Liver Cirrhosis - The First Signs And Symptoms Of Liver Cirrhosis In Men And Women, Stages And Causes Of Development

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-17 02:10

The first signs and symptoms of liver cirrhosis, causes, how to treat?

Content:

• What is liver cirrhosis?
• The first signs of liver cirrhosis
• Other symptoms of liver cirrhosis
• Causes of liver cirrhosis
• Stages of liver cirrhosis
• Child drink classification of liver cirrhosis
• Consequences and complications of liver cirrhosis
• Diagnosis of liver cirrhosis
• Can cirrhosis of the liver be cured?
• How is cirrhosis of the liver treated?
• Do you have disability in liver cirrhosis?
• Prevention of liver cirrhosis

What is liver cirrhosis?

Cirrhosis of the liver is an extensive lesion of an organ, in which tissue death occurs and their gradual replacement with fibrous fibers. As a result of replacement, nodes of various sizes are formed, which radically change the structure of the liver. The result is a gradual decrease in the functionality of the organ up to a complete loss of performance. This leads to a deterioration in the quality of life of the patient and his further death.

It is the liver that cleanses the body of harmful substances, synthesizes fats, carbohydrates, proteins, participates in digestion, produces albumins, etc. Therefore, the defeat of the hepatic lobules, consisting of hepatocytes, and their degeneration is a formidable disease for the body of both men and women …

This disease is widespread throughout the world. According to the latest data, every year up to 300 thousand people die from this pathology, and the increase in mortality is steadily growing. Despite all the advances in medicine, over the past 10 years, the frequency of deaths from cirrhosis has increased by an impressive figure - 12%. In addition, the same percentage of people with chronic alcohol addiction have a history of the disease, but it is asymptomatic.

More often, pathology is diagnosed in men than in women. There is no strict age limit, but the disease predominantly affects people aged 40 and over.

How long can you live with liver cirrhosis?

The disease has a different prognosis. With adequate treatment, which was started in a timely manner, it is possible to stop the progression of the pathological process. The presence of concomitant diseases, complications, human lifestyle, stage of cirrhosis also plays a role.

With the remaining functional capabilities of hepatocytes, if a person revises his lifestyle and adheres to the therapeutic regimen prescribed by a doctor, the survival rate for seven or more years is 50% of the total number of patients. Such a favorable prognosis is advisable for the compensated form of the disease.

In the subcompensated form, the average life expectancy is about 5 years. This is due to the fact that hepatocytes are gradually depleted and their number becomes insufficient for the normal functioning of the organ.

Among patients at the stage of decompensation, no more than 40% of people live for three years. This is due to the development of serious complications that are often incompatible with life.

In addition, there are specially developed systems for calculating the prognosis for survival in cirrhosis according to certain criteria. Among these are the Child-Pugh prognostic system, the Cox proportional risk model, and others. All of them are based on certain indicators of the health of a person with cirrhosis (the etiology of the disease, the effectiveness of treatment, the presence of jaundice, neurological disorders, ascites, enlarged veins of the esophagus, etc.) and make it possible to make a more or less correct prognosis in each case.

The first signs of liver cirrhosis

It is not always possible to suspect the presence of a disease by early signs, since in 20% of cases it proceeds latently and does not manifest itself in any way. Moreover, in 20% of patients, pathology is found only after death. Nevertheless, in the remaining 60%, the disease still manifests itself.

Therefore, among the early symptoms indicating cirrhosis, the following can be noted:

• Recurrent pain with localization in the right hypochondrium. They tend to grow after intense physical exertion or after eating fatty and fried foods, alcoholic beverages;
• A feeling of bitterness and dryness appears in the mouth, especially often in the morning;
• A person may be disturbed by recurrent stool disorders, increased flatulence;
• The patient loses some weight, becomes irritable, gets tired faster;
• Some forms of the disease, for example, postnecrotic cirrhosis, manifest themselves in the form of jaundice already in the early stages of development.

In some cases, the disease manifests itself acutely and there are no early signs.

Other symptoms of liver cirrhosis

The main symptoms of the disease increase as it progresses:

• The pain in the right side increases due to the expansion of the liver capsule, and may have the character of colic. With concomitant hypokinetic dyskinesia, they grow, become aching, accompanied by a feeling of heaviness;
• The patient experiences bouts of nausea, often accompanied by vomiting. Vomit may contain blood impurities, which indicates bleeding from the veins of the stomach and esophagus;
• In connection with the accumulation of excess bile acids in the blood, the patient develops itching of the skin;
• There is a loss of body weight, up to exhaustion;
• Decreased muscle tone, muscle atrophy;
• Acquisition of an icteric tint by the skin, its peeling. Severe jaundice is a sign of the final stage of the disease. First, the sclera of the eyes, mucous membranes of the oral cavity, palms and soles are stained, and then the whole body. This is due to the inability of hepatocytes to metabolize bilirubin;
• The appearance of xanthelasm - spots with a lipid component, localized mainly in the upper eyelids;
• The fingers thicken at the ends, take the form of drumsticks, the skin around the nail holes turns red;
• The joints become swollen and painful;
• The veins in the abdomen are dilated;
• On the upper part of the body, doctors find spider veins. A characteristic feature of cirrhosis is that telangiectasias never form below the umbilical zone. During the acute stage of the disease, the stars become larger, they look very noticeable;
• The edge of the nose and the corners of the eyes are covered with angiomas;
• Redness of the palms, less often the feet;
• The tongue swells, takes on a bright color;
• In men, mammary glands begin to grow, and the functions of the genitals atrophy. Secondary sexual characteristics are reduced: pubic hair falls out, in the armpits;
• Ascites is one of the late complications of cirrhosis, characterized by the accumulation of fluid in the abdominal cavity;
• The face takes on an unhealthy shade, cheekbones are clearly prominent, the salivary glands swell at the same time, the capillaries on the face expand, giving it a red color;
• The limbs grow thin, the stomach, on the contrary, protrudes forward;
• Nosebleeds are common;
• The spleen is enlarged;
• Obvious disturbances from the nervous activity appear: the patient suffers from insomnia and deterioration of memory function. There is tremor of the limbs, indifference to what is happening around.

Causes of liver cirrhosis

Among the main reasons leading to the development of the disease are:

• Viral hepatitis, which, according to various estimates, leads to the formation of liver pathology in 10-24% of cases. The disease ends with such varieties of hepatitis as B, C, D and recently discovered hepatitis G;
• Taking large doses of alcohol for 10 years or more. There is no dependence on a specific type of drink, the fundamental factor is the presence of ethyl alcohol in it and its regular intake into the body;
• Immune system disorders. Many autoimmune diseases lead to the development of cirrhosis;
• Various diseases of the biliary tract, including extrahepatic obstruction, cholelithiasis and primary sclerosing cholangitis;
• Portal hypertension;
• Venous congestion in the liver or Budd-Chiari syndrome;
• Hereditary diseases, in particular, genetically determined metabolic disorders (anomalies of glycogen accumulation, Wilson-Konovalov disease, a1-antitrypsin and galactose-1-phosphate-uridyltransferase deficiency);
• Poisoning with chemicals that have a toxic effect on the body. Among such substances, industrial poisons, salts of heavy metals, aflatoxins and mushroom poisons are especially harmful to the liver;
• Long-term use of drugs, including Iprazide, anabolic steroids, Isoniazid, androgens, Methyldopa, Inderal, Methotrexate and some others;
• The rare Randu-Osler disease can also cause cirrhosis.

In addition, it is worth mentioning separately about cryptogenic cirrhosis, the causes of which remain unclear. It occurs in the range of 12 to 40% of cases. The provoking factors in the formation of scar tissue can be systematic malnutrition, infectious diseases, syphilis (it is the cause of cirrhosis in newborns). The combined effect of etiological factors, for example, a combination of hepatitis and alcoholism, significantly increases the risk of developing the disease.

Stages of liver cirrhosis

The disease goes through several stages of development, each of which has certain clinical symptoms. Not only the condition of the person, but also the therapy required by him will depend on how much the pathology has progressed.

1 stage of liver cirrhosis

At this stage of development, the disease practically does not manifest itself in any way. If it is detected at this time, then it is still quite possible to compensate for the insufficiency of hepatocytes with the help of drugs. Therefore, doctors call the initial stage of the disease compensatory.

Despite the fact that the patient does not observe any clinical signs, changes in the organ have already begun. If you do not start timely treatment, then cirrhosis will rapidly progress and, after a short time, the liver will no longer be able to cope with its functions in full. As for laboratory parameters, the level of bilirubin in the blood rises, and the prothrombotic index can fall to 60. But at the same time, the person feels absolutely healthy. He only occasionally can be bothered by pain in the right hypochondrium.

It is precisely because cirrhosis can be suspected by laboratory indicators that a regular preventive examination by a doctor is so necessary.

Stage 2 liver cirrhosis

The next stage is called subcompensated. Based on the name, one can understand that there is a more pronounced decrease in the functional capabilities of the organ, which is due to an increase in the number of dead hepatocytes.

At this stage, a person is able to notice that something is happening with his body. He begins to suffer from weakness, apathy, decreased performance, nausea, weight loss and other early symptoms of the disease. In men, already at this stage, the first signs of gynecomastia appear.

As for laboratory parameters, the level of albumin begins to fall, and the prothrombotic index can reach 40. However, if treatment is started on time, it is still possible to transfer this stage to the stage of compensation. That is, with proper intake of medicines, the diseased organ will be able to function without complications for human health.

Stage 3 liver cirrhosis

The danger is the 3rd stage of the disease, because there are critically few functioning hepatocytes. This causes the progression of liver failure and an increase in the symptoms of the disease. The skin becomes jaundiced, abdominal pains bother the person more and more. Often, it is at this stage that ascites develops, which can no longer pass on its own.

Albumin level and prothrombotic index fall to critical values.

Treatment at this stage is already ineffective, although there is still a chance that medications will help cope with the disease. The patient should be in the hospital under the supervision of doctors, since this stage is characterized by a pronounced metabolic disorder.

The danger is represented by the complications of the disease, which may well become the cause of death. Among the most formidable are hepatic coma, liver cancer, internal bleeding, peritonitis, and pneumonia. This stage is called terminal.

4 stage of liver cirrhosis

The final stage of the disease is characterized by the fact that the tissues of the organ are so damaged that they are no longer able to cope with the tasks assigned to them. The pains are very strong, the patient is prescribed constant intake of strong painkillers.

It is impossible to stop the progression of the disease at this stage. The prognosis is usually poor, and without a liver transplant, the patient dies from severe complications.

Child-Pugh classification of liver cirrhosis

There is an opportunity to assess the severity of the course of the disease according to the classification proposed by doctors Child and Pugh. It is based on the assignment of a certain number of points for each symptom of the disease. Experts have distributed the prognosis for survival in three classes: A, B and C. Each class has its own percentage, which depends on the number of points scored.

1 point is given for each of the parameters if the patient has:

• Ascites is not observed;
• Bilirubin is less than 34 μmol per liter;
• Hepatic encephalopathy is absent;
• The prothrombotic index is more than 60, or the prothrombin time is in the range from 1 to 4, or the INR is less than 1.7.

2 points for each of the parameters are set if:

• Ascites is treatable;
• Bilirubin is not more than 50 μmol per liter;
• Albumin not less than 2.8;
• There is mild and controllable hepatic encephalopathy;
• PTI not less than 40, or PTV from 4 to 6, or INR does not exceed 2.2.

3 points are awarded for each of the parameters:

• Poorly controlled ascites
• Bilirubin more than 50;
• Albumin less than 2.8;
• Grade 3 or 4 hepatic encephalopathy and difficult to control;
• PTI less than 40, or PTV more than 6, or INR more than 2.2.

Estimated parameters

Child Pugh Group
A (1 point)	B (2 points)	C (3 points)
Plasma total bilirubin, μmol / L (mg / dL)	<34 μmol / L (<2 mg / dL)	34-50 μmol / L (2-3 mg / dL)	> 50 μmol / L (> 3 mg / dL)
Plasma albumin, g	> 3.5 g	2.8-3.5 g	<2.8 g
Ascites	Absent	Controlled by treatment	Poorly controlled
Hepatic encephalopathy	Absent	Grade I – II (mild, therapeutically controlled)	Grade III – IV (severe, poorly controlled)
Prothrombin index (PTI),% (or) Prothrombin time (PTT), s (or) International normalized ratio (INR)	60% 1-4 s 1.70	40-60% 4-6 s 1.71-2.20	<40% 6 s 2.20

Scoring

Scoring and totals:

1. If the patient gains from 5 to 6 points, then the one-year survival rate is 100%, and the two-year survival rate is 85%.
2. When a patient gains from 7 to 9 points, he is assigned to class B: a one-year survival rate is 81%, and a two-year survival rate is 57%.
3. Grade C equates to a range of 10 to 15 points and the prognosis worsens significantly. The one-year survival rate is 45% and the two-year survival rate is 35%.

It should be understood that this assessment system is indicative, and it is not able to take into account other parameters of the disease, such as, for example, varicose veins of the stomach and esophagus.

Consequences and complications of liver cirrhosis

The disease is dangerous for a person by the development of serious complications, which most often become the cause of death:

• The development of ascites, that is, the accumulation of fluid in the abdominal cavity;
• The onset of peritonitis, that is, inflammation of the peritoneum;
• Varicose veins passing through the esophagus or stomach, and, as a result, the development of internal bleeding. Among the symptoms characterizing the onset of such bleeding are the occurrence of vomiting with blood impurities, staining of feces in black, a drop in blood pressure and a pronounced increase in heart rate;
• Hepatic encephalopathy;
• Loss or confusion of consciousness;
• Development of a malignant tumor (carcinoma), which is difficult to treat and progresses rapidly;
• Hepatorenal syndrome, characterized by renal failure;
• A drop in blood oxygen levels or hepato-pulmonary syndrome;
• Hepatic gastropathy - disorders of the stomach;
• Hepatic colopathy - intestinal dysfunction;
• The impossibility of procreation is infertility.

Diagnosis of liver cirrhosis

A doctor cannot make such a serious diagnosis without conducting a comprehensive examination of the patient. First of all, the patient will need to donate blood for biochemical analysis. If the results alert the doctor, he will send the patient for further diagnosis.

Conducting a coagulogram will show whether there are disorders of the blood coagulation system. A complete blood count will reveal the level of hemoglobin, which, as a rule, is low in patients with cirrhosis. Anemia is often diagnosed. In addition, the number of leukocytes and platelets is markedly reduced.

To exclude or confirm the viral nature of the disease, the patient needs to be tested to detect hepatitis - A, B, C, D and G. To find out about the presence of latent bleeding in the gastrointestinal tract, a fecal occult blood test will help.

Renal failure is measured by electrolyte and creatine levels. If there is a suspicion of liver cancer, then the patient will need to donate blood for alpha-fetoprotein.

In addition, it is necessary to conduct ultrasound of all abdominal organs and portal vessels. It is important to determine the presence of ascites and an enlarged spleen.

With the help of esophagogastroduodenoscopy, the doctor will make a conclusion about the existing varicose veins of the esophagus and stomach.

A liver biopsy will help to clarify the diagnosis and determine the stage of development of the disease. If necessary, the doctor sends the patient for a liver scintigraphy or CT scan.

Biochemical parameters of blood in liver cirrhosis

As a rule, an experienced doctor is able to suspect a disease based on only one analysis - blood biochemistry. Indicators for cirrhosis change according to a certain scheme: there is an increase in the level of bilirubin, hepatic transaminases (not higher than 40 IU), alkaline phosphatase (should not be higher than 140 IU), globulins, prothrombin time, haptoglobin, specific liver enzymes. Against this background, there is a drop in albumin (less than 40 g per liter), prothrombin, urea (less than 2.5 μmol), cholesterol (less than 2 μmol).

The increase in the level of bilirubin in cirrhosis is especially indicative, since this substance is a product of the breakdown of erythrocytes and hemoglobin and must be processed by the liver. When the functionality of the organ is impaired, bilirubin begins to circulate in excess in the blood. This leads to staining of feces in a yellow-green color, as well as to yellowing of the skin, mucous membranes and whites of the eyes. Therefore, the total bilirubin normally should not exceed 20.5 μmol per liter, free - 17.1, and bound - 4.3. As the disease progresses, these numbers can grow several times.

Can cirrhosis of the liver be cured?

Most patients, having heard a terrible diagnosis from a doctor, quite reasonably ask the question: is it possible to completely get rid of the disease? Modern medicine does not have such opportunities. The only option for radical treatment is to transplant the donor organ. However, liver transplantation is not suitable for every patient and it costs a lot of money.

Nevertheless, do not despair, because if the disease was detected in the early stages, then it is quite possible to stop its progression thanks to adequate therapy. In the event that cirrhosis is detected in the later stages, doctors may be able to somewhat slow down the progression of the disease and delay the onset of complications.

Scientists are still trying to develop a drug that can get rid of cirrhosis. But so far, official medicine has not announced a single remedy that can completely cure a person. However, it is quite possible to transfer cirrhosis to the category of controlled chronic diseases.

How is cirrhosis of the liver treated?

As for the treatment, it is selected strictly individually in each case. However, there are certain criteria that apply to the treatment of the disease. So, the compensated stage of cirrhosis needs to eliminate the main cause that led to the development of pathology. The patient is prescribed drugs for the treatment of hepatitis, attempts are made to relieve him of alcohol dependence, etc. In addition, it is necessary to reduce the risk of complications that can aggravate the course of the disease.

The patient must adhere to a diet with an optimal protein and carbohydrate content. It is important to exclude any kind of alcohol, harmful products. All medications are used only as prescribed by a doctor, their intake should be due to vital necessity.

As a rule, physiotherapeutic procedures, physical activity, and heat treatment are not recommended for the patient. Not a single traditional medicine can be used without first consulting the treating doctor.

If a patient asks for help at the stage of decompensation, then he undergoes treatment in a hospital, which is due to the high risk of complications. The main goal pursued by any doctor during this period is to stop the progression of the disease. For this, drugs are used, which are selected according to an individual scheme and depend on the form of cirrhosis.

Perhaps the appointment of hepatoprotectors, ursodeoxycholic acid preparations, nitrates and b-blockers.

Liver transplant for cirrhosis

The only radical treatment is transplantation of the damaged organ. The operation is carried out in the event that the own liver is unable to cope with the functions assigned to it, and conservative therapy is powerless.

The donor organ is removed from a deceased person who, during his lifetime, did not write a refusal to such a removal, although the laws in different countries are different. Since the operation is quite complex and subsequently requires lifelong administration of immunosuppressive drugs, it is not performed in the early stages of cirrhosis.

Among the indications for transplantation are the following:

• Internal bleeding, not amenable to drug correction;
• Ascites not responding to treatment;
• The fall of albumin below the 30 g mark;
• The increase in prothrombin time is above 17 s.

These indicators are a direct threat not only to health, but also to the patient's life, therefore, they require organ transplantation. However, the list of contraindications is not shorter, including the presence of an infectious process, severe pathologies of the heart and lungs, any malignant tumors with metastases, brain damage, age over 60 years old or under 2 years old, obesity, etc.

The operation itself lasts at least 8 hours, it consists in removing the damaged organ and transplanting a healthy one. It is possible that only part of the liver will be transplanted from the donor. As for the prognosis after transplantation, it is quite favorable, although certain risks still exist, for example, liver rejection, hepatic artery thrombosis and others. The survival rate for the next five years is 75%, which is a good indicator given the severity of the disease, with about 40% of people living with a foreign organ for more than 20 years.

On the subject: Treatment of liver cirrhosis with folk remedies

Do you have disability in liver cirrhosis?

Disability registration with this disease is possible. The group that will be assigned to a person depends on the severity of the course of cirrhosis and its stage. As a rule, when diagnosing the first stage of the disease, the patient is assigned the 3rd disability group. If cirrhosis has reached the stage of decompensation, then the person will be assigned the 2nd disability group. When the disease is in the terminal stages, the first group is assigned to the person.

To receive help from the state, the patient will need to go through a special commission to which he will be referred by the treating doctor.

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Prevention of liver cirrhosis

Cirrhosis is a disease that can be completely avoided if you adhere to certain preventive measures, including:

• Treatment of hepatitis with the help of a qualified hepatologist and adherence to the prescribed therapeutic regimen;
• Limitation of self-administration of medicines, avoidance of work in hazardous industries;
• Taking vitamin and mineral complexes;
• Compliance with a diet, refusal of fatty, fried and spicy foods, from canned foods and semi-finished products;
• Quitting bad habits, in particular, alcohol abuse;
• Preventive measures aimed at preventing hepatitis infection;
• Annual endoscopic examination of the gastrointestinal tract;
• Compliance with personal hygiene and the use of personal care products;
• Vaccination against viral hepatitis B.

The author of the article: Kuzmina Vera Valerievna | Endocrinologist, nutritionist

Education: Diploma of the Russian State Medical University named after NI Pirogov with a degree in General Medicine (2004). Residency at Moscow State University of Medicine and Dentistry, diploma in Endocrinology (2006).