Cirrhosis refers to the long-term action of one or more etiology, hepatocyte degeneration, necrosis, nodular hyperplasia, fibrous tissue hyperplasia and the formation of fibrous septum, normal liver lobules are destroyed and pseudolobules are formed, resulting in smaller and harder livers and decreased function. In the early stage, it is similar to chronic hepatitis, and may have feelings such as loss of appetite, fatigue, bloating, belching, nausea, and right upper quadrant discomfort, and may also have gray face, palm of the liver (redness of the palm of the hand), spider nevi, facial capillary dilation, jaundice and other signs, at this time it is difficult to distinguish from chronic hepatitis, and the diagnosis can be confirmed by pathological biopsy by liver puncture sampling. Liver pathological changes are further aggravated, liver function is further impaired, resulting in cirrhosis into the decompensated phase, portal hypertension, splenomegaly, ascites, manifested by abdominal distension, abdominal swelling, abdominal wall varices, lower extremity edema, hematemesis or melena. Complications of cirrhosis are also evident during the decompensated phase, such as upper gastrointestinal bleeding, spontaneous peritonitis, hepatic encephalopathy, and acid-base hydrolyte metabolism disorders. Disorder, hepatorenal syndrome, etc., the mortality rate of patients has also increased significantly. Laboratory tests at this stage often show decreased liver function, such as decreased albumin, elevated globulin, inverted white/spheroid ratio, elevated bilirubin, elevated transaminases, prolonged prothrombin time, etc.; Ultrasound or CT examination often shows that the liver is smaller in appearance, the surface is not smooth, the liver is uneven, the portal vein is widened (> 13 mm), the spleen is enlarged, and ascites are easily distinguished from chronic hepatitis.
There are many causes of cirrhosis, mainly chronic viral hepatitis B in China; In recent years, with the increase in alcohol consumption, liver cirrhosis due to alcoholism is not uncommon; Other common causes are drugs, malnutrition, long-term liver congestion caused by cardiovascular disease, cholestasis, etc. Because these causes require long-term and sustained effects before cirrhosis occurs, cirrhosis is more common after the age of 40, accounting for about 60% of elderly patients.
prophylaxis
(1) Alcohol abstinence: In addition to some intermediate metabolites in wine (such as acetaldehyde) having a direct toxic effect on the liver, drinking alcohol can also affect the metabolism and nutrition of the liver, causing alcoholic hepatitis, fatty liver, and then developing into cirrhosis. Especially for those who are alcoholics, drinking heavily in a short period of time is more likely to cause liver damage. Therefore, alcohol should be abstained, at least less alcohol should be drunk, and the daily ethanol intake should be controlled below 80 g.
(2) Prevention and treatment of hepatitis B: In various viral hepatitis, hepatitis A generally does not become chronic, rarely causing cirrhosis; Hepatitis C is mainly transmitted by blood transfusion and is less common in China; Hepatitis B is the most common in China, tends to become chronic, and progresses to cirrhosis. Therefore, we must pay attention to the prevention and treatment of hepatitis B. Laboratory hepatitis markers are objective evidence to determine which virus infection, if the hepatitis B virus surface antigen (HBsAg) is positive, it means that the body has been infected with hepatitis B virus, if the transaminases are not high, it can only be said that the person is a virus carrier, did not suffer from hepatitis, this state is not harmful to the liver, but easy to become the source of infection of hepatitis B. If the transaminases are elevated, that is, hepatitis, you should rest in time, eat foods that are easily digestible and high in vitamins and carbohydrates, take liver-protecting drugs, control inflammation, and reduce the occurrence of cirrhosis. Hepatitis B virus is mainly transmitted by blood, such as injections, blood transfusions, trauma, etc., followed by vertical transmission between mother and child, and although close contact with life can also be transmitted, it is rare. Therefore, for uninfected people, that is, the surface antibodies (HBsAb) of the hepatitis B virus are negative, the HBsAg anti-core antibodies (HBcAb), the e antigen and the antibodies (HBeAg and HBeAb) are negative, the hepatitis B vaccine should be vaccinated, so that the body can develop immunity, HBsAb become positive, and avoid hepatitis B. Items used by HBsAg positives should be disinfected or avoided, and a meal sharing system should be implemented. Use a disposable syringe to do one shot per person.
(3) Cautious use of drugs that damage the liver: people to old age, the volume of the liver shrinks, the weight is reduced, the liver blood flow is reduced, the function is reduced, the detoxification and tolerance of toxic substances are reduced, and it is easy to be damaged by drugs that have toxic effects on the liver. Therefore, when taking the drug, we should pay attention to the type and dosage of the drug, observe the side effects of the drug, and once there is loss of appetite, fatigue and jaundice during the medication. Elevated aminotransferases should be stopped in time, drug replacement, and hepatoprotective drugs should be used. Common drugs with greater liver damage are: (1) anti-tuberculosis drugs; (2) Sex hormone drugs; (3) Anticancer drugs; (4) Anesthetics; (5) Sulfonamides; (6) Others: such as inorganic arsenic, carbon tetrachloride, erythromycin. Tetracycline, etc.
(2) Prevention and treatment of extrahepatic diseases that are prone to liver damage: these diseases are often caused by various reasons for increased right atrial pressure, such as chronic right heart dysfunction, pericardial effusion, constrictive pericarditis, inferior vena cava and hepatic vein obstruction syndrome, cholestasis caused by various causes, such as cholelithiasis, bile duct tumors, bile duct stenosis, nutritional disorders, etc.
