Diagnosis of liver cirrhosis

Often people who feel soreness in the right hypochondrium are asked how to determine cirrhosis at the initial stage. But unfortunately, the disease initially occurs almost without symptoms, and signs appear when the gland has already increased in size.

In order to protect the liver from a chronic disease, it is necessary to eat properly, lead an active lifestyle and undergo preventive medical examinations that will help to see a malfunction of the liver.

Cirrhosis of the liver( transformation of parenchymal tissue into pathological connective) is a common disease, which is the final stage of a number of chronic liver diseases. The diagnosis of "cirrhosis of the liver" is made, taking into account the history of the disease, physical examination, functional tests, laboratory and hardware research.

What indicates cirrhosis of the liver

Cirrhosis of the liver is often preceded by viral hepatitis B and C, and the disease develops against the background of alcohol abuse. Pathology can also develop against a background of chronic autoimmune hepatitis, sclerosing cholangitis, bile stasis, narrowing of ducts, cystic fibrosis, glycogenosis, galactosemia, Wilson's disease, chronic heart failure, hepatotoxic drugs, intestinal surgery, intestinal parasitic invasion and liver.

If a person regularly consumes ethyl alcohol, the probability of cirrhosis within 5-10 years is 35%

Therefore, in the diagnosis of cirrhosis of the liver, it is very important to study the patient's anamnesis. Symptoms of cirrhosis depend on the etiology of the disease, the rate of flow and the degree of organ damage. About 20% of patients at an early stage of the process do not notice any signs of the disease, while others mention only increased gas production and reduced efficiency.

As the tissue degenerates, temporary dull pain in the right side, which occurs after drinking alcohol or heavy food, is added and does not go away after taking antispasmodics. Signs of stagnation of bile are rapid saturation and itching of the skin.

In some cases, nasal bleeding opens and heat begins. With the progression of the disease, jaundice and signs of portal hypertension, varicose hemorrhages from hemorrhoidal and esophageal veins are detected, and the amount of fluid( ascites) increases in the abdominal cavity.

For patients with cirrhosis, the following symptoms are typical:

• "drumsticks"( phalanx of the fingers thickened);
• "watch glass"( changing the nail plate);
• palmar erythema( red palms);
• "spider veins"( thin vessels are visible through the skin of the face and body).

In men, sometimes a decrease in testes and breast augmentation( gynecomastia)

Thus, to presume cirrhosis of the liver the doctor can already at the first examination of the patient, after studying his medical history. In the late stages of cirrhosis, even the appearance of the patient changes, which can serve as an indirect sign of the development of pathology.

After the patient is questioned about his medical history, complaints and lifestyle, the physician conducts a physical examination, which includes palpation and percussion of the abdominal cavity, examination of the skin. Upon examination, the doctor notes yellowing of the skin and sclera, weight loss, capillaries on the body and face, abdominal veins, enlarged abdomen, swelling of the legs, redness of the palms, red rash.

The severity of these signs depends on the degree of the disease and at an early stage they may be absent altogether. When probing and listening to the abdominal cavity, the doctor may notice:

• hepatosplenomegaly;
• decreased muscle tone of the abdominal wall;
• change in the contour of the liver and spleen during percussion;
• a dull sound when tapping.

When probing the liver, the doctor receives a lot of information, since the enlargement of the gland is characteristic even for the initial stages of the pathology. In the stage of decompensation, the organ is already enlarged considerably and protrudes beyond the edge of the costal arch by two centimeters. The doctor feels by touch that the gland is too dense and uneven due to the formed nodules.

For a patient, palpation of the liver is painful.

. What are the analyzes of

. Blood tests for liver cirrhosis show a deficiency of hemoglobin, leukocytopenia and thrombocytopenia, which indicates a pathological increase in the gland. Coagulogram notes a decrease in the prothrombin index, that is, the blood is curled more slowly than normal.

In blood biochemistry, increased activity of liver enzymes( alkaline phosphatase, Alt, AsT), increased total and direct bilirubin, potassium, sodium, as well as urea and creatinine, decreased albumins. Additionally, liver cirrhosis assays for antibodies to viral hepatitis, and the content of alpha-fetoprotein is determined.

According to the blood test, it is possible to presume a diagnosis and determine the degree of compensation. To confirm primary biliary cirrhosis, the level of liver enzymes, cholesterol, antimitochondrial antibodies is checked, and a biopsy of the gland is also required. In the urine, the patient displays protein and red blood cells.

Diagnostic tests for diagnosis of

Diagnosis of cirrhosis only on the basis of patient complaints, its medical history and laboratory blood tests can not be done, because the same data can be obtained with completely different pathologies of the biliary system, and the characteristic signs of cirrhosis develop with significant liver damage.

Hardware diagnostics can also detect the cause of the disease, which is important for determining the

treatment regimen. Differential diagnosis is performed between cirrhosis and cancer. The diagnosis is verified and confirmed by ultrasound, laparoscopy and biopsy. If cirrhosis has led to liver cancer, then pathology can be distinguished only with laparoscopy.

Also, the symptoms of cirrhosis are similar to a parasitic disease with echinococcosis, in which the gland is enlarged and compacted. In this case, informatively, ultrasound, and confirms the diagnosis of a laboratory test that elicits antibodies to the eosinococcus.

During the diff-diagnosis it is possible not only to put the only correct diagnosis, but also to determine the type of cirrhosis. During the research, the biliary system is thoroughly studied, which makes it possible to determine the cause of the pathology and take measures to eliminate it.

US

Diagnosis of liver cirrhosis involves the ultrasound examination of the gland. Ultrasound accurately sets the size of the body and its shape, notes sound permeability, see if there are signs of portal hypertension, changes in the spleen. This study gives a picture with a low resolution, but still it allows to recognize inflammatory processes and neoplasms in the gland.

At the initial stage of cirrhosis, the structure of the liver is still homogeneous, and at the stage of subcompensation and decompensation fibrotic tissue replacing parenchymal tissue is already noticeable. In the case of small-node cirrhosis, the echogenicity of the gland is increased evenly, and for a large-nodule, separate nodes and a heterogeneous tissue structure are distinguished.

In the later stages of the disease, the right lobe of the liver is reduced, and the last gland becomes less normal. Thus, ultrasound examination of the liver allows not only to diagnose, but also to determine the stage of development of cirrhosis.

Tomography

Computed tomography of the abdominal cavity makes it possible to see in more detail the gland, its vessels and bile ducts. If necessary, an MRI of the liver is performed. Based on the study, a conclusion is made about the homogeneity and density of the gland tissue.

With the help of this method, it is possible to examine vessels and bile ducts, and draw conclusions about their patency. The examination, in view of the high cost, is carried out to refine the results of other diagnostic studies.

The pictures show congenital anomalies of the hepatobiliary system, metastasis of extrahepatic tumors, accumulation in iron hepatocytes, obstruction of the bile ducts. This information is useful in diagnosing and determining further treatment tactics, and can also shed light on the etiology of the disease.

Dopplerometry

Dopplerometry of the gland vessels determines the course of the vessels, whether there are obstructions to the blood flow, and also the diameter of the vessels and the blood flow velocity are measured. It turns out whether there is a change in the rate of blood flow when breathing is delayed, straining.

Laparoscopy

Laparoscopy is an operation that is performed to confirm a diagnosis. The doctor visually assesses the surface of the gland. With a large-nodular cirrhosis, individual nodes more than 3 mm are distinguished, between which are the strands of fibrous tissue. When small-nodules on the liver, small nodules, the space between them is filled with connective tissue.

During the operation the doctor can take the material for histological examination

Liver biopsy

You can finally determine the diagnosis and treatment tactics after carrying out a liver biopsy. This procedure is not performed for all patients, because it has a number of contraindications and is somewhat painful, and in most cases the diagnosis can be made with the help of non-invasive diagnostic methods.

The study of the material taken reveals the morphological changes in the hepatic tissues and suggests the cause of their degeneration. Biopsy is performed to clarify the diagnosis for diffuse lesions of the liver( hepatitis, cirrhosis, hepatomegaly).

For the collection of material, the skin is punctured with a puncture needle in the right hypochondrium between the 7-9 rib, sampling is carried out using a special syringe aspirator. With cirrhosis, during examination of the biopsy specimen, surrounded by fibrous tissue, are found under the microscope, and hepatocytes differ in size, the vessels between them with uneven lumens.

With active cirrhosis, necrosis of parenchymal tissue, an increase in cells, a lack of a boundary between normal and pathological tissue is revealed. And with inactive cirrhosis, necrosis is absent, and the border between normal and pathological tissue is obvious.

As additional methods for revealing the causes of cirrhosis, the methods used to detect enzyme deficiencies are used, the parameters of iron metabolism and the activity of proteins that are markers of the metabolic disorder are checked.

Cirrhosis is an incurable disease, but if it is detected at an early stage, a provoking factor is identified and eliminated, then in the case of following dietary recommendations, the prognosis for the patient's life is relatively favorable.

It is therefore important to consult a doctor at the first sign of a liver disruption. And since the pathology in most cases is the result of another chronic liver disease, cirrhosis can be avoided altogether if you consult a doctor in time and get treatment for a primary illness.