Description liver cirrhosis
Hepatic cirrhosis is a chronic process, during which the necrosisof the liver and subsequently to an increased formation of connective tissue (fibrotic) remodeling and nodular liver cells.
In such a way there is a complete breach original structure of the liver, which adapts the resulting unfavorable situation and the vascular bed of the liver. Cirrhosis name comes from Greek and means kirrhos yellowish.
The number of patients with liver cirrhosis is increasing year by year. Most cirrhotic patients in France – an obvious connection with the consumption of wine. In the Czech Republic every year appears to 2,000 patients in the last phase patients, which is 2 × less than in France, Austria, Italy and Germany.
Liver cirrhosis is one of the few diseases that occur more productive adults than when in old age. Since it is such a large percentage, it is possible for liver cirrhosis declare that it is an economic burden to society since the liver transplant, which is very costly.
Cirrhosis of the liver may be caused by various causes, but in Europe is found most often on the basis of viral hepatitis oralcoholism. From here other causes include metabolic disorders, biliary cirrhosis, cardiac cirrhosis, nutrition disorders, or idiopathic damaging drugs.
1) Viral Hepatitis
This is mainly an infection of hepatitis B virus (HBV). This type is more common in men and is described in 3% of cases after suffering a viral hepatitis B with a history of hepatitis C virus (HCV) speaks in 5-15% of cases.
In the Czech Republic, talks about 1/3 of patients with liver cirrhosis, caused by a general viral hepatitis. Cirrhosis formed either immediately after viral hepatitis or chronic effect after its delivery.
Given the current epidemiological situation We can expect that in the representation of hepatitis cirrhosis We will increase. It is good, therefore, to use the available vaccinations.
2) Alcohol
Alcohol is one of the most prominent causes of liver disease, since it is the degradation of the alcohol is carried out in the liver, via the oxidation of acetaldehyde. This process requires much substances in the body.
Chronic alcohol abuse leads to metabolic changes. The average man has alcohol dehydrogenaseenzyme that performs the detoxification of alcohol in the liver, two and a half times more than the average woman. Fortunately, alcoholism, yet forfeit more men than women, which is the way to liver cirrhosis much shorter. Increasing levels of fats and iron (other substances: lipoproteins, lactate, pyruvate, etc.) in the liver. And at the same time reduces the level of glycogen.
A tolerance level of alcohol intake for women is three times lower than for men. Dangerous dose for men is measured over 60 grams per day (2 liters of beer or 0.7 liters of wine or 0.2 liters of spirits) for women above 20 grams per day.
The greatest risk lies in alcoholism – daily intake of alcohol, which, despite the high regenerative ability of the liver, the liver is constantly being put to the task to clean the blood, and she herself suffers.
Yet alcoholic cirrhosis arises in all alcoholics – it is clear that it must be present another factor – orfamily history of viral hepatitis or by a combination of medications.
It can run for years without symptoms (asymptomatic) and discovers the true cause until after death. In other cases, we discover it through liver enlargement (hepatomegaly) or signs of liver disease (especially from blood tests).
After the diagnosis of alcoholic cirrhosis of the liver is important to immediately stop drinking alcohol and diet modification. Since the main cause of death is being alcoholics liver failure, bleeding from the gastrointestinal tract (digestive tract) or tumors in the cirrhotic liver, all on the basis of liver cirrhosis.
3) Metabolic Disorders
Type steamed rare inborn errors of metabolism, wherein the stuck processing of various substances in the liver. It eg. By Wilson’s disease (a disorder of copper metabolism), hemochromatosis (a disorder of iron metabolism), porphyria, cystic fibrosis, galactosemia.
4) Biliary Cirrhosis (BC)
Biliary cirrhosis is a result of long term cholestasis, or impairment of bile formation and its outflow from the liver. BC is a congenital primary, secondary, BC is a manifestation of the obstacle (obstruction) in the biliary tract (examples include stones in the bile duct).
5) Damage drugs
Many drugs – eg. Cytostatics (drugs to treat cancer), antituberkulotika (medicines used to treat tuberculosis – TB), hormonal contraception – can cause liver cirrhosis.
Also in vitamin A overdose causes liver cirrhosis. Further, antibiotics (drugs for inflammatory diseases caused by the bacteria).
6) Cardiac Cirrhosis
Thanks to ever-improving levels of treatment for heart disease is becoming a very rare form.
7) Idiopathic (cryptogenic) Cirrhosis
As idiopathic cirrhosis of the liver is called cirrhosis each of which has no explainable reason according to the division above.
The first stage before the onset of cirrhosis, fatty liver (steatosis). Another point that consists of nodes and liver macroscopic changes until the final stages of hardened liver.
Risk factors for liver cirrhosis
Risk factors are recurrent viral hepatitis (mainly HBV or HCB), alcoholism, or metabolic disordersubstances, which are processed by the liver.
Prevention of liver cirrhosis
Prevention of liver cirrhosis has a lot of planes that are worth avoiding. It is necessary to properly treat acute viral hepatitis status and pursue its prevention by vaccination against hepatitis.Currently, most available vaccines for hepatitis A – e.g. Avaxim, Havrix, hepatitis B – e.g. Engerixcombined vaccine for hepatitis A and B – e.g. Twinrix.
Consume alcohol nepředávkovat drugs that act on liver toxic – unnecessary prescribing medications that the patient needs – for example antibiotics when influenza contraception if not needed.
If you have one of the hereditary diseases that can cause cirrhosis, follow the prescribed diet.
In advanced stages, it is good to attend counseling and strictly abide by advice of doctors. In the first and second phase, it is recommended to reduce working hours and partial disability pension. In the last stages of the disease the patient ceases to go to work and receives a full disability pension.All, however, depends on the condition of the patient.
Signs and symptoms of liver cirrhosis
Cirrhosis of the liver may be a long time without symptoms (asymptomatic). Initially the symptoms are subtle and classic symptoms are manifested only in the later stages, when with respect to treatment time it is too late.
Classic symptoms are often such that they can be more diseases, and thus does not fall suspected cirrhosis. These include fatigue, loss of appetite, bloating and constipation (constipation), decreased libido, disruption of the menstrual cycle (amenorrhea), and significant weight loss(cachexia).
Among the already certain symptoms for this disease, but already at an advanced stage, include the following. Indigestion, intolerance to certain foods, pressure in the right upper quadrant tenderness, bloating, rash, abdominal chest – called. Spider nevi, yellowing of the skin, in the last stages of the disease bleeding from the esophagus – based mouth like spitting or vomiting large amounts of blood, symptoms of encephalopathy – a reduction in brain capacity , constructional apraxia (impaired spatial perception – the patient is able to create a simple pattern of matches), tremor of the extremities, enlarged spleen (splenomegaly), portal hypertension (high blood pressure in the veins of the liver – porta or gatehouse is the main vein of the liver), dropsy belly ( ascites).
Hepatic coma – a sudden worsening of cirrhosis leading to unconsciousness often ending in death.
Diagnosis of the disease itself is evident from analysis of blood (liver function tests), ultrasoundexamination of the liver, liver biopsy (biopsy of the liver in removing the sample on
Treatment of cirrhosis of the liver
Treatment is difficult. During the ongoing disease is essentially symptomatic – thus reducing the difficulties – perhaps we can mention only a positive effect called. Hepatoprotektiv – substances that help regenerate liver tissue – eg. Silymarin, which appeared popular medicine – an extract of milk thistle.
It is necessary to remove the effect of factors acting cirrhosis, introduce a complete ban on alcoholliver diet – no fat, spicy foods, and treatment or prevention of viral hepatitis.
In selected cases might liver transplantation. Each transplant preceded by complex testing and rigorous psychological evaluation persons since transplantation is a complex process affecting the patient’s life.
After transplantation must be strictly adhered to various types of diets, do not drink, smoke, and every day the patient must swallow handfuls of drugs that affect the immune system so the body does not destroy the transplanted organ. Because of organs for transplantation is low, this testing must take place if a person is suitable for transplantation. For example, if the transplanted liver alcoholic who would not survive without additional year, and he just after transplantation persists in drinking alcohol, such transplantation ineffective and essentially “unnecessary”.
How can I help myself
Liver cirrhosis is a disease, which is not to be trifled with. Liver cirrhosis is currently becoming a disease with frequent mortality.
It is important to avoid alcohol – Drink alcohol in moderation. Human liver has a high regeneration capability-up to 75%. Therefore, it is possible to transplant the graft and then they “grow” to the desired function. If you already cirrhosis showed immediately stop drinking alcohol – still have a chance to help the liver to regenerate little to prevent the disease coming into the final stage.
Another advice is not to overdo it with strong drugs. But be careful even “ordinary” Paralen is dangerous for the liver. Already ten overdose of aspirin simultaneously destroying his liver toxicity.When untimely intervention of a practitioner occurs within a few hours to liver failure and the failure of the body. This type of overdose is often seen in childhood. Therefore, avoid drugs that do not need a medication, always carefully So keep away from children.
For example, for influenza do not request the doctor antibiotics (ATB) – Influenza is a viral nature and angina or inflammatory diseases are caused by bacteria which are in effect the antibiotic.
Against other risk factors, which are viral hepatitis (A, B, C), must be protected. It is important toobserve hygiene (handwashing – hepatitis A), to avoid contamination with the blood of an infected person and to protect themselves during sexual intercourse appropriate contraception(hepatitis B and C). Today it is possible to protect the vaccination as mentioned above.
Complications of liver cirrhosis
Complications of cirrhosis of the liver, as previously mentioned, are very serious and essentially irreversible. For signs of chronic liver failure – indigestion, weight loss, paradoxically, with a big belly full of water (ascites), bleeding from ruptured esophageal varices (varicose veins of the esophagus), liver scarring, impaired brain function, increased chance of developing liver cancer.
For the biggest complication is considered a form of asymptomatic (without symptoms) disease, which is the true cause of death of a patient comes up after death during autopsy. Since cirrhosis of the liver leads to many other diseases, liver failure, cirrhosis of the liver but is now the primary cause of death.
Other Names: cirrhosis, cirrhosis of the liver, liver cirrhosis, alcoholic cirrhosis, biliary cirrhosis, primary biliary cirrhosis, PBC, cardiac cirrhosis, cryptogenic cirrhosis, idiopathic cirrhosis
