Liver cirrhosis
Liver cirrhosis is the result of chronic liver disease that causes scarring of the liver and liver dysfunction. Cirrhosis is caused by chronic liver disease. Liver cirrhosis can be cured in the early days or may seriously impact life quality and endanger life. Many causes of chronic liver disease include hepatitis C infection, long-term alcohol abuse, hepatitis B, viral hepatitis, japonicum infection, hereditary diseases, circulation obstruction, intestines infection, malnutrition, medications, autoimmune inflammation of the liver, disorders of the drainage system of the liver (the biliary system) and metabolic disorders. The rising trend of prevalence rate is significant.
Clinical phenomena:
â… . Compensated cirrhosis:
You may have no symptoms or fewer symptoms in the early stages of cirrhosis, including: losing appetite, persistent fatigue, vomiting, light pain in the right upper abdomen, diarrhea and so on. Losing appetite and a persistent fatigue are the most typical symptoms. The appearance of those symptoms is intermittent often with fatigue and can be mitigated after having a rest.
Systemic condition is normal and the physical signs are not obvious. Livers have no enlargement or with a little tumefaction. Some patients have splenomegaly and with spider angioma and liver palms. The liver function examination is normal or a little abnormal.
â…¡. Decompensated cirrhosis:
Patients always have two kinds of distinct manifestations. Plasma albumin reducing, dropsy, ascites, jaundice, hepatic encephalopathy and etc. are caused by liver dysfunction. While portal vein obstruction and portal hypertension could lead to splenomegaly, hyperfunction of spleen ascites and so on.
1. Symptoms:
a. Losing appetite and sometimes with vomiting;
b. Weight loss;
c. Tiredness and weakness;
d. Nausea and vomiting;
e. Abdominal pain and always accompanied with jaundice, fever, and liver aches;
f. Nosebleeds and easy bruising;
g. Abdominal distension;
h. Small, red spider-like blood vessels on the skin;
i. Hepatic encephalopathy like sleepiness and excitement.
2. Physical signs:
a. Countenance. Patients always with yellow eyes or skin, red spider-like blood vessels on the skin, reddened palms, contracted fingers and so on;
b. Jaundice. It is a typical sign for liver cells’ serious and obvious damages;
c. Fever. Almost one-third of the patients with liver cirrhosis have irregular low fever. This phenomenon will be disappeared with liver conditions getting better;
d. Venodilation on abdominal wall and dilated abdominal wall veins
e. Ascites. The appearance of ascites means that liver cirrhosis is in advanced stage. Infections, upper gastrointestinal hemorrhage, portal vein thrombosis and surgical are the inducements of ascites. Ascites forms rapidly and difficult to subside.
f. Hydrothorax. Patients with cirrhosis ascites always have pleural effusion of right cavity.
g. Splenomegaly. It is often median size. When digestive tract bleeding complicates with splenomegaly, spleen may shrink.
h. Liver conditions. Liver surface is smooth, medium hardness and may get swelled in early cirrhosis, while in the late stage, liver is shrunken and stiff. The size, rigidity and smooth level of liver are related to the degree of fatty infiltration, liver cells regeneration, fibroustissue hyperplasia and contraction degree.
i. Reproductive endocrine dysfunction.
j. Bleeding. Petechia, ecchymosis and haematoma are often on skin.
k. Nutrition deficiency. Symptoms are emaciation, anemia, pachylosis, dropsy, angular stomatitis, pale nail, and polyneuritis etc.
Complications:
As Liver cirrhosis progresses, it often has many complications.
1. Bleeding in the stomach or in the esophagus. This is the most common complication.
2. Hepatic encephalopathy. This is the most usual death cause.
3. Hepatorenal syndrome. Patients with Liver cirrhosis often present with functional renal failure and this resulted from blood deficiency insufficient effective circulating blood volume.
4. Bacterial infections. Liver cirrhosis is complicated with various infections easily like bronchitis, pneumonia, tuberculous peritonitis, bile tract infection, intestines infection, spontaneous peritonitis and septicemia etc.
5. Portal vein thrombosis. It has the relationship with slow bleeding in portal vein, portal vein cirrhosis and portal vein intimitis etc.
6. Respiratory system damages. In recent years, many scholars called various kinds of lung changes that caused by liver diseases as hepatopulmoary syndrome. The essence of it is the hypoxemia that resulted from abnormal exangia and artery ocygenation in lung.
7. Primary liver cancer. The combination rate of liver cancer and Liver cirrhosis is 84.6%. It shows an intimate relationship between the two diseases.
Diagnosis:
The doctor will start with a physical exam and questions about your symptoms and past health. If the doctor suspects cirrhosis, you may have blood tests and imaging tests, such as an ultrasound or CT scan. These tests can help your doctor find out what is causing the liver damage and how severe it is.
1. With the history of virus hepatitis, long-term use of alcohol, long-term malnutrition, schistosomiasis and chemical drug poisoning etc.
2. Symptoms. Symptoms in compensated cirrhosis are losing appetite, persistent fatigue, ascites, vomiting, diarrhea, slight hepatosplenomegaly, vascular nevi and so on. Ascites, bleeding tendency, jaundice, liver palms, splenomegaly and hepatatrophia are the clinical features in the advanced stage (decompensated cirrhosis) of cirrhosis.
3. Liver function examination. Livers function is normal or a little abnormal in the compensated period while dysfunction of liver is obvious in decompensated period. The symptoms include decreasing plasma albumin, increasing globulin and the obvious increasing of protein electrophoresis γ-globulin.
4. Blood image examination. White cells and blood platelets are reducing in the body of patients with hypersplenism. And with it progresses, whole blood cells may decrease seriously.
5. Esophagogram and endoscopic examination. Use these two methods to check whether there is varicosity in stomach and oesophagus or not.
6. B- ultrasound. To check the change of liver size, surface and shape, portal vein, ascites and spleen volume enlargement.
7. Hepatic histology examination. Diseases can be diagnosed according to the formation of fibrous septa or mixed nodular hyperplasia.
Treatments:
Treatment is directed at managing the complications of cirrhosis and preventing further liver damage, so it is important to get treated for cirrhosis as soon as possible.
1. Persons with cirrhosis often begin to experience difficulty digesting and absorbing fat, so it important to get rid of high fat foods. Patients with cirrhosis tend to better tolerate the protein from dairy and plant sources than from meat sources, and therefore may benefit from a more vegetarian type diet. At this stage the diet is generally high in complex carbohydrates (breads, cereals, grains, legumes, dried beans and peas, pasta, rice). These foods are important because they provide our bodies blood glucose. It is important that you do not take vitamins or minerals not prescribed by your doctor as toxicity can occur with overdosing. Sodium typically needs to be restricted with cirrhosis. Unfortunately for many salt lovers, this means learning to enjoy the taste of foods without salt.
2. Improving liver function. Abnormal transaminase and bilirubin are signs for liver cells damage.
In accordance with hepatitis curing principle, it should be gave the combined traditional Chinese medicine and western medicine therapy.
3. Therapy of anti-hepatic fibrosis. Using the drugs that can promote liver cells’ growth to cure fibrosis and early cirrhosis.
4. Active prevention and treatment of complications. Decompensated cirrhosis often has many complications and may lead to severe results. Complications include esophageal and gastric varices, ascites, hepatic encephalopathy and combined infection etc. According to one’s personal situation, patients should choose an effective method for curing.
Medical treatment of Liver cirrhosis:
â… . General treatments:
1. Rest. Patients with compensated cirrhosis can join few activities and pay attention to keep a proper balance between work and rest, while patients in the advanced stage should rest in bed.
2. Diets. It should be full of nutrition and easy to digest. The foods are generally with high protein, high caloric, high vitamin and low fat. Patients with ascites must take less salt. Do not drink any alcohol. If you don't stop completely, liver damage may quickly get worse. Follow a low-sodium diet. This can help prevent fluid buildup, a common problem in cirrhosis that can become life-threatening.
3. Supporting treatment. Patients in decompensated period are treated with supporting therapy. Persons who have the symptoms like nausea, vomiting, eating less or aphagia should take intravenous injection of glucose with vitamin C, potassium chloride, inosine, insulin and so on. Attentions should be paid on keeping balance among water, electrolyte and acid-base, and the potassium supplementation is also worthy for us to notice.
â…¡. Medication: (The miracle drugs were always no found, the treatment ways were also different according to the different patients)
1. Vitamin supplementation. Vitamin C, vitamin E and B-group vitamins can protect liver cells and improve liver cells metabolism and yeast pills have the same efficacy too. Patients also can take vitamin K, vitamin B12 and folacin conditionally.
2. Medicines for protecting liver cells.
3. Chinese traditional medicine. Chinese medicine has unique opinions on the treatment of chronic hepatitis. So a combined therapy of Chinese traditional and western medicine can achieve desired medical effects.
â…¢. Treatments of ascites: (The degree of difficulty or easiness to the treatments of ascites depends on the duration of ascites and degree of liver damage. So the basic measure is improving liver function such clinic rest, more nutrition and supporting treatment etc.)
1. Restriction of sodium intaking. Limitation of water intake and therapy for adding salt are safe and effective in the treatment of hyponatremia. The daily intake of water is1000ml approximately. Patients with obvious hyponatremia should limit the water intaking in 500ml and intakes of sodium between 10 to 20mmol per day.
2. Increase of sodium discharging.
a. Diuretic. Ascites is treated with diuretics, fluid and salt restriction, and removal of fluid (paracentesis). Use principles for diuretic are joint, intermittent and alternating. A suitable dosage and moderate diuretic speed should be given to avoid serious side effects like hepatic coma and hepatorenal syndrome. Attentions should be paid on keeping balance among water, electrolyte and acid-base.
b. Catharsis. When the effect of using diuretic is poor, patients can take Chinese traditional medicine or mannitol to excrete water via gastrointestinal tract and this is generally without serious side effects. This method is suitable for the patients complicated with alimentary tract bleeding, diluted hyponatremia or functional renal failure.
3. To increase the plasma colloid osmotic pressure. Patients should be gave a regular, frequent and small intravenous infusion of fresh blood, plasma or albumen every week. This can improve body status, recover liver function, increase the plasma colloid osmotic pressure and decrease ascites.
4. Abdominal Paracentesis and ascites concentration and reinfusion
Surgical treatment of Liver cirrhosis:
â… . Surgical therapy of ascites
Abdominal- jugular vein drainage (Leveen drainage operation). It is one of the most effective surgical methods of curing schistosomiasis liver fibrosis by increasing the blood capacity, improving renal blood flow and supplying protein etc. Patients with ascites infection or suspected cancer ascites can not adopt this mthod.
â…¡. Surgical treatment of portal hypertension and hypersplenism
Using a variety of drainage operations and splenectomy to reduce the pressure of the portal vein and eliminate hypersplenism
â…¢. Liver transplant
If cirrhosis progresses and becomes life-threatening, a liver transplant should be considered.
Liver transplant is a surgery to replace a diseased liver with a healthy liver. Liver transplants have become common operations worldwide.
A healthy liver is usually obtained from a donor who has recently died, but has not suffered liver injury. The donor liver is transported in a cooled saline solution that preserves the organ for up to 8 hours, thus permitting the necessary tests for donor-recipient matching. The diseased liver is removed through an incision in the upper abdomen. The donor liver is put in place and attached to the patient's blood vessels and bile ducts. The operation may take up to 12 hours and requires a large amount of transfused blood. In some cases, a living donor may donate a section of liver for transplant to someone else, often a family member or friend. This poses some risk to the donor because of the nature of the operation, but since the liver can regenerate itself to some extent, both parties usually end up with fully functioning livers after a successful transplant.
A liver transplant may be recommended for patients with liver damage (such as cirrhosis or primary biliary cirrhosis), long-term active infection (hepatitis), hepatic vein clot (thrombosis), birth defects of the liver or bile ducts (such as biliary atresia), metabolic disorders associated with liver failure. While liver transplant surgery is not recommended for patients who have heart, lung, or kidney disease, diabetes mellitus or other life-threatening diseases
Liver transplants can save the lives of people who might otherwise die. Approximately 75% of patients survive 3 years or more after the transplant. Major problem with liver transplant is finding a healthy liver.
Liver cirrhosis VS YHK
When YHK rapidly reduces the value of GPT（ALT）and GOT（AST）, it can also effectively restrain the fibrosis of liver cell. In Japanese clinical research, we have a liver puncture test on three hepatocirrhosis patients. The result shows, a patient’s fibrosis degree improved from F2 to F0~1 (0--without fibrosis, 1--fibering expansion of portal vein region); another patient’s inflammation condition of liver is improved from A2 (medium degree putrescence) to A0 (normal); the condition of the third patient was not improved obviously. We suggest him to continue to take YHK.
