Cirrhosis – a disease characterized by disruption of the structure of the liver due to the proliferation of connective tissue; manifest functional impairment of the liver.
The main risk factors for cirrhosis is considered to be:
- viral hepatitis
- toxic effects of industrial poisons, drugs (methotrexate, isoniazid, etc.) and other mycotoxins.
- venous stasis in the liver associated with prolonged and severe heart failure
- hereditary diseases – hemochromatosis, hepatolenticular dystrophy lack alfa-one-antitrypsin deficiency, galactosemia, glycogen storage, and others.
- long lesions of the biliary tract
- Approximately 50% of patients with cirrhosis of the liver disease develops due to the actions of a few causal factors (usually hepatitis B and alcohol).
Manifestations of liver cirrhosis
- The complaints of weakness, fatigue, decreased performance and appetite, dyspeptic disorders (nausea, vomiting, bitter taste in the mouth, belching, intolerance to fatty foods, alcohol).
- Characterized by a feeling of heaviness or pain in the abdomen, especially in the right upper quadrant and epigastric region. Among the signs of cirrhosis are important so-called “hepatic signs” in the form of reddening of palms, vascular “stars” (mainly in the skin of the upper half of the body). Often there are hemorrhages in the skin, as well as increased bleeding of mucous membranes.
- There have itchy skin, joint pain, reduce hair in the armpits and pubic area, lower sex drive. The body temperature rises moderately or remained in the normal range.
- Often there is an asthenic syndrome, manifested by weakness, fatigue, irritability, tearfulness, mood instability. Patients impressionable, often touchy, picky, suspicious, prone to hysterical reactions. Characterized by sleep disorder – insomnia at night, sleepiness during the day.
The course of liver cirrhosis are caused by colds, violation of the regime, the use of alcohol.
- The diagnosis of cirrhosis in the early stages presents considerable difficulties because the disease develops gradually and at first does not have pronounced symptoms.
- Essential in recognition of cirrhosis are ultrasonic, radiographic and radionuclide methods. Fairly accurate information about the status of liver cirrhosis can be obtained by computed tomography.
- Radionuclide studies of the liver – scintigraphy is inferior in its informativeness ultrasound and computed tomography, but unlike them it also allows you to evaluate the function of the organ.
- Crucial in the diagnosis of cirrhosis of the importance of the tissue obtained by needle biopsy – a blind or sighting conducted under ultrasound or laparoscopy.
Treatment of liver cirrhosis
Limit the mental and physical stress. With the general good condition recommended therapeutic walking, therapeutic exercises. Women with active liver cirrhosis should avoid pregnancy.
Compensated cirrhosis inactive medication, are generally not required. Furthermore, it should generally limit the intake of drugs, especially sedatives.
When sub- and decompensated forms of choice of drug therapy is determined by the nature of the main manifestations of the disease. In the case of the low protein content in the blood administered anabolic steroids, transfusion and plasma albumin. The presence of anemia is an indication for iron supplementation. When edema and ascites restrict fluid intake, exclude from the diet of table salt, prescribe diuretics (hydrochlorothiazide, furosemide) in combination with aldosterone antagonists (spironolactone). Paracentesis produce for health, releasing simultaneously no more than 3 liters.
Applied also called hepatoprotectors – B vitamins, orotic acid, extracts and hydrolysates liver, silibinin (is legal), Essentiale, and others.
In the case of process activity using the same means as in chronic active hepatitis, the main ones being hormones (prednisone) and immunosuppressants (azathioprine, etc.). Their effectiveness is inversely proportional to the depth of the restructuring of the liver tissue and in advanced stages of cirrhosis of the liver is close to zero.
To prevent infection, all patients with cirrhosis at any intervention (tooth extraction, sigmoidoscopy, paracentesis, and others.) Prophylactically prescribe antibiotics. Antibiotic therapy is also shown even when lung infection.
General advice to patients with liver cirrhosis:
- Rest when you feel tired.
- Do not lift gravity (it can cause gastrointestinal bleeding)
- Achieve stool frequency of 1-2 times per day. Patients with cirrhosis of the liver for the normalization of the intestine and the intestinal flora in favor of “good” bacteria is recommended to take lactulose (Duphalac). Dufalac appointed to the dose that causes a mild poluoformlenny chair 1-2 times a day. The dose varies from 1-3 to 1-3 teaspoons tablespoons a day, chosen individually. There are no contraindications of the drug, it can take even the small children and pregnant women.
- To improve digestion polyenzyme patients prescribed drugs.
- When fluid retention (edema, ascites) necessary to limit the intake of salt up to 0.5 g per day of liquid – up 1000-1500ml per day.
- Daily measure body weight, the volume of the abdomen at the level of the navel (the increase in the volume of the stomach and the body weight of said fluid retention);
- Daily fluid balance count per day (diuresis): calculate the volume of all received into the liquid (tea, coffee, water, soup, fruit, etc.) and count all the liquid released during urination. Fluid levels should be approximately 200-300 mL greater than the amount received liquid.
- To control the degree of damage to the nervous system is recommended to use a simple test with hand: every day write a short phrase such as “Good morning” in a special notebook. Shows its notebook family – when you change the handwriting, contact your doctor.
Diet in cirrhosis
Excluded from the diet:
- mineral water containing sodium;
- salt foods should be prepared without the addition of salt (I use salt-free bread, crackers, biscuits and bread, as well as salt-free butter);
- products containing baking powder and baking soda (cakes, biscuits, cakes, pastries and ordinary bread);
- pickles, olives, ham, bacon, corned beef, languages, oysters, mussels, herring, canned fish and meat, fish and meat pate, sausage, mayonnaise, various sauces and canned all kinds of cheeses, ice cream.
- It is recommended to use in cooking seasoning: lemon juice, orange zest, onion, garlic, salt-free ketchup and mayonnaise, pepper, mustard, sage, thyme, parsley, marjoram, bay leaf, cloves.
Permission is granted to 100 grams of beef or poultry, rabbit or fish, one egg per day (one egg can replace 50 grams of meat). Milk is limited to one glass per day. You can eat low-fat sour cream. You can eat boiled rice (no salt). Resolve any fruits and vegetables fresh or in the form of dishes prepared at home.
Sample menu for the day for a patient with liver cirrhosis:
Breakfast: cereal porridge (semolina, buckwheat, millet, barley, oats) with cream and sugar, or baked fruit. 60 g of salt-free bread or crisp bread (slices), or salt-free crackers with unsalted butter and jelly (jelly or honey), 1 egg, tea or coffee with milk.
Lunch: 60 g of beef or poultry, or 90 g white fish, potatoes, herbs, fruit (fresh or baked)
Snack: 60 grams of salt-free bread or crisp bread, unsalted butter, jam or tomato, tea or coffee with milk.
Dinner: soup without salt, beef, poultry, or fish (for lunch), potatoes, herbs, fruit or fruit juice jelly and gelatin, cream, tea or coffee with milk.