Often people who feel soreness in the right hypochondrium ask how to determine cirrhosis at the initial stage. But unfortunately, at first the disease proceeds almost without symptoms, and the symptoms appear when the gland has already increased in size.
In order to protect the liver from a chronic disease, it is necessary to eat properly, lead an active lifestyle and undergo preventive medical examinations that will help to see the violation of the liver.
Liver cirrhosis (the transformation of parenchymal tissue into a pathological connective) is a common disease that is the final stage of a number of chronic liver diseases. The diagnosis of liver cirrhosis is made, taking into account the data of the medical history, physical examination, functional tests, laboratory and hardware studies.
What indicates liver cirrhosis
Often, liver cirrhosis is preceded by viral hepatitis B and C, and the disease also develops against the background of alcohol abuse. Pathology can also develop against the background of chronic autoimmune hepatitis, sclerosing cholangitis, stagnation of bile, narrowing of ducts, cystic fibrosis, glycogenosis, galactosemia, Wilson’s disease, chronic heart failure, hepatotoxic drugs, intestinal surgery, and parasitic invasion of the liver and intestines.
Therefore, in the diagnosis of liver cirrhosis, the study of the patient's history is of great importance. Symptoms of cirrhosis depend on the etiology of the disease, the speed of the course, and the degree of organ damage. About 20% of patients at an early stage of the process do not notice any signs of the disease, while others mention only increased gas formation and decreased performance.
As the tissue degenerates, a temporary dull pain in the right side joins that occurs after drinking alcohol or heavy food, and does not go away after taking antispasmodics. Signs of stagnation of bile are rapid saturation and itching of the skin.
In some cases, nosebleeds open and fever begins. With the progression of the disease, jaundice and signs of portal hypertension, varicose bleeding from hemorrhoidal and esophageal veins are detected, the amount of fluid (ascites) in the abdominal cavity rises.
The following symptoms are characteristic of patients with cirrhosis:
- “Drum sticks” (phalanxes of the fingers are thickened),
- “Watch glasses” (changing the nail plate),
- palmar erythema (red palms),
- “Spider veins” (thin vessels are visible through the skin of the face and body).
Thus, the doctor may suggest cirrhosis even at the first examination of the patient, after studying his medical history. In the late stages of cirrhosis, even the appearance of the patient changes, which can serve as an indirect sign of the development of pathology.
After interviewing the patient about his medical history, complaints and lifestyle, the doctor conducts a physical examination, which includes palpation and percussion of the abdominal cavity, examination of the skin. Upon examination, the doctor notes yellowing of the skin and sclera, weight loss, capillaries on the body and face, expansion of the veins on the abdomen, an enlarged abdomen, swelling of the legs, redness of the palms of the hands, red rash.
The severity of these signs depends on the degree of the disease and at an early stage they may be absent altogether. When probing and listening to the abdominal cavity, the doctor may notice:
- decreased muscle tone of the abdominal wall,
- a change in the contour of the liver and spleen during percussion,
- a dull sound when tapping.
When probing the liver, the doctor receives a lot of information, since an enlargement of the gland is characteristic even for the initial stages of the pathology. In the stage of decompensation, the organ is already enlarged significantly and protrudes two centimeters beyond the edge of the costal arch. The doctor determines by touch that the gland is too dense and uneven due to nodules formed.
What the tests show
Blood tests for cirrhosis show hemoglobin deficiency, leukocytopenia and thrombocytopenia, which indicates a pathological enlargement of the gland. The coagulogram notes a decrease in the prothrombin index, that is, blood coagulates more slowly than normal.
With blood biochemistry, an increased activity of liver enzymes (alkaline phosphatase, Alt, AcT), an increase in total and direct bilirubin, potassium, sodium, as well as urea and creatinine, a decrease in albumin are detected. Additionally, tests are carried out for cirrhosis of the liver for antibodies to viral hepatitis, the content of alpha-fetoprotein is determined.
According to a blood test, a diagnosis can be made and the degree of compensation determined. To confirm primary biliary cirrhosis, the level of liver enzymes, cholesterol, antimitochondrial antibodies is checked, and a biopsy of the gland is also required. In the patient’s urine, protein and red blood cells are detected.
Diagnostic hardware research
It is impossible to diagnose cirrhosis only on the basis of the patient’s complaints, his medical history and laboratory blood tests, since the same data can be obtained with completely different pathologies of the biliary system, and characteristic signs of cirrhosis develop with significant liver damage.
Differential diagnosis is carried out between cirrhosis of the liver and cancer. Diagnosis is checked and confirmed by ultrasound, laparoscopy and biopsy. If cirrhosis led to liver cancer, then pathology can be distinguished only with laparoscopy.
The symptoms of cirrhosis are also similar to the parasitic disease of echinococcosis, in which the gland enlarges and becomes denser. In this case, an ultrasound scan is informative, and a laboratory test confirms the diagnosis, revealing antibodies to ezinococcus.
During the differential diagnosis, it is possible not only to make the only correct diagnosis, but also to determine the type of cirrhosis. During the research, the biliary system is thoroughly studied, which makes it possible to determine the cause of the development of the pathology and take measures to eliminate it.
Diagnosis of cirrhosis includes an ultrasound scan of the gland. On ultrasound, the size of the organ and its shape are precisely established, sound permeability is noted, are there signs of portal hypertension, changes in the spleen? This study provides a low-resolution picture, but still it allows you to recognize inflammatory processes and neoplasms in the gland.
At the initial stage of cirrhosis, the liver structure is still homogeneous, and at the stage of subcompensation and decompensation, fibrous tissue replacing the parenchymal tissue is already visible. With small-node cirrhosis, the echogenicity of the gland is increased evenly, and with large-node cirrhosis, individual nodes and an inhomogeneous tissue structure are distinguished.
In the later stages of the disease, the right lobe of the liver is reduced, and in the last iron it becomes less than normal. Thus, an ultrasound examination of the liver allows not only to make a diagnosis, but also to determine the stage of development of cirrhosis.
Computed tomography of the abdominal cavity makes it possible to see in more detail the gland, its vessels and bile ducts. If necessary, an MRI of the liver is performed. Based on the study, a conclusion is drawn about the homogeneity and density of the gland tissue.
Using this method, you can consider the vessels and bile ducts, and draw conclusions about their patency. The examination, due to the high cost, is carried out to clarify the results of other diagnostic studies.
In the pictures you can see congenital anomalies of the hepatobiliary system, metastases of extrahepatic tumors, accumulation of iron in hepatocytes, and obstruction of the bile ducts. This information is useful in diagnosing and determining further treatment tactics, and may also shed light on the etiology of the disease.
Laparoscopic examination is an operation that is performed to confirm the diagnosis. The doctor visually assesses the surface of the gland. With coarse-grained cirrhosis, individual nodes of more than 3 mm are distinguishable, between which there are strands of fibrous tissue. With small nodes on the liver, small nodules, the space between which is filled with connective tissue.
You can finally determine the diagnosis and treatment tactics after a liver biopsy. This procedure is not performed for all patients, since it has a number of contraindications and is somewhat painful, and in most cases the diagnosis can be made using non-invasive diagnostic methods.
The study of the material taken reveals the morphological changes in the liver tissue and suggests the cause of their degeneration. A biopsy is performed to clarify the diagnosis of diffuse liver lesions (hepatitis, cirrhosis, hepatomegaly).
To take the material, the skin is punctured with a puncture needle in the right hypochondrium between the 7th-9th rib, the sample is taken using a special syringe aspirator. With cirrhosis, during examination of the biopsy specimen under a microscope, nodules are found surrounded by fibrous tissue, and hepatocytes differ in size, the vessels between them with uneven gaps.
With active cirrhosis, necrosis of the parenchymal tissue, cell enlargement, and the absence of a border between normal and pathological tissue are detected. And with inactive cirrhosis, there is no necrosis, and the border between normal and pathological tissue is clear.
As additional methods to identify the causes of cirrhosis, methods are used to detect enzyme deficiencies, iron metabolism indicators and protein activity are checked, which are markers of metabolic disorders.
Cirrhosis is an incurable disease, but if it is detected at an early stage, a provoking factor is identified and eliminated, then in case of following dietary recommendations, the prognosis for the patient's life is relatively favorable.
Therefore, it is important to consult a doctor at the first sign of liver dysfunction. And since the pathology in most cases is the result of another chronic liver disease, then cirrhosis can be completely avoided if you consult a doctor in time and undergo treatment for the primary disease.
What is liver cirrhosis?
Cirrhosis of the liver - A chronic liver disease characterized by persistent damage to it, in which normal liver tissue is replaced by fibrous connective tissue. The end result of the defeat, if you do not take any action, is the development of liver failure and portal hypertension, after which the patient usually leads to death. Death usually occurs in 2-4 years of illness. Sometimes cirrhosis results in liver cancer.
The liver plays one of the main roles in cleaning the body of toxic substances, it also contributes to the synthesis of fats, proteins and carbohydrates, participates in the digestion processes and the production of substances necessary for normal functioning of the body. With cirrhosis, the liver becomes scarred, grows and increases or decreases in size, becomes dense, rough and bumpy. Its cells (hepatocytes) degenerate and cease to fulfill their functions, which is why the destruction of this organ poses a threat to the life of a living organism, whether it be a person or an animal.
The main signs of cirrhosis of the liver are gradually increasing pain in the abdomen (mainly in the right hypochondrium), which at the last stage of the patient’s development becomes so strong that even narcotic drugs and digestive upset (pain in the abdomen, nausea and vomiting) are prescribed as painkillers.
The main reasons for the development of liver cirrhosis in most cases are hepatitis, as well as the frequent and excessive use of alcoholic beverages, which in fact poison not only the liver, but the entire body.
How many live with cirrhosis of the liver?
The number of years of life with cirrhosis largely depends on the degree (stage) of the pathological process in the liver, methods of therapy and strict adherence to the therapeutic and prophylactic prescriptions of the attending physician, as well as the patient’s lifestyle.
The compensated form of cirrhosis is usually characterized by survival in 50% of cases. With a subcompensated form, doctors predict the patient's lifespan, on average - 5 years, with a decompensated form - up to 3 years.
Many experts establish the stage of the disease according to the Child-Pugh, Cox and others prognostic system.
However, I hasten to note that the network contains testimonies of people who believed in Jesus Christ who recovered after conversion, even in the most advanced stages of cirrhosis, when doctors did not give a chance for recovery, therefore, there is always hope!
Doctors note that cirrhosis is observed mainly in the male half of the population, about 3 to 1. This is due primarily to the fact that men more often than women like to drink strong alcoholic beverages, and this, as we have already said, in most cases, is the main cause of cirrhosis.
If we talk about the general picture, then pathological changes in the liver (cirrhosis, hepatitis, cancer) lead to the death of about 300 thousand people annually. Moreover, in developed countries, cirrhosis occurs on average in 20 people per 100,000 population, while in the former USSR, this figure is 1% of the population. Below is a map of the prevalence of cirrhosis worldwide (as of 2004). The lighter the color (closer to yellow), the less cases of the disease, the darker, the more:
Over the past 10 years, the percentage of incidence of this disease has increased by 12%!
The age of patients in most cases is from 40 to 60 years.
Symptoms of liver cirrhosis
The main sign of cirrhosis is abdominal pain, mainly in the right hypochondrium, but the onset of the disease can be accompanied by other symptoms. In addition, there are cases (approximately 20%) when liver damage is asymptomatic, and pathology can be detected only after the death of a person. Nevertheless, we will consider how the disease manifests itself in the initial stages, in the middle and at the end of its development.
The first signs of cirrhosis
- Periodic abdominal pain, mainly in the right hypochondrium, worse after eating fatty, fried and pickled foods, alcoholic beverages, as well as during excessive physical exertion,
- A feeling of bitterness and dryness in the oral cavity, especially in the morning,
- Fatigue, irritability,
- Periodic disorders of the gastrointestinal tract - lack of appetite, bloating, nausea, vomiting, diarrhea,
- Possible yellowing of the skin, mucous membranes and eye proteins.
The main symptoms of liver cirrhosis
In addition to the initial symptoms, the patient also shows the following signs of liver cirrhosis:
- Abdominal pain intensifies over time, at the final stages to intolerance, are aching or stitching in itself, with a feeling of heaviness,
- Rapid weight loss, exhaustion of the body, especially losing weight legs, while the stomach can bulge forward, as in kyphosis,
- Nausea accompanies the patient more often, like vomiting, and vomit may contain blood, which usually indicates bleeding of the veins of the digestive system,
- Muscles weaken, atrophy, a person is often in a weak state,
- There is pain and swelling in the joints, the tips of the fingers thicken, and the skin of the nails acquires a reddish tint,
- Palms, feet, capillaries on the face are also painted in red tones,
- The upper body of the patient is covered with spider veins, the number and visibility of which increase with the progression of liver decomposition,
- The mammary glands in men increase, the armpit and pubic hairs fall out, the genitals atrophy,
- The skin, mucous membranes and eye proteins (sclera) acquire a yellowish tint, which indicates that the liver can no longer process bilirubin,
- Swelling of the legs and tongue, itching of the skin, nosebleeds, which along with the eyelids are also covered with tumors (angiomas) appear, and xanthelasm begins to appear in the eyelid region,
- The patient is followed by apathy to everything, insomnia, confusion and impaired consciousness, memory is deteriorating,
- Body temperature is usually elevated, and normalizes mainly only when the condition and normalization of the liver are improved,
- There is also an increase in the size of the spleen, the amount of fluid in the abdominal cavity, portal hypertension.
Complications of liver cirrhosis
Among the complications of cirrhosis of the liver, the following signs and consequences of the disease can be distinguished:
- Ascites (excess fluid in the abdominal cavity),
- Hepatic encephalopathy,
- Varicose veins throughout the body, thrombosis, as well as internal bleeding,
- Low blood pressure, followed by the development of arterial hypotension,
- Renal failure
- Hepatic gastropathy, colopathy or coma,
- Joining secondary infectious diseases - pneumonia, sepsis and others,
- Malignant tumor of the liver (hepatocellular carcinoma),
- Fatal outcome.
Причины цирроза печени
Основными причинами цирроза печени являются:
- вирусные гепатиты, преимущественно типа В, С, D и G, конечным результатом которых и является патологическое перерождение печени,
- regular consumption of alcoholic beverages, especially excessive
- metabolic disorder, which is accompanied by fatty hepatosis,
- liver poisoning with certain drugs (androgens, anabolic steroid drugs, Iprazid, Inderal, Metyldofa, Methotrexate, etc.), heavy metal salts, industrial poisons, food (mushrooms) and other substances,
- systematic malnutrition, as well as eating mainly junk food,
- the presence of chronic hereditary and other diseases, as well as pathological conditions - hemochromatosis, deficiency of alpha-1-antitrypsin and galactose-1-phosphate-uridyltransferase, Wilson-Konovalov disease, Randu-Osler disease, autoimmune liver disease, gallstone disease, extrahepatic obstruction, , portal hypertension, congestive heart failure, Budd-Chiari syndrome, the presence of infections (aspergillosis, candidiasis, opisthorchiasis, schistosomiasis) and others.
The simultaneous effect on the body of several of the above factors, for example, hepatitis with alcohol, accelerate the pathological degeneration of the liver, sometimes tens of times!
- Secondary biliary,
- Congenital, due to the following diseases:
- hepatolenticular degeneration,
- deficiency of α1-antitrypsin,
- Budd-Chiari Disease and Syndrome,
- Stagnant (with insufficient blood circulation),
- Exchange-alimentary arising from:
- The imposition of a bypass small intestinal anastomosis,
- Severe diabetes mellitus,
- Idiopathic (unclear etiology), which may be:
- Primary biliary,
- Indian children.
Stages of Cirrhosis
The development of cirrhosis of the liver occurs during several stages, each of which is characterized by its clinical manifestations, as well as treatment methods. Let's consider them in more detail.
Stage 1 liver cirrhosis (compensatory stage). Liver cirrhosis of the 1st degree is characterized by the absence of almost any signs - the patient can rarely be bothered by short-term pain in the right hypochondrium, and mainly only in cases when a person drank an alcoholic drink or ate something from fatty or fried. Tests usually show a decrease in bilirubin and prothrombic index (up to 60). A positive prognosis of treatment is very favorable, and therapy includes mainly the use of drugs aimed at restoring hepatocytes (liver cells).
Stage 2 liver cirrhosis (subcompensated). Grade 2 cirrhosis is characterized by frequent abdominal pain on the right side, a constant feeling of fatigue and weakness, periodic bouts of nausea, weight loss, and short-term ascites. In men, signs of gynecomastia are manifested, in which the mammary glands increase in size, in addition, the hairline in the armpits begins to thin. Laboratory studies show a decrease not only in bilirubin, as in the first degree of the disease, but also in albumin, in addition, the prothrombic index decreases to 40. It is very important to choose the right treatment and transfer the disease from a subcompensated to a compensated form.
Stage 3 liver cirrhosis (terminal). Grade 3 cirrhosis is characterized by acute pain, rapid weight loss, nausea and vomiting, yellowing of the skin and mucous membranes, nosebleeds, spider veins, persistent weakness, apathy, and insomnia. The patient has a metabolic failure. Laboratory studies show a decrease in bilirubin, albumin, and the prothrombic index to critical levels. At this stage, the patient sometimes develops internal bleeding, liver cancer, hepatic coma, peritonitis and other diseases and conditions in which a person can quickly die.
Stage 4 liver cirrhosis. Liver cirrhosis of the 4th degree is characterized by an exacerbation of all kinds of signs and symptoms of the disease, severe pains that only strong drugs, sometimes narcotic ones, help to stop. Doctors today can not stop the further development of the disease and the person dies.
Child-Pugh classification of liver cirrhosis
The severity of cirrhosis of the liver, as well as the percentage of deaths, is also determined by the Child-Pugh system. True, you need to remember that this "test" does not take into account many additional factors of the disease, therefore it is only indicative, and therefore, so that it does not show, do not give up!
The peculiarity of this classification is a small test. For each answer, there are from 1 to 3 points, after which a calculation is made, and based on the number of points, the patient’s condition and further prognosis for his recovery are determined.
So, in the following table there are 4 columns - 1 of them are test questions, the next three (A, B and C) - answers and the number of points for each of them.
- The total score is 5-6 (the patient belongs to class A): the patient's survival in the first year from the time of testing leaves 100%, in the second year about 85%,
- The total score is 7-9 (the patient belongs to class B): the survival rate in the first year from the moment of testing leaves 81%, in the second year about 57%,
- The total score is 10-15 (the patient belongs to class C): the survival rate in the first year from the time of testing leaves 45%, in the second year about 35%,
Treatment of cirrhosis
How to treat liver cirrhosis? Treatment of cirrhosis usually begins with the elimination of the cause of the disease and includes the following items:
1. Drug treatment
2. A strict diet
3. Physiotherapeutic treatment,
4. Dosed physical activity,
5. Surgical treatment (liver transplant, if necessary).
1.1. Liver cell protection
As we have already said, the main mechanism for the development of cirrhosis of the liver is the degeneration of its cells (hepatocytes). Therefore, one of the most important points in the treatment of cirrhosis is the use of drugs that protect hepatocytes from pathological degeneration and replacement. In addition, usually these drugs support the liver itself and its functioning.
To protect liver cells, hepatoprotectors are used, a conditional group of drugs that indirectly in certain situations have a beneficial effect on the performance of the liver.
The following groups of drugs can be attributed to hepatoprotectors:
- Herbal preparations for the treatment of cirrhosis of the liver,
- Essential phospholipids,
- Lipotropic substances
- Vitamins for the liver.
Herbal preparations for the treatment of cirrhosis. All hepatoprotectors of plant origin are based mainly on the plant - milk thistle. This is due to the fact that spotted milk thistle contains silymarin, which performs the protective function of liver cells from pathological effects and destruction on them.
Another wonderful medicinal plant, which is the basis of some hepatoprotectors, is the artichoke, whose seeds are rich in cynarin. Cinarin is similar in its protective function to silymarin.
Among other plants that perform the protective function of liver cells, as well as contribute to the normalization of liver activity, extracts of birch, tansy, cassia, yarrow and others can be distinguished.
Among the drugs against plant cirrhosis of plant origin can be noted: “Karsil”, “Legalon”, “Silymarin”, “Hepabene”, “Galstena”, “Tsinariks”, “Allohol”, “Sibektan”, “Bondzhigar”, “Dipana” ,
Essential phospholipids. This group of drugs is an indispensable complex fat that is part of the membranes of all body cells, which play an important role in the normal metabolism, for example, between blood plasma and red blood cells (red blood cells). Maintain a normal balance of fats, carbohydrates and cholesterol.
Essential phospholipids contribute to the destruction of collagen, due to which, in fact, liver cells are replaced by fibrous tissue.
Among modern essential phospholipids can be distinguished - "Phosphogliv", "Phosphoncial", "Essential", "Essential Fort N", "Eslidin", "Essliver forte".
Lipotropic substances. It is a group of drugs consisting mainly of amino acids that lower the level of “bad cholesterol” in the blood (low density lipoproteins - LDL), enhance the action of lipase, which helps break down fats, and also protects the liver from fatty infiltration. Many lipotropic substances are vitamin-like substances.
Lipotropic drugs are usually based on the following substances - ademethionine, arginine, betaine, inositol (vitamin B8), carnitine (vitamin B11), S-methylmethionine (vitamin U), ornithine, choline (vitamin B4), cysteine and others.
Among the lipotropic drugs can be distinguished: "Betargin", "Hepa-Merz", "Heptral", "Glutargin-alkocline", "Ornilatex".
Vitamins for the liver. Vitamins play a crucial role in almost all vital processes of the body, and when they are deficient (hypovitaminosis), human health and quality of life usually worsen. Therefore, with cirrhosis of the liver, like other diseases, the body must be additionally supplied with vitamins.
With cirrhosis, special attention should be paid to the intake of vitamins such as A (retinol), C (ascorbic acid), E (tocopherol), lipoic (thioctic) acid and cocarboxylase.
In addition, you also need to focus on the vitamins of group B (B1, B2, B3, B6, B9, B12), D (calciferol) and P (rutin).
Specific vitamins and their dosages are prescribed only by a doctor, and only on the basis of analyzes, because some of the vitamins in case of an overdose can cause allergic reactions and other adverse effects.
1.2. Recovery of bile acid deficiency
With biliary insufficiency, the production of bile acid, which is directly involved in the digestion of food, decreases in the body. In addition, in this state, the conversion of enzymes is disrupted, which later also participate in the maintenance and normal functioning of the organs of the gastrointestinal tract (GIT).
In order to restore the flow of bile and pancreatic juice into the intestine, ursodeoxycholic acid (UDCA), which is a synthetic analogue of bile acid, is prescribed. The dosage is usually 10-15 mg per 1 kg of weight / 1 time per day, preferably at night.
In addition, UDCA helps normalize the body’s immune response to infectious agents in the liver, prevents the liver from absorbing so-called “bad” cholesterol, enhances the action of the lipase enzyme, which helps break down fats, and UDCA helps lower blood sugar. In fact, ursodeoxycholic acid can be attributed to hepatoprotectors.
Among the preparations of ursodeoxycholic acid can be distinguished: "Ursonan", "Ursodex", "Ursor", "Exhol."
1.3. Strengthening and stimulating the immune system
To strengthen and stimulate the functioning of the immune system, as well as to further strengthen the liver and maintain normal functioning of the whole organism, immunostimulating drugs are prescribed.
Among the drugs designed to stimulate the immune system can be identified: Vilosen "," Zadaxin "," Timogen.
1.4. Removal of excess fluid from the body
Cirrhosis of the liver is often accompanied by the accumulation of an extra large amount of fluid in the abdominal cavity. This process is called ascites. With ascites, patients also have swelling of the arms and legs, internal organs. To prevent this from happening, the patient is additionally prescribed diuretics (diuretics). However, some doctors, for preventive purposes, prescribe diuretics before the appearance of visible signs of ascites.
Among the diuretics for liver cirrhosis, the following groups of drugs can be distinguished - aldosterone antagonists, potassium-sparing agents, thiazides, carbonic anhydrase inhibitors and loop diuretics.
Each group is very different in principle of action, so their independent use is strictly contraindicated. The doctor prescribes a specific group of diuretics only on the basis of tests.
1.5. Symptomatic therapy
To facilitate the course of cirrhosis of the liver, symptomatic drugs can additionally be prescribed.
Against nausea and vomiting: Motilium, Pipolfen, Tserukal.
With severe itching - antihistamines: Diazolin, Claritin, Suprastin, Diphenhydramine.
Against insomnia, anxiety - sedatives: "Valerian", "Tenoten."
2. Diet for cirrhosis
A diet for cirrhosis is one of the fundamental points, without which the favorable outcome of the disease is reduced to minimal values. From a medical point of view, the diet for cirrhosis is aimed at unloading the liver from processing "heavy" food, normalizing metabolism, restoring liver cells and preventing complications of the disease, for example, ascites.
In medical practice, M.I. Pevzner developed a diet for liver cirrhosis, which is called diet No. 5 (table No. 5).
In short, diet No. 5 is based on the rejection of foods that irritate the digestive tract and the liver itself, as well as an increase in the diet of proteins and carbohydrates, while the amount of fat in food should be reduced by 30%. It is also necessary to reduce salt - up to 1-2 tsp / day, no more! Calorie content of products should not exceed 2500-3000 kcal / day, the amount of liquid - not more than 1.5 liters. Fractional nutrition. All coarse food should be ground and consumed only in a warm form.
What can I eat with cirrhosis of the liver?
- Soups: vegetable, on various cereals, fruit, milk, but without frying.
- Meat: low-fat varieties of meat and fish - chicken, beef, low-fat meat, turkey, hake, pollock.
- Eggs: You can eat in the form of steamed omelettes,
- Salads - from fresh vegetables and vegetable oil
- Bakery products: wheat bread from premium flour (not fresh), not pastry, not pastry,
- Dairy products: non-fat milk, sour-milk drinks, cottage cheese, mild cheese,
- Sauces: milk and vegetable sauces are allowed, preferably home-made, as well as sweet fruit gravy,
- Sweets: fresh and dried fruits and berries, but in a soft (grated) form, jelly, honey, jam, marshmallows, sugar.
- Drinks: stewed fruit, freshly squeezed juices, rosehip broth, kissel, weak tea.
- It is allowed to use butter, but from natural ingredients.
What can not be eaten with cirrhosis of the liver?
- Fresh baked goods, fried pies,
- Fatty soups, borscht and other first courses on fatty meat, mushrooms, cabbage,
- Fatty meat - pork, duck, goose, smoked meats, sausages, lard, liver, kidneys, brains, fatty fish,
- Vegetables and fruits: legumes, cabbage, turnips, spinach, sorrel, radish, radishes, garlic, green onions, mushrooms, pickled vegetables, sour fruits and berries,
- Fatty dairy products - cream, sour cream, cottage cheese, spicy cheese,
- Eggs - fried or cooked in a steep,
- Savory foods, sauces, ketchups, mustard, peppers, horseradish, pickles, canned food,
- Sweets: chocolate, ice cream, cream products,
- Drinks: alcohol (any), strong tea, coffee, cocoa, soft drinks.
3. Physiotherapeutic treatment
Physiotherapeutic procedures for cirrhosis of the liver contribute to improving metabolism, maintaining liver health. Among physiotherapeutic procedures can be identified:
- Ultrasound on the liver,
- Iontophoresis with solutions of iodine, novocaine or magnesium sulfate.
5. Surgical treatment (liver transplant, if necessary)
Surgical treatment of cirrhosis includes liver transplantation (transplantation). This is a rather expensive procedure, which, in addition to finances, is also complicated by the search for a donor.
Transplantation is usually prescribed in cases where conservative treatment of cirrhosis has not brought the necessary results, and the pathological process of destruction of this organ continues to mercilessly develop.
In addition to the price, the disadvantage of a liver transplant is the continued use of immune-suppressing drugs, and throughout life.
Contraindications to liver transplantation are malignant tumors (cancer) with metastases, some severe pathologies of the heart and lungs, obesity, infectious diseases, inflammatory processes in the brain and others.
However, once again I want to remind you, even if doctors refuse to help and write off a person, there is a way out in God!
Prevention of cirrhosis
Prevention of cirrhosis includes compliance with the following preventive measures:
- Stop giving up alcohol, smoking,
- Do not leave the diseases of the organs of the gastrointestinal tract on its own, especially of an infectious nature (hepatitis, etc.),
- Try to limit yourself to eating fatty, spicy, fried and smoked foods, processed foods and other low-useful and unhealthy foods,
- Try to eat foods enriched with vitamins and minerals,
- Do not take medications without consulting your doctors, remember that most medications have serious side effects,
- Соблюдайте правила личной гигиены,
- Соблюдайте профилактические меры по недопущению заражения вирусами гепатита.
Preliminary diagnosis of cirrhosis at home
In order for a person to turn to a specialist for help, he must have a reason, that is, a complaint about the manifestation of certain unpleasant signs. At home, the presence of such a disease can be assumed independently, based on the manifestation of such symptoms as:
- jaundice - acquires a yellow tint not only the skin, but also the mucous membranes of the oral cavity and eyes. This process is caused by the fact that the liver begins to function incorrectly and produce a large amount of bilirubin,
- a change in the shade of urine and feces, which develops against the background of the previous sign. The urine turns dark brown, and the feces become discolored to gray,
- an increase in the size of the anterior wall of the abdominal cavity - suggests that such a disorder has become a predisposing factor to the accumulation of fluid in the peritoneum. This process is caused by stagnation of bile in the ducts of the liver. In addition, discomfort and pain in the abdomen may appear when performing heavy physical exertion, as well as swelling of the lower extremities,
- loss of appetite, which causes a decrease in body weight. At the same time, a person eats normally, but a weakened liver is not able to process and assimilate useful substances coming from food,
- severe weakness - a large number of patients note a decrease in strength to such an extent that a person cannot perform even basic actions,
- a depressive state, which is accompanied by sleep disorders and indifference to everything that happens,
- the lack of sexual desire for the opposite sex - often indicates the presence of cirrhosis, because the inflammatory process can affect the nearby organs of the peritoneum and pelvis,
- a feeling of heaviness in the stomach and quick satiation from food - due to the fact that an enlarged liver compresses the stomach,
- the acquisition by males of some signs of femininity, in particular an increase in the size of the mammary glands,
- constipation, followed by diarrhea. In this case, a decrease in the period of time for digesting food occurs. After eating, no more than an hour passes before the bowel movement,
- skin loss of moisture and elasticity. In addition to a yellowish tint, the skin can be covered with dark brown spots,
- redness of the tongue and palms.
But the main symptom of cirrhosis of the liver with which people turn to a medical institution is pain. In order to identify problems with the liver, you need to slightly press on the area of its projection, i.e., in the area under the right ribs. With such a disease, a person will feel severe pain of a pulling nature, which persists for a sufficiently long time. With a strong increase in the affected organ, you can independently feel the contours of the liver through a thin layer of skin.
After the patient enters the hospital, he is immediately sent for examination to a gastroenterologist. The first thing a specialist should do is to get acquainted with the medical history and history of human life. This will make it possible to determine some of the causes of such a disorder, for example, long-term alcoholism or the presence of hepatitis.
Then the doctor must necessarily interview the patient. This will help to identify the presence, initial time of occurrence and intensity of expression of the clinical picture. After listening to the complaints, the specialist conducts a thorough physical examination to detect external signs of the disease.
Such an examination should necessarily include palpation of the entire area of the anterior wall of the abdominal cavity. Such a measure will not only detect fluid accumulation and an increase in liver size, but also differentiate liver cirrhosis with other ailments that may have similar symptoms. For example, acute inflammatory processes in the peritoneum, gall bladder or pancreas. Such conditions require immediate surgery.
There are several ways to preliminarily approve cirrhosis. They can serve as certain zones on the abdomen, which in response to palpation give increased susceptibility, pain points in the right hypochondrium, as well as various ways of pressing and studying the patient's reaction. With a similar ailment in the projection of the liver, the doctor will feel the edge of this organ - it is dense, sharp and causes pain to a person. With a significant increase, when the liver goes beyond the hypochondrium, the doctor gropes for hard tuberous formations.
Be sure to palpate the spleen in the area under the left ribs. Such an illness is characterized by a slight increase in its volume. Palpation and tapping of the lower parts of the peritoneum is performed to detect accumulated fluid in this zone.
Swelling of the lower extremities is determined by the remaining fingerprints after pressure.
Laboratory diagnostic techniques
To find out the extent of liver damage and determine the future treatment tactics, the patient is shown laboratory diagnostic methods to determine the presence of characteristic changes in the blood, urine and feces.
General and biochemical blood tests are necessary to detect changes in its composition. With cirrhosis of the liver, an increase in the number of leukocytes is detected, as well as a decrease in red blood cells and hemoglobin. Check the ability of blood to coagulate and the presence of indicators that indicate liver damage.
A blood study is also carried out for the differential diagnosis of liver cirrhosis with hepatitis and echinococcosis. In both cases, the presence of antibodies to viruses and parasites in the blood is checked.
The study of urine and feces, first of all, is aimed at identifying changes in their shade - the main indicator of a violation of the normal functioning of the affected organ. In addition, urine tests are necessary to determine the presence of a concomitant disorder, since with cirrhosis of the liver, immunity decreases and a person is prone to frequent viral or catarrhal diseases.
After completing laboratory diagnostics, patients need to undergo a hardware examination.
Instrumental methods for diagnosing cirrhosis
Instrumental diagnosis of cirrhosis includes the following:
- Endoscopic endoscopy is a procedure for examining the surface of the abdominal organs, and also to consider the expanded venous network and the location of possible hidden bleeding, which may be accompanied by cirrhosis,
- Ultrasound - will show a change in the volume of the affected organ, the presence of stagnation of blood and bile,
- Laparoscopy is an endoscopic procedure for studying the liver, during which a biopsy is performed.
In addition, the radionuclide method is often used, in which isotopes deposited in the liver cells are injected into the blood. With cirrhosis, dark spots will be visible on the ultrasound screen.
However, the most informative and common diagnostic method is ultrasound with cirrhosis. During such an examination, the dimensions of the affected organ are studied, the correspondence of the parameters between the liver lobes is traced, the features of blood supply are determined, as well as the structure of the bile ducts and gall bladder.
During this procedure, it is very important to detect specific manifestations of the disease. Ultrasound signs of liver cirrhosis are:
- an increase in the size of the affected organ and a pronounced roughness of the contours,
- surface change - it is uneven and bumpy, due to the formation of fibrous nodes,
- the presence of a large number of sites with increased echogenicity, i.e., sensitivity to ultraviolet rays,
- wrinkling of the right lobe of the liver - is noted in the late stages of the course of the disease,
- a change in the vascular pattern, a reverse flow of blood in the vessels is noted,
- decrease in gallbladder parameters,
- detection of a large amount of fluid in the peritoneum,
It is by ultrasound examination that the diagnosis of cirrhosis of the liver is clarified and the most effective treatment strategy for this disease is prescribed.