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 DEFINITION
The hepatic cirrhosis is a chronic illness of the liver, consisting of the progressive death of the normal hepatic textile and his replacement for fibrous textile, what it takes to:
- incapability of the liver to exercise his functions of detoxificación of the organism (hepatic insufficiency).
- phenomena of bled (coagulopatía).
- pressure increase in the vein carries, that causes liquid accumulation in the abdomen (dropsy) and dangerous dilation of the veins of the esophagus (varicose veins esofágicas), which if they break can produce a severe digestive hemorrhage.
- alterations of the brain, with drowsiness and disorientation due to the ammonia circulation in blood (encefalopatía hepatic).
CAUSES, INCIDENCE AND FACTORS OF RISK
1. Alcohol. Most of the cases of cirrhosis owes to the alcoholism.
2. Other causes:
- chronic infections for virus (hepatitis)
- defects of the biliary routes (biliary obstruction)
- fibrosis quística
- increases in the absorption of iron or of copper, which will settle in the liver.
SYMPTOMS
- Many patients remain without symptoms for years, what delays the diagnosis.
- "Constitutional syndrome": Lacking in appetite, weariness and slimming.
- Morning sickness and vomiting. The vomiting can be of blood when there exist esofágicas varicose veins and/or alterations of the coagulation of the blood.
- Jaundice (yellow Dye of the skin and the mucous membranes due to the excess of circulating bilirrubina).
- Abdominal distension, when dropsy takes place.
- Menstrual alterations in the woman.
- Powerlessness and development of breasts in the man.
- "Vascular chandeliers": Red blood glasses in the skin, doing figures similar to chandeliers.
DIAGNOSIS
Physical examination. A hard liver sometimes increased of size is felt (hepatomegalia) and in other cases of small size. If there is hypertension portal it will be liquid in the abdomen (dropsy) and a developing spleen of size.
Blood test. The red globules are diminish you in the blood (anemia), and there exist alterations of the coagulation and decrease of the albumin in blood. There can rise the bilirrubina and the enzymes of the liver (transaminasas), and when it exists encefalopatía, it usually demonstrate ammonia in blood. The cirrhosis can alter many other analytical tests.
X-ray studies. Although a simple abdomen radiography can show a shaken hepatic silhouette, the most specific test will be an abdominal ultrasound scan, which the desestructuración of the liver will show also, and the big spleen that usually coexists. A radiography with contrast can demonstrate the varicose veins esofágicas. These procedures are painless.
If varicose veins exist esofágicas, they will be visualized by means of the endoscopia.
Hepatic biopsy. It can be necessary to come to the definitive diagnosis of the cirrhosis, since it demonstrates the shaken architecture of the liver. It is a procedure that can turn out to be very uncomfortable.
COMPLICATIONS
- Bled by varicose veins esofágicas.
- Phenomena of bled at other levels.
- Dropsy episodes (abdominal distension for liquid accumulation).
- Mental confusion and comma.
TREATMENT
1. General beginning:
- Absolute alcohol abstention.
- Diet without salt, with supplements of vitamins of the group B and with abundant proteins (except if it exists encefalopatía).
2. Treatment of the complications:
- DROPSY. It talks each other with sodium restriction (diet without salt), medicines diuretics, and sometimes there is necessary the extraction of liquid of the cavity peritoneal across the abdominal wall.
- VARICOSE VEINS ESOFAGICAS. They talk each other by means of the sclerosis of the extensive veins of the esophagus with a chemical substance, preventing so they break and bleed, or placing a few flexible bands. Also they can talk each other with surgery.
- TENDENCY TO THE BLED ONE. It talks each other with vitamin injections K or with blood transfusions.
- ENCEFALOPATIA. To prevent the bacteria of the intestine from making more ammonia from the proteins of the diet, the proteins of the diet are restricted, antibiotics happen for mouth that kill locally the bacteria of the intestine. It is necessary to avoid the constipation with soft laxatives (lactulosa).
PROGNOSIS
It is much better when the alcohol gives in completely, before the illness becomes severe. The advanced cirrhosis has bad prognosis, with 50 % of survival at the age of 2.
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