- liver Causes of liver cirrhosis
- Symptoms of liver cirrhosis
- complications of cirrhosis
- Laboratory and instrumental methods of diagnosis
- disease Treatment of liver cirrhosis
irrecoverablechanges in the structural organization of the liver as a result of chronic diseases, with a persistent breach of its functions, in the portal vein system, the pressure increases - called cirrhosis.
disease is widespread and is in sixth place as a cause of death in the age group from 35 to 60 years, with the number of cases, about 30 per 100 thousand people per year.Of particular concern is the fact that the incidence of the disease over the past 10 years has increased by 12%.Men suffer three times more often.The main peak incidence occurs in the period after forty years.
liver - the biggest iron in the body of the digestive and endocrine.
most important functions of the liver:
- neutralization and disposal of hazardous substances entering the body from the external e
nvironment and produced in the process of life.
- construction of proteins, fats and carbohydrates, used for the formation of new tissue and replacement exhaust their resources cells.
- bile formation, involved in the processing and digestion of food masses.
- Regulation of blood rheology by synthesis in her part of the coagulation factors.
- hold the balance of protein, carbohydrate and fat metabolism through the synthesis of albumin, the creation of additional reserves (glycogen).
structural unit of the liver is the slice (acinus), consisting of several cells (hepatocytes).They are united in a unique hexagonal cylinder.
The center passes hepatic acinus (central), venules, and in the corners of the alleged hexahedron between hepatocyte - portal tracts.
portal tracts consist:
- hepatic artery.She brings a fresh, oxygen-rich blood to the viability of the liver of the branches of the aorta.
- enterohepatic venule.It is a branch of the portal (portal) vein, formed by the merger of the upper and lower mesenteric vein carrying blood from the intestine.This blood is rich in lessons from food substances.Some of them, without prior treatment in the liver itself, can cause irreparable harm to the body.
- bile capillaries.They collect hepatocytes secreted enzymes necessary for digestion, thereby forming bile.Bile capillaries merging into larger bile ducts, formed by depositing a part of the secret in the gallbladder, subsequently, through the common bile duct, exit into the lumen of 12 duodenal ulcer, where the bile and mixed with food.
- nerve trunks.
- lymphatic vessels.
In accordance with the available data on the blood supply, common bile duct branching and innervation in the liver secrete eight segments.This has implications for operations on this organ.The segments form the left and right lobe of the liver.Conditional shares border passes through the gates of the liver to the place of confluence of the hepatic veins into the inferior vena.
It is with violation of the structure of hepatic lobules, begins an irreversible chain of structural changes in the liver, leading eventually to the death of a person.
processes occurring during the development of liver cirrhosis:
- Death for various reasons, a number of hepatocytes.
- Formation in their place, connective tissue, compressing and disrupts normal blood flow in the portal tracts, the central vein.Formed connective tissue also violates the formation and outflow of bile by the gall capillaries.As a result, part of the bile required for digestion, it is absorbed directly into the bloodstream, causing the intoxication symptoms and jaundice.
- Restructuring of the vascular system that fed the victim hepatic acinus, with the formation of new communications (anastomosis).
- proliferation of the bile ducts.
- Divide the remaining hepatocytes to form a node-regenerates.However, a functional incapacity of these nodes, does not allow the result would be the normal liver tissue.
- Part-regenerates nodes because of its unbridled growth, depleted blood supply and squeezing the sides formed by connective tissue - are killed.This results in stimulation of new scarring processes leading to the liver and reduce compaction and without operating a limited number of hepatocytes that time.
described processes are diffuse, continuously, throughout the liver, not limited to one segment or shares.The time period can stretch over months and even years.Gradually and disturbance of genomic apparatus hepatocytes.With minimal genetic changes are included in the process of autoimmune mechanisms that activate speed occurring inflammatory and sclerotic changes.In the largest genetic anomalies, begins to form malignant neoplasm of the liver, the so-called "cirrhosis, cancer."
With increasing volume of the affected liver tissue, happening and a qualitative shift in the abnormal liver functions.
Causes of liver cirrhosis
- Chronic alcohol intoxication.On average, cirrhosis formed in 10-15 years from the start of abuse.Moreover, this is necessary for the daily dose of pure alcohol consumption per 96% alcohol for women is three times lower than for men and is 20 grams per day.
- Viral hepatitis B, C and D.
- variety of autoimmune diseases with an initial development of hepatitis.
- Biliary Diseases (secondary biliary cirrhosis).
- Mechanical obstruction of intrahepatic and extrahepatic biliary tract due to the formation of gallstones.For the development of cirrhosis with, the presence of sufficiently passing disorders of bile from 3 to 18 months.
- Primary sclerosing cholangitis.A very rare disease, combining, as a rule, with the presence of ulcerative colitis.This results in infection of the bile ducts.The inflammatory process extends to the nearby liver tissue damage occurs it to the further development of cirrhosis.
- hepatotoxic chemical Intoxication (carbon tetrachloride, imetilnitrozamin, chloroform, benzene, nitro and amino compounds, mercury, lead and gold) and medicinal substances (and anti-cancer drugs, anabolic steroids and other means.).
- Plant poisons: mushroom (phalloidin, falloin, beta-amanitin) and cereals (aflatoxins) generated in overwintered cereals, corn, rice.These substances cause acute toxic liver dystrophy with massive tissue necrosis.Instead, she later formed and cirrhosis.
- genetically caused metabolic disorders (hepatolenticular degeneration, Wilson's disease, hepatolenticular degeneration, galactosemia, glycogen storage disease, cystic fibrosis, hemochromatosis, .alpha.1-antitrypsin deficiency).
- Reduced blood flow through the portal vein at flebotromboz, squeezing from the outside (chronic pancreatitis, pancreatic tumors).
- Long venous congestion of the liver in chronic cardiovascular diseases (constrictive pericarditis, venooklyuzionnaya disease, heart failure).
- Primary biliary cirrhosis is no apparent reason.It occurs mostly in women in menopause.
- Cryptogenic cirrhosis.The cause of it remained undetected.It characterized by extremely aggressive incessant flow.It is an absolute indication for liver transplantation.
- congenital absence of the bile ducts in infants.
- Rendu-Osler disease.Otherwise, the disease known as hereditary hemorrhagic telangiectasia.The disease is rare and is caused by congenital hypoplasia and dysfunction intrahepatic vascular system of the liver.
- fatty liver in the presence of disturbances in the metabolism (obesity, diabetes).
- Parasitic and infectious diseases of the liver (hydatid disease, brucellosis, opistorhoz, toxoplasmosis, ascariasis, and others.).
- cause of congenital liver cirrhosis in newborns and can be developed in the mother during pregnancy, viral infection (salivary gland disease, herpes infection, rubella).The ability of these viruses to penetrate the placenta and cause damage to the liver, here becomes the main mechanism of cirrhosis in the infant.The developed serum hepatitis by immunization of pregnant women, as this can cause disease in unborn child.It is noted as liver disease in newborns from mothers in the presence of diseases such as syphilis, toxoplasmosis, listeriosis.
- after bypass surgery on the gastrointestinal tract.
a separate note that more than half of cases of liver cirrhosis, are multifactor reasons for its occurrence.The most common combination is the immoderate desire for alcohol and the presence of chronic hepatitis.
Symptoms of liver cirrhosis
In cases where cirrhosis develops gradually, is a clear connection with any intoxication or the influence of aggressive factors, the disease may be of clinical symptoms hidden, appearing for the first time on the stage of complications.The intensity of the complaints, the manifestation of symptoms and their combinations depends on many components.But in general, in the initial stages of the disease, symptoms of the following groups can be distinguished, which are combined into syndromes.
- asthenic syndrome (loss of appetite, high fatigue, weakness, weight loss, episodes of transient slight rise in body temperature, difficulty in concentration, daytime sleepiness with sleep at night, irritability, tearfulness, resentment, and faultfinding, suspicion of others, hysterical reactions).
- dyspeptic syndrome (nausea, vomiting, residual bitterness in the mouth, belching, feeling of heaviness in the abdomen at the reception of fatty foods and alcohol from the onset of pain, flatulence).
symptoms gradually expanding.Joints increase in size, they become movement painful.High body temperature is adjusted prescription of antibiotics.Unpleasant sensations in the stomach already localized predominantly in the upper abdomen and right upper quadrant.
appears jaundice of the skin or eyes.Skin color can take a variety of shades from yellow-green to bronze-brown.The urine becomes saturated dark beer.At the same time, the feces becomes the color of white clay or chalk.
Along with jaundice appears itchy skin that takes sometimes intrusive nature.Sometimes intradermally, on the eyelids eyes you can see the small yellow spots - xanthelasma.Fingers are beginning to resemble the contours on the drumsticks.Nail bed congested.
Fuzzy abdominal pain intensified simultaneously with the increase in the size of his.The patient becomes difficult to breathe.It pants in a horizontal position, and the side surface of the stomach with the sink.On palpation of the abdomen is determined by the liquid is running, indicating the presence of ascites (effusion in the abdominal cavity noninflammatory genesis).
Just at palpation of the abdomen, enlargement of the liver is determined by the normal boundaries with heaving the lower edge of a costal arch.When large-cirrhosis, on the contrary, it may be noted a decrease in liver size.
coat is in the genital area and armpits thins.
sharply reduced libido.In men, weakened erections and increase in the size of breasts (gynecomastia).Do women have menstrual irregularities of various types.
patient reduces the overall muscle mass with a decrease in the tone and strength of the rest.Children with cirrhosis are lagging behind in the sexual and physical development.
begin to determine the so-called "hepatic signs»:
- Redness palmar surfaces of the hands.
- manifestation in the superficial parts of the skin upper third of the body, the contours of fine red capillaries.They are woven together and resemble small spiders.They are called "spider veins".Characteristically, when pressed on them, they disappear and reappear after the withdrawal of a finger.
- Language takes a bright scarlet, crimson and becomes smooth.It is also called in such cases, "lacquer".
The violation clotting, there are signs of hemorrhagic syndrome.In the initial stages it appears in a plurality of marks on the body without any specific reasons before during normal impacts, such as from the panty elastic or close bra.blood stops later than usual In light cuts.Then there are long nasal and hemorrhoid bleeding.When you vomit, you can see the blood in the vomit.
Due to the current difficulties arising from the blood through the liver, growing manifestations of portal hypertension syndrome, comprising:
- presence of free fluid in the abdomen (ascites).
- Expansion of submucosal veins of the rectum to the formation of hemorrhoids in his absence earlier.
- Increased lumen submucosal veins in the lower third of the esophagus to form a plexus.
- varicose saphenous veins of the lower extremities with the increase of swelling in the subcutaneous tissue.
- significant increase in the size of the spleen, which is manifested by pain in the left upper quadrant.Furthermore, previously palpable, and she sometimes starts palpable its contours can be seen in this region of the abdomen.
- appearance of varicose veins on the anterior surface of the abdomen, mostly in the umbilical region.Woven together, the appearance of dilated veins circuits may resemble the form of the head of the legendary Medusa.Sometimes you can hear the noise of venous, especially around the navel - a symptom Cruveilhier - Baumgarten.Mostly it is observed in cleft umbilical vein.
Jaundice accompanied by increase of signs of portal hypertension, suggests that liver cirrhosis in its development has passed the stage of decompensation, and all the resources of the remaining able-bodied individual hepatocytes - exhausted.
It is in this stage of disease and complications appear serving the immediate cause of death.
complications of cirrhosis
1. Spontaneous ascites-peritonitis.The most common explanation for his development of the theory is "propotevanie" intestinal flora, is located in the lumen of the intestine in the fall general immunity, so characteristic of cirrhosis.Thus, there is sterile before sowing time ascites and symptoms appear "acute abdomen", sharply increases intoxication.Sometimes the symptoms can be wiped off or even flattened.
2. Bleeding.Due to the general increase in pressure and bleeding in the portal system, there may be recurrent spontaneous internal bleeding in the liver gate.
More often found bleeding from varicose veins of the esophagus, taking the character of massive blood loss.Clinically, the patient feels a sharp weakness with faintness, there is a black chair, dёgtevidnogo color.For nausea, to vomit blood can be seen from scarlet to type "coffee grounds" in different variations and large quantities.In the absence of timely assistance provided, such cases end fatally.
Less arise from massive bleeding hemorrhoidal veins of the rectum.In such cases, the chair can be seen the liquid blood and the general form of the stool will look like raspberry jelly.
If you have chronic stomach ulcers and 12 duodenal ulcer, bleeding from them at an exacerbation can also lead to death.
unstoppable nosebleeds conventional methods, can also meet and become part of the common hemorrhagic syndrome.
3. hepatic encephalopathy.This extreme manifestations of hepatic encephalopathy, developing due to massive intoxication due to liver failure.