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The first signs and symptoms of liver cirrhosis, the causes, how to treat?

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What is cirrhosis of the liver?

Liver cirrhosis – extensive lesions of the body, in which there is death of tissue and their gradual replacement by fibrous fibers. As a result of substitution are formed of different size nodes, which fundamentally change the structure of the liver. The result is a gradual decrease in functionality on up to the complete loss of efficiency. This leads to deterioration in the quality of life of the patient and his subsequent death.

It is the liver cleanses the body from harmful substances, synthesize fats, carbohydrates, proteins involved in digestion, produces albumin, etc. So the lesion of the hepatic lobules, consisting of hepatocytes, and their degeneration is a terrible illness to the body by both men and women.

This disease is widespread throughout the world. According to the latest data, every year from this disease killed up to 300 thousand people, and mortality is steadily increasing. Despite all the advances in medicine over the last 10 years, the frequency of deaths from cirrhosis has increased by an impressive figure of 12%. In addition, the same percentage of people with chronic addiction to alcohol have a disease history, but it flows asymptomatic.

Pathology is diagnosed more often in men than in women. Strict age limits are not available, but the disease affects mainly people aged 40 years and older.

How long can you live with cirrhosis of the liver?

The disease has a different prognosis. With adequate treatment, which was promptly initiated, you can stop the progression of the pathological process. The role also presence of comorbidities, complications, lifestyle, stage of cirrhosis.

With preserved functional capacity of hepatocytes, if the person reviewing your lifestyle and adheres to therapeutic schemesprescription, the survival rate for seven years or more is 50% of the total number of patients. This favorable forecast is appropriate for the compensated form of the disease.

When subcompensated form the average life expectancy is about 5 years. This is due to the fact that the hepatocytes are gradually depleted and their number is not sufficient for the normal functioning of the body.

Among patients at the stage of decompensation of not more than 40% of people live three years. It is associated with serious complications, which are often incompatible with life.

In addition, there are specially designed systems calculation of the forecast survival in cirrhosis based on certain criteria. Among these prognostic system child-Pugh, model Cox proportional hazard and others. They are based on certain health indicators of a person with cirrhosis (etiology of the disease, effectiveness of treatment, presence of jaundice, neurological disorders, ascites, dilatation of the esophagus etc.) and allow you to make more or less correct predictions in each case.


First signs of liver cirrhosis

To suspect the presence of the disease early symptoms are not always possible, as in 20% of cases it occurs latent and does not manifest itself. And even in 20% of patients the pathology is discovered only after death. However, the remaining 60% of the disease still manifests itself.

Therefore, among the earlier symptoms that indicate cirrhosis, are the following:

  • Recurrent pain localized in the right hypochondrium. They have a tendency to rise after hard physical exercise or after taking fatty and fried foods, alcoholic beverages;
  • In the mouth there is a sense of bitterness and dryness, especially in the morning hours;
  • People can disturb the periodic frustration of a chair, reinforced flatulence;

  • Few patient loses weight, becomes irritable, gets tired quickly;
  • Some forms of the disease, for example, postnecrotic cirrhosis, manifest themselves in the form of jaundice in the early stages of development.

In some cases, the disease manifests itself acutely and early signs are missing.


Other symptoms of liver cirrhosis

The main symptoms of the disease is increasing as they progressed:

  • Pain in the right side are amplified in connection with the expansion of the liver capsule may havethe nature of colic. In related hypokinetic dyskinesia they grow, become aching, accompanied by a feeling of heaviness;

  • The patient has nausea, often accompanied by vomiting. Vomit can contain blood, which indicates bleeding from veins of the stomach and esophagus;

  • In connection with the accumulation in the blood of an excess of bile acids in a patient occurs itching of the skin;

  • There is a loss of body weight, up to exhaustion;
  • Decreased tone of muscles and their atrophy;

  • The acquisition of skin icteric hue its peeling. Severe jaundice is a symptom of end-stage disease. First, turn the sclera of the eyes, mucous membranes of the mouth, palms and soles, then whole body. This is due to the inability of hepatocytes to metabolize bilirubin;
  • The appearance xanthelasma – spots with the lipid component, which is localized mainly in the region of the upper eyelid;
  • The fingers are thickened at the ends, take the form of drum sticks, the skin around the nail holes blushes;
  • The joints swell and start to ache;
  • Veins on the belly expand;
  • On the upper part of the body doctors find spider veins. A characteristic feature of cirrhosis telangiectasia never formed below the umbilical area. During the acute stage of the disease stars getting more, they look very noticeable;
  • The edge of the nose and the corners of his eyes covered angiomas;
  • Reddening of the palms, at least a foot;
  • Tongue swells, takes a bright color;

  • Men begin to grow Breasts, and the functions of the genital organs atrophy. Secondary sexual characteristics are reduced: loss of hair on the pubes, in the armpits;
  • Ascites is one of the late complications of cirrhosis, characterized by accumulation of fluid in the abdominal cavity;
  • A person acquires an unhealthy tint, clearly distinguished by the cheeks, salivary glands thus swell the capillaries in the face dilate, giving it a red color;
  • Limbs lose weight, belly, on the contrary, sticks forward;
  • There are often bleeding from the nose.
  • The spleen is increased;
  • There are clear violations of nervous activity: the patient suffers from insomnia and deterioration of memory function. Observedtremor of the limbs, indifference to what is happening around.

Causes of cirrhosis of the liver

Among the main reasons leading to the development of the disease, there are:

  • Viral hepatitis, which according to various estimates leads to the formation of liver pathology in 10-24% of cases. Disease over such kinds of hepatitis, as In, With, D and the recently discovered hepatitis G;

  • The administration of large doses of alcohol for 10 years or more. According to the specific kind of drink there, a fundamental factor – the presence in it of ethyl alcohol and its regular intake;
  • Disorders in the immune system. To the development of cirrhosis lead to many autoimmune disease;

  • Various diseases of the biliary tract, among whom extrahepatic obstruction, gallstone disease and primary sclerosing cholangitis;
  • Portal hypertension;
  • Venous stagnation in a liver or Budd-Chiari;
  • Diseases transmitted by inheritance, in particular, genetic metabolic disorders (abnormal accumulation of glycogen, Wilson's disease, deficiency of A1-antitrypsin and galactose-1-phosphate uridyltransferase);
  • Poisoning chemical substances which have toxic effect on the body. Among these substances particularly harmful to the liver industrial poisons, salts of heavy metals, aflatoxins and fungal toxins;
  • Long-term use of drugs, including Iprase, anabolic steroid means, Isoniazid, androgens, Methyldopa, Inderal, Methotrexate and some other;
  • Rare disease Rendu-Osler also may cause cirrhosis.

In addition, we should also mention cryptogenic cirrhosis whose causes remain unclear. It takes place in the range of 12 to 40% of cases. The factors triggering the formation of scar tissue can become systematic malnutrition, infectious diseases, syphilis (sometimes a cause of cirrhosis in infants). Significantly increases the risk of developing the disease, combined with the influence of etiological factors, such as the combination of hepatitis and alcoholism.


Stagecirrhosis of the liver

The disease goes through several stages of development, each of which has certain clinical symptoms. On how progressed pathology, will depend not only on the human condition, but also require therapy.

Stage 1 cirrhosis of the liver

At this stage of development the disease is practically invisible. If it is detected at this time, to compensate the insufficiency of hepatocytes with the help of medicines still quite possible. Therefore, doctors call the initial stage of the disease compensatory.

Despite the fact that no clinical signs of the patient is not watching changes in the body has already begun. If you do not start timely treatment, the cirrhosis will progress quickly and, after a short time, the liver can no longer cope with its functions in full. With regard to laboratory parameters, the level of bilirubin in the blood, and protrombine index may fall to 60. But this person feels absolutely healthy. It can only rarely pains in the right hypochondrium.

Due to the fact that cirrhosis is suspected on laboratory parameters, as required regular preventive examination by a doctor.

Stage 2 cirrhosis of the liver

The next stage is called subcompensated. As the name suggests, you can understand what is happening more marked reduction in the functional capacity of the organ, caused by a growth in the number of dead hepatocytes.

At this stage, the person is able to see that in his body something happens. He begins to suffer from weakness, apathy, reduced performance, nausea, weight loss and other early symptoms of the disease. Men already at this stage the first signs of gynecomastia.

As for laboratory parameters, it starts to fall the level of albumin and prothrombine index can reach 40. However, if early treatment, there is still the opportunity to translate this stage into the stage of compensation. That is, with proper medication a sick body will be able to function without complications for human health.

Stage 3 cirrhosis of the liver

Dangerous is stage 3 of the disease, because of functioning hepatocytes becomes critically small. This leads to the progression of liver failure and a buildup of the symptoms of the disease. The skin becomes jaundiced, abdominal pain increasingly concerned about the man. Often it is at this stage develops ascites, which on their own pass.

The level of albumin and prothrombine index fall to critical values.

Treatment at this stage is ineffective, although there is still the likelihood that the medication will help to cope with the disease. The patient should be in hospital under medical supervision, as this stage is characterized by marked disturbance of metabolism.

The danger of disease complications that may become lethal. Among the most formidable – hepatic coma, cancer of the liver, internal bleeding, peritonitis and pneumonia. This stage is called terminal.

Stage 4 cirrhosis of the liver

The final stage of the disease is characterized by the fact that the tissue of the organ is so damaged that it is no longer able to cope with the tasks assigned to them. Pain is very strong, the patient is assigned to a permanent taking strong painkillers.

To stop the progression of the disease at this stage is impossible. The prognosis is generally poor, and without a liver transplant patient dies from severe complications.


Classification of liver cirrhosis child-Pugh

It is possible to estimate the severity of the disease according to the proposed doctors and Childs Pugh classification. It is based on assigning a certain number of points for each symptom of the disease. Experts forecast distributed on survival for three classes: A, b and C. each class has a percentage, which depends on the number of points.

1 point is set for each setting if the patient:

  • Ascites is not observed;
  • Bilirubin is less than 34 mmol per liter;
  • Hepatic encephalopathy is absent;
  • Protrombine index is over 60, or prothrombin time is in the range from 1 to 4, or INR less than 1.7.

2 points for each of the parameters is adjusted, if:

  • Ascites is treatable;
  • Bilirubin not more than 50 µmol per liter;
  • Albumin is not below 2.8;
  • There is a light and verifiable hepatic encephalopathy;
  • PTI at least 40, or PTV 4 to 6, or INR does not exceed 2.2.

3 points is set for each of the parameters:

  • Poorly controlled ascites;
  • Bilirubin more than 50;
  • Albumin less than 2.8;
  • Hepatic encephalopathy 3 or 4 degree and it is difficult to control;
  • PTI less than 40 or more than 6 PTV, or INR greater than 2.2.
The estimated parameters

Group child-Pugh

A (1 point)

B (2 points)

C (3 points)

Total plasma bilirubin, µmol/l (mg/DL)

<34 µmol/l (< 2mg/DL)

34-50 µmol/l (2-3 mg/DL)

The albumin of blood plasma, g

2.8 to 3.5 g

<2.8 g

Ascites

Missing

Controlled treatment

Poorly controlled

Hepatic encephalopathy

Missing

Degree I–II (easy, therapeutically controlled)

Degree III–IV (severe, poorly controlled)

Prothrombin index (PTI), %

(or) Prothrombin time (PTV), with

(or) International normalized ratio (INR)

>60%

1-4

>1,70

40-60%

4-6 with

Of 1.71 to 2.20

<40%

>6

>2,20

The scoring

The scoring and the results:

  1. If the patient scores 5 to 6 points, one-year survival rate is 100%, and two-year – 85%.

  2. When the patient is gaining from 7 to 9 points, it belongs To the class: one-year survival rate is 81% and two-year 57%.

  3. The class is equivalent to the range from 10 to 15 points and the prognosis is much worse. One-year survival rate is 45% and two-year 35%.

It is understood that this system of assessment is indicative only, and she is unable to consider other parameters of the disease, such as varicose veins of the stomach and esophagus.

The consequences and complications of liver cirrhosis

The disease is dangerous to humans the serious complications that often cause of death:

  • The development of ascites, i.e. accumulation of fluid in the abdominal cavity;
  • The occurrence of peritonitis, i.e. inflammation of the peritoneum;
  • Varicose veinsextending through the esophagus or stomach, and, as a result, the development of internal bleeding. Among the symptoms that characterize the beginning of such bleeding – the emergence of vomiting with admixture of blood, staining of stool in black color, drop in blood pressure and a marked acceleration of the pulse;

  • Hepatic encephalopathy;

  • Loss or confusion;
  • The development of malignant tumors (cancer) that is difficult to therapy and progresses rapidly;

  • Hepatorenal syndrome is characterized by kidney failure;

  • The drop in the level of oxygen in the blood or hepatopulmonary syndrome;
  • Hepatic gastropathy, violations on the part of the stomach;
  • Hepatic kalapati – disorders of bowel function;
  • The impossibility of procreation – infertility.


Diagnosis of liver cirrhosis

To put such a serious diagnosis, the doctor may not, without undertaking a comprehensive examination of the patient. First, the patient may need to donate blood for biochemical analysis. If the results are alarming doctors, he will send the patient for further diagnosis.

Holding coagulation will show whether there are violations of the blood coagulation system. Common blood test will reveal the level of hemoglobin, which, as a rule, patients with cirrhosis reduced. It is often diagnosed with anemia. In addition, markedly reduced the number of leukocytes and platelets.

To rule out or confirm viral nature of the disease, the patient should be tested for detection of hepatitis – A, b, C, D and G. Learn about the presence of hidden bleeding in the gastrointestinal tract will helpthe stool test for occult blood.

Kidney failure is determined by the level of electrolytes and creatine. If there is a suspicion of liver cancer, the patient will need to donate blood for alpha-fetoprotein.

In addition, it is necessary to conduct ultrasound of all abdominal organs and portal vessels. It is important to determine the presence of ascites and enlarged spleen.

With the help of esophagogastroduodenoscopy the doctor will make a conclusion about the existing varicose veins of the esophagus and stomach.

To clarify diagnosis and determine the stage of disease development will help a liver biopsy. If necessary, the doctor sends the patient for scintigraphy of the liver or CT scan.

Blood biochemical parameters in liver cirrhosis

Typically, an experienced doctor can suspect the disease based only on a single analysis – blood chemistry. Indicators of cirrhosis vary according to a certain pattern: there is an increase in levels of bilirubin, liver transaminases (40 IU), alkaline phosphatase (should not be above the level of 140 IU), globulins, prothrombin time, haptoglobin, specific enzymes of the liver. Against this background, there is a drop in albumin (less 40 g per liter), prothrombin, urea (less than 2.5 µmol), cholesterol (less than 2 mmol).

Especially significant increase in the level of bilirubin in the cirrhosis, as this substance is a breakdown product of red blood cells and hemoglobin and has to be processed by the liver. When the functionality of the body violated, the bilirubin starts in an excess amount to circulate in the blood. This leads to staining of stool in yellow-green color, and yellowing of the skin, mucous membranes and whites of the eyes. Therefore, the total bilirubin in norm should not exceed 20,5 µmol per liter, free – 17,1 and associated and 4.3. As the progression of the disease these numbers may grow several times.


Is there a cure for cirrhosis of the liver?

The majority of patients, hearing from the doctor the diagnosis, it is reasonable to ask the question: is it possible to completely get rid of the disease? These capabilities, modern medicine does not have. The only option of radical treatment is to transplant a donor organ. However, liver transplantation is not for every patient and this costs money.

However, do not despair, because if the disease was discovered in the early stages, to stop its progression it is possible, through adequate therapy. In that case, if cirrhosis is detected in the later stages, doctors may be able to slow down the progression of the disease and delay the onset of complications.

Scientists are still trying to develop a cureable to get rid of cirrhosis. But so far official medicine has not announced about any tool that is able to completely heal people. However, to translate cirrhosis in the category of controlled chronic diseases is quite real.


How to treat liver cirrhosis?

As for treatment, it is selected strictly individually in each case. However, there are certain criteria applicable to the therapy of the disease. Thus, the compensated stage of cirrhosis needs to be addressed the main reason that led to the development of pathology. Patient prescribe medicines for the treatment of hepatitis, attempting to rid of his alcohol addiction, etc. besides, it is necessary to reduce the risk of complications that can aggravate the disease.

The patient needs to adhere to a diet with optimal protein and carbohydrate content. It is important to exclude any type of alcohol, harmful products. All drugs are applied only on prescription, and it must be driven by necessity.

Typically, the patient is not recommended physiotherapy, exercise, heat therapy. No one remedy of folk medicine can not be used without prior consultation with your doctor.

If the patient seeks help at the stage of decompensation, he is being treated in hospital, due to the high risk of complications. The main goal pursued by any doctor during this period – stop the progression of the disease. For this purpose, drugs that are selected individually and depend on the forms of cirrhosis.

Perhaps the appointment of hepatoprotectors, drugs ursodeoxycholic acid, nitrates and b-blockers.

Liver transplant cirrhosis

The only radical method of treatment is transplantation of the damaged organ. The operation is carried out in the case if your liver is unable to cope with the tasks entrusted to it, and conservative treatment is powerless.

The donor organ is taken from a deceased person who during his life wrote a waiver of such exemptions, although the laws are different in different countries. As the operation is quite complex, and subsequently requires life-long administration of drugs that suppress the immune system, it is not carried out in the early stages of cirrhosis.

Among the indications for transplant are the following:

  • Internal bleeding beyond medical correction;
  • Ascites not responsive to treatment;
  • The fall of albumin below the level of 30 g;
  • The increase of prothrombin time above 17 C.

These indicators are a direct threat not only for health, but for the life of the patient, therefore, require organ transplantation. However, not shorter and the list of contraindications, including the presence of an infectious process, severe pathology of the heart and lungs, any malignant tumor with metastases, brain lesions, age older than 60 years or under 2 years of age, obesity , etc.

The operation itself lasts at least 8 hours, is to remove the damaged organ and transplant healthy. It is possible that a donor will be transplanted only part of the liver. As for the forecast after planting, it is quite favorable, although some risks still exist, for example, rejection of the liver, thrombosis of the hepatic artery and others. The survival rate for the next five years is 75%, it is a good indicator, given the severity of the disease, and about 40% of people live with a stranger on more than 20 years.

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Give disability for cirrhosis of the liver?

The registration of disability in this disease is possible. The group that will be assigned to the individual depends on the severity of cirrhosis and its stages. As a rule, when the diagnosis first stage of the disease the patient is put 3rd group of disability. If the cirrhosis has reached the stage of decompensation, then the person will assign 2 group of disability. When the disease is in the terminal stages, the person entitled to the first group.

To get help from the state, the patient may need to undergo a special Commission, which he will be sent to the treating doctor.

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Prevention of liver cirrhosis

Cirrhosis is the disease, it is possible to avoid if you follow certain preventive measures, including:

  • Treatment of hepatitis with the help of a qualified physician-hepatologist and complianceprescribed therapeutic scheme;
  • The restriction of self-medication, avoidance of work in hazardous industries;
  • Vitamin and mineral complexes;
  • Diet, refusal of fatty, fried and spicy food, canned products and semi-finished products;
  • Avoiding harmful habits, in particular alcohol abuse;
  • Preventive measures to prevent Contracting hepatitis;
  • Annual passage of endoscopic examination of the gastrointestinal tract;
  • Personal hygiene and use of personal care products for yourself;
  • Vaccination against hepatitis B.