillamine;
- antihistamines.
If the patient has entered the last stage, which reaches cirrhosis of the liver, the signs and symptoms clearly indicate the need for surgical intervention. For example, a sharp increase in hepaticinsufficiency. In this case, only a liver transplant can save the patient. Most people after such an operation can live almost 10 years. After transplantation, only 15% of patients relapse.
Secondary biliary cirrhosis
Secondary biliary cirrhosis develops with partial or complete obstruction of the pathways that remove bile. Women get sick twice as often as men. Usually the secondary form occurs after gallbladder surgery, long-term chronic pancreatitis, or a tumor.
In a disease such as secondary biliary cirrhosis, the symptoms are primarily related to the cause of the obstruction. And then the same ones appear as in the primary form.
Treatment of secondary biliary cirrhosis
In the treatment of secondary biliary cirrhosis, the cause of the disease is initially eliminated. With the help of surgical manipulations (bougienage, extraction of stones, expansion of ducts, etc.). After the end of the operation, it becomes possible to prolong the life of the patient.
If surgery is not possible, then therapy is similar to that used for primary biliary cirrhosis. Treatment in this case depends on the degree of obstruction, its causes and the possibility of their elimination.
Compensated liver cirrhosis
With compensated cirrhosis, a person may not know about the disease, since there are no special symptoms. The liver is working normally. The patient is not worried about anything. And the diagnosis can be made only on a routine examination. Or suddenly - during the operation.
The only symptoms of cirrhosis that can occur with compensated cirrhosis are fever, reddened palms, and nosebleeds. But with this form of the disease, people can live for decades. Moreover, without any complications.
Treatment of compensated liver cirrhosis
Treatment for compensated cirrhosis depends on the stage of the disease. If it is in a "sleeping" state and does not progress, then only vitamin-mineral complexes and a strict diet No. 5 are prescribed. It is necessary to completely abandon cigarettes and alcohol. Do not take hepatotoxic drugs.
If compensated cirrhosis progresses, then diet No. 5a is prescribed until the exacerbation subsides. Vitamins B, folic acid and cocarboxylase are needed. Milk thistle helps to remove toxins from the body. In addition, it has anti-inflammatory, hepatoprotective effects and relieves muscle spasms.
Decompensated cirrhosis: symptoms and treatment
With decompensated cirrhosis, the liver is in worse condition than with compensated cirrhosis. Fibrosis begins. All signs of cirrhosis are present. The most noticeable are deterioration in general condition, jaundice and ascites.
In the treatment of decompensated cirrhosis, the emphasis is on the elimination of local manifestations (ascites, etc.) and existing pathologies. In the acute course of the disease, devices that support liver function are used. But for this, the patient must be transported to special medicalcenters where devices are installed.
In decompensated cirrhosis with the presence of active hepatitis B, Lamivudine therapy is used. It significantly improves the patient's condition and has a positive effect on the liver. At the first manifestations of decompensation, the best option would be liver transplantation.
Pigmentary cirrhosis of the liver: symptoms and treatment
Pigmentary cirrhosis of the liver is manifested outwardly by spots on the skin and the presence of sugar in the urine. Another name for the disease is bronze diabetes. Most often, it is inherited in the form of an inferior number of enzymes. As a result, lipofuscin and hemosiderin are deposited in many organs (including the liver).
Then, inflammatory processes and sclerotic changes in small capillaries begin. This leads to deformation of the organs. The liver enlarges and becomes more dense. But her work is not interrupted. Periodically there are symptoms of diabetes: thirst, increased appetite. Sugar appears in the urine and its level in the blood increases.
Prognosis for pigmentary cirrhosis is unfavorable. Death occurs from liver failure, diabetic coma, or bleeding. In the treatment prescribed bloodletting, injection courses. Diabetes and complications are treated with symptomatic therapy.
