Liver cirrhosis

Liver cirrhosis

Summary

Liver cirrhosis is a kind of common chronic hepatopathy, are acted on long-termly and repeatedly by one or more causes of disease, cause the liver filling the air damage. It is early on clinic because the liver function compensates stronger, there can not be obvious symptoms; How give much trouble systematically later stage, damage with the intersection of door and the intersection of pulse and high pressure for behave mainly with liver function, appear the intersection of digestive tract and bleed, liver nature encephalopathy, continue, take place serious complications such as infecting, canceration,etc. often.


Cause of disease

Cause cause of disease of liver cirrhosis numerous, pathology its change and clinical manifestation there are differences. The same cause of disease can develop into liver cirrhosis of different pathologic types; And liver cirrhosis of the same pathologic type can be developed by many kinds of causes of disease, so not combined its unity classification on theory and clinical practice of pathologic shape according to the cause of disease yet so far.

1,Virus hepatitis is mainly B-mode and C-mode virus hepatitis, first type virus hepatitis seldom develops into liver cirrhosis.

2,Snail fever.

3,Chronic alcoholism.

4,Medicine and the chemical poisonous substance, such as taking isonicotinyl hydrazine, first Quito bar etc. for a long time, or contacting some chemical poisonous substance such as tetrachloromethane, phosphorus, arsenic, chloroform,etc. repeatedly for a long time can be caused.

5,Malnutritive.

6,Circulate the obstacle.

7,The bile is deposited.

8,Intestinal infection and inflammation.

9,Supersession disease.


Symptom

Liver cirrhosis get up disease and course of disease develop generally relatively slow, can lie concealed 3- 5 year or ten several long year, its clinical manifestation can be divided into liver function compensating and losing, compensating one, but or the phenomenon of overlapping that two boundaries are not obvious.

First, liver function compensate one

Symptom is relatively light, often lack the specificity, take tired and weak, appetite failing and indigestion as the core. It is uncomfortable that can be disgusting, detest oil, belly bloated air, upper abdomen, secret anguish and diarrhoea.

Second, liver function are lost, compensated a symptom prominently.

1,The clinical manifestation that liver function fails:

The symptom general situation and nutritional status of whole body are relatively bad, it is weak to become thin, depression, serious disease person is weak and bedridden. The skin dries up coarsely, complexion is gloomy and dark. Often have anaemia, glossitis, angular stomatitis, nyctalopia, multiple neuritis and edema,etc..

Digestive tract symptom.

Bleed and is inclined to and anaemia.

Endocrine regulation.

2,Clinical manifestation that pulse solicits under high pressure on the door

Setting-up and opening, ascites, there are important meanings on clinic of three clinical manifestation and first splenomegaly, collateral circulation forming pulse of door and soliciting under high pressure. Especially with have characteristic nature value diagnosing while being open setting-up of collateral circulation.


Check

1,Blood routine: How normally to compensate one, losing and compensating one has more anaemia of different degrees, leucocyte and blood platelet are counted and reduced when the spleen is overbearing.

2,Urine routine.

3,Liver function experiment

Check the diagnosis of liver cirrhosis and treat, all have important meanings in liver function.

(1)Serum GPT (ALT) : ALT is the most abundant in the liver in the tissue, the hepatocyte that any reason causes can make serum inner ALT rise to damage, measure the hepatocyte most sensitive index. ALT rises and mainly sees acute one and activity one at various hepatitis, ALT can rise at the time of hepatitis activity damaged in liver cirrhosis progress or with the hepatocyte. But must get rid of diseases such as various gallbladder departments, pancreas, myocarditis, big leaf pneumonia,etc..

(2)Transaminase of millet straw (AST) : Contain transaminase of millet straw in the hepatocyte too, when the hepatocyte is damaged, AST can rise, but not so sensitive as ALT, as hepatocyte serious necrosis, AST vigor higher than ALT. Without heart illness (such as myocardium infarction) , AST and ALT rise at the same time, announces the hepatocyte is damaged.

(3)Serum bilirubin is determined: Serum bilirubin does not reflect whether there is cirrhosis, but can brief on the properties of jaundice. Liver, at the cellulous jaundice, direct bilirubin and indirect bilirubin increases in the blood, rely mainly on the fact that indirect bilirubin increases.

(4)Albumin of blood is determined: The albumen supersession is the important behaviour that the liver compensates ability, it is the reflection after chronic disease of the liver is damaged. At the time of liver cirrhosis formate to reduce albumin often,whose name is white in in blood /reduce even invert globulin ratio, the lower the ratio is, prove it is the worse that the liver compensates ability.

(5)The electric swimming of albumen: The electric swimming of albumen increases, briefs on chronic hepatopathy - globulin proportion. After hepatitis when liver cirrhosis is lost, compensated, it is the most prominent that - globulin increases.

(6)The time determination of thrombinogen: When liver essence cells are damaged, synthetic many kinds of blood coagulation factors of liver can be reduced. When liver function is severed, thrombinogen time determine one comparatively sensitive index, the time of thrombinogen lengthens in the later period of liver cirrhosis.

(7)Alkaline phosphatase (AKP) : There is no specificity in liver cirrhosis, when present more tumours in obstructive jaundice, primary bile liver cirrhosis and liver.

(8) - ext. peptide enzyme: Rise more obviously in silt gallbladder type hepatitis, chronic active hepatitis, going on liver cirrhosis and primary hepatocarcinoma.

(9)Immunoglobulin (Ig) is determined: Increase to see more with IgG and IgA, increase as the main fact with IgG more in liver cirrhosis after hepatitis. IgM increases at the time of primary bile liver cirrhosis, IgA increases commonly when alcohol hepatitis is hardened.

4,Immunology is checked.

5,The ascites is checked.

6,The supersonic wave of the Model B is checked.

7,The liver punctures the biopsy: If necessary can make, wear the intersection of liver and biopsy to difficult case by leather liver, can fix, diagnose.


Diagnosis

Liver cirrhosis patient's definite diagnosis with typical symptom is easy, but some patients can not have typical clinical symptoms, in invisible compensation period, have certain difficulties to make a definite diagnosis of at this moment. So, diagnose liver cirrhosis is a comprehensive diagnosis.

(1)There are medical history such as virus hepatitis, addicted to drinking, for a long time malnutritive, snail fever or chemical medicinal toxicity for a long time.

(2)Symptom: It is early (compensate one) Have losing the appetite, the ascites, nausea, diarrhoea, liver spleen are swelling slightly, blood vessel moles, later period (lose and compensate one) Prone to ascites, bleeding, dwindle etc. at jaundice, liver palm, splenomegaly, liver volume.

(3)Liver function is checked: It is normal or unusual to compensate a liver work slightly, it is obviously unusual to lose and compensate a liver work, the plasma albumin is reduced, globulin is raised, its proportion is inverted, electric swimming globulin of albumen obviously increases.

(4)The blood is like the inspection: Spleen function the hyperfunction one leucocyte and blood platelet are reduced, the whole blood cell reduces when being serious.

(5)Oesophageal barium or inner mirror check, have esophagus or variceal fundus of stomach completely.

(6)Ultrasonography B inspection: All kinds of change of liver, surface and shape, the echo changes, portal vein, spleen vein are increased thickly, there is ascites, it is obvious the liquid dark district, the spleen volume increases.

(7)Liver histology is checked: Fiber separates and forms and small and nodular or the person who mixes nodular hyperplasia can be made a definite diagnosis of.


Complication

(1)Liver encephalopathy. It is the most common death reason.

(2)A large amount of bleeding of upper digestive tract. Break and bleed to see more with a vein of song of oesophageal fundus of stomach, other bleeding reasons such as acute bleeding vesicant gastritis, cardia mucous membrane tear syndrome etc..

(3)Infection. Liver cirrhosis is apt to erupt various infection such as bronchitis simultaneously, pneumonia, tuberculosis peritonitis, biliary tract infect, the intersection of intestine and infect with, spontaneous peritonitis and the intersection of leather and getting blue negative the intersection of bacillus and septicaemia,etc..

(4)Primary hepatocarcinoma. The relation between liver cirrhosis and hepatocarcinoma attracts people's attention, infer its mechanism may be that the B-mode hepatitis virus causes the hepatocyte to damage then hyperplasia or not typical hyperplasia takes place, thus to the carcinogen (such as the aflatoxin) Sensitive, cause the canceration under the circumstances that low dose is stimulated.

(5)Liver kidney syndrome: And liver hard compound and getting obstinate ascites have not obtained appropriately and can present liver kidney syndrome while treating. Its characteristic is few urine or does not have urine, nitrogen blood disease, low blood sodium or low urine sodium, kidney do not have organic disease, so also claim the functional renal function is depleted. Prognosis of this complication is extremely bad.

(6)The phlebothrombosis of door: Thrombosis with portal vein inner blood flow of portal vein, slowly, the portal vein is hardened obstruct, factors such as inner membrane inflammation of the portal vein,etc. have something to do. If thrombus take shape slowly, limited to portal vein outside the liver, and organic to take, or the collateral circulation is abundant, there can not be obvious clinical symptoms, for instance emerged to totally obstruct suddenly, could present violent abdominal pain, abdominal distension, having blood in one's stool, spittinging blood, shock,etc..


Treat the principle

At present, the treatment of liver cirrhosis takes complex treatment as the core. Liver cirrhosis relies mainly on maintaining in early days, prevent the condition from further aggravating; Lose, compensate issue besides protect liver, resume liver function, should prevent and cure complication actively. Generally speaking, treat the principle as follows:

(1)Rational diet and nutrition: Liver cirrhosis patient's rational diet and nutrition, help to resume the hepatocyte function, stabilize the condition. High-quality high protein diet, can lighten internal protein to decompose, promote the formation of liver protein, keep the protein metabolism balanced. When liver function fails or has encephalopathy omen of liver nature notably, should limit protein foods strictly. Enough carbohydrate supply, not only protect liver but also strengthen organism resistance, reduce protein to decompose. Liver function fails, fat supersession obstacle, require the low fat diet, otherwise apt to form fatty liver. High vitamin and microelement abundant diet, can meet organism's needs.

(2)Improve liver function: Transaminase and bilirubin in the liver work are unusual to announce more the hepatocyte is damaged, should offer midwest medicine to combine treating according to the therapeutic principle of hepatitis. Reasonable the intersection of application and.

(3)Resist the liver fiber to treat: Study at home in recent years, employ drug therapy liver fibers such as Radix Astragali, root of red-rooted salvia, urge the hepatocyte to grow plainly,etc. and early cirrhosis, make better result. Penicillamine curative effect sure, bad reaction much to advocate application more, colchicum alkali resist the intersection of liver and fiber, take, have certain result too.

(4)Prevent and cure complication actively: Liver cirrhosis is lost, compensated more a complicated diseases, can cause the serious consequence. As to complications such as the oesophageal fundus of stomach is variceal, ascites, liver encephalopathy, erupt simultaneously and is infected with,etc., according to the patient's detailed conditions, choose the effectual method.


Treat

First, generally treat:

1,Rest the person who compensates liver function, should be appropriate and reduce the activity. Losing should rely mainly on staying in bed to compensate a patient.

2,Generally by heats high in diet,whose name is high for protein, vitamin abundant delicious food for should.

(1)Diet diversification is all relatively bad because of appetite and digestion power of the liver cirrhosis patient, so,diet should diversification as much as possible,and it take fresh, delicious,in order to stimulating by appetite, promote and digest.

(2)Eat protein food of high price on the choice of the food, should eat a certain amount of protein food such as fish, red meat, egg and milk of high price with essential amino acid,etc. as much as possible first, in order to meet the need of recovering.

(3)Guarantee that there are enough carbohydrate and vitamin.

(4)Restraining the absorption of the animal fat from appropriately should secrete the bile to help by the liver because of the digestion of the fat, resolving after the fat is taken in, by mainly going on in the liver. So, take in too much fat, not only increase the liver to bear, it is decomposed that it but also can be too late because of entering fat of the hepatocyte, and cause the fatty infiltration of liver, thus aggravate the liver to damage. Propose supplying fat quantity and can be controlled about 4.0- 5.0g every day, it will influence the appetite to limit tightly.

(5)Rigorously enforce the beverage containing alcohol of fasting.

(6)Careful to eat the spicy food (including spring onions, garlic etc.) of some food , include plant cellulose more vegetables,etc. should careful to spend too, because there are stimulating or dreg too much foods that can cause the oesophageal vein of one of song to break, bleed.

(7)When and liver cirrhosis in later period of low protein diet is prone to hepatic coma, should change into low protein diet. Because protein is a material containing ammonia, can produce ammonia in internal supersession, and ammonia is poisonous to the human body. When liver function is severed, the taking off ammonia function of liver fails, it is the main reason that hepatic coma emerges that ammonia of blood increases.

(8)The diet of less salt wants for the little salt or on diet with the patient of ascites or edema. Because the principal ingredients of the salt are sodium chloride, sodium can make water store and stay in the body. Generally still need the amount of drinking water of appropriate restriction in salt of limit while. But because a main reason why liver cirrhosis produces the ascites is that the liver function fails, it is not good that the liver makes albuminous ability, make the albuminous density in the blood plasma fail and cause the colloid of blood plasma to permeate, press, reduce, so, for liver cirrhosis patient, it is more passive methods to limit water, sodium. Only increase the appetite, strengthen digesting, absorbability, increase absorption and absorption of patient protein, it is the most important step in diet treatment.

3,Support the treatment.

There is not specific drug at present in second, drug therapy, unsuitable to abuse medicines, otherwise aggravate the liver burden and run counter to desire.

1,Various supplementary vitamins.

2,Medicine such as glucurolactone to protect hepatocyte, would rather link third liver, liver, benefit liver clever ' Plain slice of Herba Silybi mariani) The intersection of skin and glucoside,etc.. Add vitamin C, B6, chlorine potassium, soluble insulin in 10% of the glucose liquid.

3,Traditional Chinese medicine.

Third, liver transplantation are counted abroad, the survival rate of 3 years that the liver has been transplanted since 1980, the amount of depending on number is that the preface is: Non- alcohol about 41% of liver cirrhosis in later period; Alcohol 20% of liver cirrhosis; Biliary tract is locked 60%; Liver cell cancer 20%; Bile duct cancer <10%. In view of to the hepatopathy patient of later period, mostly have a satisfactory treatment, but the survival rate after liver transplantation will continue improving. It is estimated that various increasingly many chronic hepatopathy patients accept liver transplantation in the future. The factor influencing liver transplantation is mainly to support the liver question.

Fourth, treatment of complication. Liver cirrhosis often dies from complications.


Prevent

This disease is virus hepatitis in the most common cause of disease of our country, and mainly B-mode virus hepatitis, secondly it is hepatitis C, so prevent the prevention and cure that a disease should be paid attention to virus hepatitis first. Find in early days and isolate patients to treat actively. Pay attention to the diet, rational nutrition, control and drink, strengthen and work health care, it is the positive measure prevented too to prevent various chronic chemistry from being poisoned. For having the above-mentioned disease therefore the person who suspected to has liver cirrhosis should carry on overall physical examination and relevant laboratory inspections in time, try, compensate issue, get reasonable positive treatment, prevent from, compensate issue, develop to lose. Some patients can be in compensating one for a long time. Has already made a definite diagnosis of the person who suffers from liver cirrhosis, middle, Western medicine combines and protects the liver treatment; Fixed physical examination, including test liver function, first fetus protein and hepatobiliary pancreas spleen supersonic wave are checked; Avoid various inducements at the same time, it is variceal to prevent and treat the esophagus, fundus of stomach and break to bleed, primary peritonitis, liver encephalopathy (go into a coma) ,Liver kidney syndrome (little urine or has no urine) ,Complications such as hepatocarcinoma,etc., thus improve the patient's prognosis.


Liver cirrhosis
|