Diseases of the liver

The human liver is a multifunctional parenchymal organ which, on the one hand, is the largest gland involved in digestion, on the other hand it serves as a biochemical plant that provides the production of substances necessary for the body and waste disposal.

Symptoms of liver disease begin to appear when a significant part of the structural units( hepatocyte cells) ceases to work. Sick liver leads to a malfunction of the main regulatory nerve endocrine mechanisms, affects and leads to damage to all types of metabolism.

It is difficult to determine clearly in the statistics of the prevalence of liver diseases. This is due to the current International Classification, in which all infectious hepatitis, parasitic diseases are excluded from the class of diseases of this body with code K70-K77.

They are taken into account in the special rubric "Infectious Diseases".Therefore, speaking about the growth of cases of liver damage, it is necessary to mention a specific type of pathology and its relationship with causes.

What is known about the structure of liver pathology?

An annual analysis of morbidity and mortality in children and adults shows an increase in the proportion of the able-bodied population among cases of liver disease. Depending on the severity of the consequences of organ failure, the structure of the lesion can be divided into levels from the prevailing to rare diseases:

• in the first place - viral hepatitis( 41%) with transition to cirrhosis, hepatic and renal insufficiency, especially modern infectious disease, the growth of the role of the virusherpes;
• on the second - alcoholic cirrhosis or according to the modern interpretation "alcoholic liver disease";
• on the third - other types of cirrhosis and malignant tumors arising as its complication;
• autoimmune hepatitis and liver damage caused by hereditary metabolic disorders are rare.

Non-alcoholic fatty disease includes all types of metabolic disorders that are not associated with the toxic effect of alcohol

Indirectly, the prevalence of hepatic pathology can be judged from the results of a study of 5000 adults in Moscow( people were chosen without taking into account any typical symptoms indicative of liver problems): deviationsin indicators of tests indicating liver dysfunction, found in 30.6% of cases.

What does the liver do in the human body?

Scientists-hepatologists rightly believe that so many functions, like the liver, are not performed by a human body. It has been established that the liver filters the whole volume of the adult's blood 400 times a day.

The liver synthesizes:

• protein components for cell membranes, transport proteins, essential amino acids;
• immunoglobulins that provide the formation of antibodies and an immune barrier;
• clotting and anticoagulation factors in the blood system;
• vitamins of group B, PP, C, K, E, D;
• steroid sex hormones, adrenal and thyroid gland;
• cholesterol, lipoproteins, triglycerides, providing fat metabolism.

At the same time, the liver provides regulation of the listed active substances by destroying the surplus. It conducts inactivation of harmful compounds and utilization of slag decomposition products: alcohol, toxins, most of the medications, products formed during the breakdown of proteins, phenols, ketone bodies, acetone. Forms the depot of the most important trace elements( iron, cobalt, copper).

It is here that the energy is "extracted" for the vital activity of all cells due to the transformation of glucose, glycogen in the Krebs cycle, by glycolysis and glycogenolysis. The liver participates in hematopoiesis, it is especially important in fetal development of the fetus and for the child's organism, plays the role of blood deposition and its redistribution in accordance with the needs( hemorrhagic shock in case of blood loss).

Problems with the liver can occur both in the violation of the work of hepatocytes, and as a result of poor patency of the hepatic vessels, bile ducts in thrombosis, inflammation, cholelithiasis.

Causes of liver disease

The appearance of symptoms of impaired liver function may be due to a violation of one or more of the body's functions. Cells-hepatocytes are relatively stable. They have the possibility of independent recovery, if the nature of the lesion does not go into an irreversible phase.

Most of the destructive factors are related to human activity. This is of great importance in prevention. Improper diet - if a person eats exclusively fatty meat food, fried and smoked dishes, does not limit himself in spicy seasonings, sauces, then he has a violation of the formation of bile and its transport along the aisles. This causes stagnation and increases the risk of stone formation.

Consumption of alcoholic beverages( including beer) - is accompanied by direct toxic effects on hepatocytes, intensive disposal of ethyl alcohol and its processing into acetaldehyde, acetic acid and leads to increased waste of enzyme systems. As a result, the fat metabolism is broken first, then all other species. The result is fatty hepatosis, then transformation into cirrhosis with necrosis of the liver.

For the reasons mentioned, the hereditary factor

should be added. Intoxication of the body can cause some production factors( contact with pesticides, heavy metal salts, acids).Severe damage with signs of liver failure may occur with acute poisoning.

Drugs are most often rendered harmless in the liver, so long-term use, increased sensitivity to the toxic properties of drugs are difficult for the patient. The most toxic are: antibiotics, hormones, antifungal agents, cytostatics.

Infection with hepatitis viruses depends on the type of pathogen in terms of the extent of the lesion. Hepatitis A - proceeds most favorably, the acute stage has no tendency to transition to a chronic disease, with the help of treatment it is possible to achieve complete recovery. The violation of liver function in hepatitis B and C is accompanied by a rapid transition to a chronic process, cirrhosis.

Function disorders with traumatic abdominal injury, open and closed wounds, appear immediately after the injury or after a certain period. In this case, great importance is the violation of blood supply to cells, the occurrence of ischemia of certain areas with a subsequent heart attack. A few years later, the formation of cysts, the emergence of tumor growth.

With the action of ionizing radiation, obtained as a result of extreme circumstances or in the treatment of diseases, liver cells are damaged one of the first. Therefore, patients in the course of treatment have signs of liver problems.

Weighed family heredity, defects caused by mutation of chromosomes lead to abnormalities in the structure of blood vessels and liver structure, promote hypoplasia( underdevelopment), various enzymopathies.

Liver diseases

It is difficult to bring all diseases listed in the list of liver diseases. As we have already noted, it is necessary to "extract" the main pathology of the organ from different statistical classes. A generally accepted classification does not exist. The whole pathology is divided into primary and secondary.

Primary lesions begin with hepatic cells, vascular and bile ducts, usually acute, capable of transitioning to chronic diseases. These include:

• hepatitis of different etiology( viral, alcoholic, bacterial, toxic, ischemic, autoimmune);
• cirrhosis;
• joint diseases of the gallbladder, ducts and liver;
• infarction due to portal vein thrombosis;
• pylephlebitis( inflammation of the hepatic veins).

Vascular "sprockets" - one of the signs of liver damage

Secondary are the processes that originate in other organs and tissues, but involve the liver and cause serious manifestations of the disease. This group includes:

• tumors of the liver and other organs, metastases in cancer of separated localization;
• various pathology of endocrine, nervous and cardiovascular systems;
• metabolic changes( fatty hepatosis, hemochromatosis, glycogenosis);
• pronounced pathology of the gallbladder and ducts by the type of dyskinesia, inflammation( cholecystitis, cholangitis), cholelithiasis;
• infection with parasites( amebiasis, ascariasis, giardiasis, echinococcosis, trichinosis, opisthorchiasis).

Symptoms of liver disease

The liver is called a "silent" organ. There are no nerve endings in it. Therefore, the expressed pain syndrome does not appear in the initial stage of the disease, but when the organ significantly increases in size and stretches the covering capsule. It is in it that the sensitive zones are located.

There are types of liver pathology, which are accompanied by intense pain of paroxysmal nature. For example, a liver abscess is accompanied by blunt intense pains against a background of high body temperature.

In patients with portal vein thrombosis due to pylephlebitis, tumor compression( more often pancreas), cirrhotic scar tissue, paroxysmal pain is localized in the hypochondrium on the right, in the epigastrium( due to the left lobe of the liver).

Sometimes a person does not even know the signs of the disease, that his liver is bothering him. It is difficult to suspect the disease if the first signs of liver disease consist of such common symptoms as malaise, weakness, sweating, insomnia, headaches.

Further impairment of liver function results:

• to a constant feeling of heaviness in the hypochondrium on the right;
• bitterness in the mouth;
• of lagging of the tongue with a thick yellowish coating, a smell from the mouth;
• yellowing of the skin and sclera;
• noticeable darkening of urine, light feces;
• frequent diarrhea and bloating;
• nausea;
• loss of appetite and weight loss;
• prone to bleeding( nasal, gum, in women with menstruation), bruises on the skin( bruises);
• puffiness on the feet and legs;
• increase in the size of the abdomen due to the accumulation of fluid in it( ascites), the appearance around the navel of an enlarged venous network of subcutaneous vessels;
• skin disorders( itching, dryness).

Dimensions of the liver can be enlarged to varying degrees. With hepatitis, the edge is palpable as rounded, soft. The presence of cirrhosis is confirmed by a dense pointed lower border.

In tumors, a significant increase is possible, palpation of the tubercles. Abscess of the liver can not always be palpated, it depends on its location. When the portal vein is blocked, the liver is not enlarged, but the spleen is palpable.

Symptoms of liver dysfunction are manifested in the violation of endocrine functions and intoxication of the brain. In men, there are signs of sexual weakness, and in women, the broken hormonal composition is manifested by dysmenorrhea, infertility, leads to uterine tumors, atrophy and neoplasm of the mammary glands.

The signs of the nervous system are not limited to headaches. There are problems with memorization, mental skills are lost, character changes( irritability, apathy appear).The increase in temperature can be cyclical in hepatitis, accompany pain attacks with chills with abscess, cholecystitis, sharply "jump" and hold with pylephlebitis.

Bleeding has a different intensity. It can be expressed in the appearance of blood in the mouth when cleaning teeth, it is not clear how the resulting bruises, small petechial rash. In portal vein thrombosis, portal hypertension, bleeding from the veins of the stomach and intestines is explained by rupture of regional vessels of the stomach and esophagus, providing additional ways of outflow of blood. In patients there is bloody vomiting, black stool( melena).

If the first signs of a sick liver do not attract attention, then the developed stage of the disease leaves no doubt. Ascites indicates stagnant phenomena. It must be distinguished from cardiac edema. In the abdominal cavity, more than 10 liters of fluid can accumulate.

Memorable "hepatic palm"

Symptoms of unhealthy skin include:

• increased dryness, early wrinkles, peeling;
• numbness in the fingers( due to damage to sensitive nerve endings);
• red spots on the palms;
• modified nail phalanx;
• jaundice of the skin, sclera and mucous membranes;
• brittleness and hair loss on the head, in the groin area, under the armpits;
• itching rashes( hepatic purpura, small abscesses, urticaria);
• presence of vascular asterisks on the face, chest;
• bruising;
• white stretch marks in the abdomen( stria);
• formation of brownish spots on the forehead, in the underarm area, under the eyes.

What diseases are accompanied by "hepatic" symptoms?

These changes are caused by an increase in body intoxication, the accumulation of toxins and harmful compounds in the blood. Liver dysfunction is clearly manifested in chronic processes, a long course of disease. Acute diseases must be differentiated with another pathology, which is accompanied by metabolic disorders in the hepatic tissue.

It is necessary to exclude:

• cholelithiasis;
• possible diseases of the stomach, intestines and pancreas;
• signs of vitamin deficiency, depending on nutritional deficiency;
• diabetes, obesity, thyroid pathology;
• cardiovascular disease and severe atherosclerosis;
• neuroses and organic diseases of the nervous system;
• of the genital sphere.

What is necessary for proper diagnosis?

The appearance of these symptoms requires mandatory examination to exclude signs of liver pathology. Laboratory methods include:

• carrying out a general analysis of blood and urine;
• study of biochemical tests for enzymes, glucose, components of the coagulation system;
• detection of markers of viral hepatitis and cancer;
• immunoassays by ELISA, immunoblotting methods for detection of antibodies to immunoglobulins and viruses;
• • polymerase chain reaction method - allows to register the presence of genetic material of viruses.

Ultrasonic and magnetic resonance methods for studying the structure of the liver are widely used: ultrasound, computer and magnetic resonance imaging. They detect changes in size, body tissue density, the presence of a tumor, cysts and abscesses, and check the condition of the vessels.

The methods of radio scintigraphy are based on the introduction of substances labeled with the isotope and digestible by the liver, the subsequent scanning allows to determine the degree of liver damage( loss of working cells)

In difficult situations, a punctate examination may be required by the biopsy method of the material. Laparoscopy, conducted through a small incision of the peritoneum, helps to examine the external surface of the liver, identify nodes, localize the abscess. Treatment of liver diseases after diagnosis includes a comprehensive approach with the use of diet, medication, surgical method.

What kind of food is indicated to patients?

Patients are advised to comply with the diet no less responsibly than to medicines. Food can improve the situation by normalizing bile secretion, digestion, reducing the load on the liver, and provoke an exacerbation of the disease by excessive intake of fat, alcohol in the blood.

Therefore, from the diet of a sick person, all sharp and fatty meals should be excluded. The patient will have a long time( perhaps all his life) adhere to the diet table number 5 on Pevzner. It is necessary to drink up to 2 liters of liquid daily. Contraindicated juices: tomato, grape, orange.

Cooking is necessary only by cooking, steaming, quenching, mistresses know how to adjust the kitchen inventory.

Medication for treatment

For the restoration of impaired liver function, preparations of various groups are used. Hepatitis requires serious antiviral drugs in combination with immunomodulators - Interferon-A, Lamivudine, Vidarabin, Adefovir, Baraklyud. In autoimmune processes, high doses of corticosteroids are used.

Drip, to remove intoxication and provide energy, inject a solution of 10% glucose with insulin, Hemodez. In the inactive stage of hepatitis, as well as to strengthen the protection of the liver with the activation of inflammation, hepatoprotectors are used: Essentiale Forte, Karsil, Phosphogliv, DIV- 52, Esliver, Hepabene, Hofitol, Silymarin. Leviron duo - contains a natural anti-inflammatory agent dihydroquercetin, extracted from the bark of larch.

Parasitic liver diseases are treated with antibiotics and specific drugs. If the liver abscess is caused by an amoeba, Yatren, Diiodohin, Hingamin, Emetine, Chloroquine, Tinidazole, Metronidazole, Ornidazole are shown. In alveococcosis, Albendazole, Mebendazole are prescribed, and liver echinococcosis is cured with preparations of the benzolimidazole group.

For the removal of toxins from the intestine it is recommended to take sorbents( Enterosgel, Smektu).In the treatment of ascites, diuretics, cardiac glycosides can not be dispensed with. With too much fluid accumulation, puncture( laparocentesis) with pumping is applied.

The drug is enriched with vitamins, minerals, extracts of other medicinal plants( artichoke, yarrow, sugar beet, chanterelles mushrooms), is an oily liquid

Severe cirrhotic changes, tumor growth requires removal of the liver, partial resection or replacement by a donor organ.

Prevention measures

To prevent liver diseases, it is necessary: ​​

• adhere to proper nutrition, constantly consume vegetables and fruits, eliminate overeating, hunger diets, alcohol.
• to support motor activity, abdominal muscles serve as natural natural stimulants for the activation of metabolism in the liver, prevent stagnation of bile;
• not allow independent uncontrolled treatment with any medications, dietary supplements;
• when working with poisonous substances comply with safety regulations, undergo medical examinations;
• in order to prevent infection with viral hepatitis it is necessary to use only disposable syringes, needles, to reduce the fascination with tattooing, manicure excesses, piercing, maintain intimate contact only with trusted partners.

The health of the liver depends on many aspects of life. A person must support himself, and not destroy the work of the body.