In the article, we will consider the clinic, diagnosis and treatment of liver cirrhosis.
The term “cryptogenic” is used in medicine to denote a disease whose origin cannot be established. The diagnosis of cryptogenic cirrhosis is made in cases where the causes of the disease do not correspond to any category of etiological classification of cirrhosis. Let's try to establish the main causes of the disease and find out what symptoms this severe illness can be accompanied by.
Causes of occurrence
The reasons that provoke the occurrence of cryptogenic cirrhosis of the liver are not fully understood to date. There are a number of hypotheses and assumptions that the appearance of this pathology is affected by nutrition factors, as well as autoimmune processes and heredity. True, not one of these theories has found final confirmation.
Despite the increasing growth of diagnostic capabilities, in our time it is often not possible to establish the causes of the development of cirrhosis of this organ by doctors, unfortunately. Very often, cirrhosis can be directly related to a person’s alcoholism in the past or to the fact that the patient hides his addiction to alcohol. True, very often cryptogenic cirrhosis of the liver (ICD code 10 K74.3.) Also has a non-alcoholic nature. It is also very difficult to establish the causes of the disease according to symptoms or external signs.
Medical statistics
According to medical statistics, the survival rate of patients who were operated on in the compensated stage is approximately ninety percent. Such patients manage to extend their lives by an average of seventeen years. In the case of assigning a disease of class “B”, they talk about the possibility of extending life for ten years. In the stage of decompensation, we can talk about no more than three years of life. The main feature of cryptogenic cirrhosis of the liver (ICD code 10 K74.3.) Is the forced nature of the transition from the first stage to the third.
Varieties of pathology
The disease of this type is divided into three subspecies:
- Primary biliary form. According to some reports, the cause of its occurrence is blockage of the hepatic duct due to malfunctions in the immune system. This form is diagnosed mainly in women over forty years old. The disease is characterized by erroneous work of the immune system, which begins the production of antimitochondrial antibodies, which are specific immunoglobulins that oxidize intermediate products of energy metabolism. Based on this, the primary biliary form is classified as an autoimmune disease.
- Indian baby uniform. This subspecies is a fatal diagnosis for children under the age of three years who live in India, as well as in the region of neighboring states. The occurrence of this disease is associated with unsanitary conditions of life, but there are no direct facts that would indicate a connection between unsanitary conditions and this pathology.
- Other subspecies. This category includes fatal liver diseases that differ in unknown genesis and are not dependent on gender and ethnicity.
Cryptogenic cirrhosis in the decompensation stage is very dangerous. Organ tissues are almost completely scarred and replaced with inert fibrin. As a result, the liver cannot perform its functions. The main signs of decompression in hepatic cirrhosis are severe exhaustion, refusal to eat, constant nausea, yellowness of the sclera and skin, abdominal pain, impotence, and bleeding. Untimely treatment of the disease leads to death due to the development of ascites, portal hypertension, bacterial peritonitis.
Differentiation of pathology cryptogenic cirrhosis of the liver is not of great importance for therapy and diagnosis. The clinical picture, as well as diagnostic methods and treatment are identical for all subspecies.
Next, find out how this dangerous disease manifests itself.
Symptomatology
The main symptoms of liver cirrhosis at the initial stage are irritation of the skin receptors, rapid fatigue and increased weakness. Subsequently, the following symptoms may be observed:
- The appearance of a yellow skin tone.
- The occurrence of swelling of the face.
- The appearance of pain in the right side and epigastric epigastric region.
- Intense accumulation of gases in the intestines.
- The appearance of a bitter taste in the mouth, regardless of the meal.
- The presence of a reflex discharge of contents from the stomach through the mouth, i.e. vomiting.
- General weight loss and heart rhythm disturbance.
Due to abnormal processes in the digestive system, secondary diseases may develop or chronic pathologies of organs may worsen.
Immediately before the treatment of cryptogenic cirrhosis, an extensive diagnosis is carried out. We will find out what research methods are used today to make this diagnosis.
Diagnostics
At the initial examination, the doctor fixes an increase in the liver during palpation. At later stages of the disease, this organ, on the contrary, decreases in size. As part of further diagnostics, laboratory tests, an ultrasound examination, an intake of organic material for microscopic studies, and so on are prescribed.
Laboratory tests
Against the background of this disease, the following picture will be observed in the results of a clinical blood test and biochemistry:
- A sharp increase in the content of liver enzymes and alkaline phosphatase.
- Increased leukocyte count and erythrocyte sedimentation rate.
- The presence of disorders in lipid fat metabolism.
- Decreased thyroid function, against which low levels of hormones are noted in the blood.
One of the main indicators is the presence of antimitochondrial antibodies.
Ultrasound diagnostics
As part of an ultrasound examination, the following manifestations can be recorded:
- Resizing an organ.
- The presence of an uneven contour of the liver with a round lower edge.
- The lack of a homogeneous structure due to the presence of multiple nodes.
The presence of increased ability to absorb ultrasound indicates an increase in hepatic density, which is characteristic of the initial and subcompensated stages of pathology. In the decompensated stage of the disease, hypoechoicity, i.e., organ contraction, is observed. This feature is directly related to the fact that in the first two stages of the disease, the reflection of the ultrasonic wave comes from the dense connective tissues that replace liver cells. At the final stage, this organ atrophies, not fully reflecting the ultrasound.
Relative signs of the disease
These include:
- Pathological enlargement of the spleen in volume. Given that this lymphoid organ performs hematopoietic and immune functions, and also participates in the metabolic process, its changes in the presence of cirrhosis are inevitable.
- The occurrence of ascites or dropsy, when fluid accumulates in the peritoneum.
With cryptogenic cirrhosis of the liver in the stage of decompensation, anemia is a common occurrence.
As part of an ultrasound scan with dopplerography (which involves the study of the patient’s vascular system), there may be an enlargement of the splenic vein by ten millimeters or more, as well as an increase in speed indicators in the veins.
Taking a liver biopsy
This type of instrumental diagnosis is performed under local anesthesia and under mandatory ultrasound guidance. For the collection of the hepatic fragment, the following two types of biopsy are used:
- Laparoscopic, which is carried out through a scanty incision. It is done in the anterior wall of the peritoneum.
- Puncture, which is performed by entering a special needle into the hypochondrium.
A biopsy establishes a pronounced lesion of the bile duct, up to its complete destruction. Also, thanks to this study, it is possible to identify the rapid proliferation of tissues of the bile canaliculi.
Treatment of liver cirrhosis
Therapy should be comprehensive. The main treatment for this disease is a donor organ transplant. True, this procedure requires the presence of a suitable donor liver for transplantation, the search for which can take a very long time.
About half of the patients are not able to wait for such treatment or afford a liver transplant operation because of its high cost. There are the following drug methods to support the health of such patients, prolonging their life:
- Diuretic treatment. The ideal medicine in the case of cryptogenic cirrhosis is Veroshpiron, which allows fluid to be removed from the abdominal region, which reduces the manifestation of ascites. This medication is prescribed in short or frequent courses.
- Hepatoprotective treatment in the form of “Hepabene” and “Berlition”. Such drugs are prescribed in long, very often lifelong courses. What other medicines are used in the treatment of cirrhosis of the liver?
- Therapy with vitamins. Such drugs are prescribed in the form of injections. Most commonly used are Vitamin A, C, D, and B12.
- The use of solutions for detoxification. For example, Ringer's solution is often used. These funds are prescribed in case of intoxication at the terminal stage of the disease.
- Use of albumin solution. Such a solution is prescribed in courses throughout the disease, thanks to it the rate of disease progression decreases.
When is surgical treatment for liver cirrhosis indicated? In cases of severe ascites and the lack of effects of drug therapy, patients undergo drainage of the abdominal region. A tube is introduced into the abdomen through the front wall under the control of an ultrasound device, after which the accumulated fluid is drained. In the case of fluid more than 5 liters, this procedure is divided into several stages, gradually saving the patient from ascites.
Disease complications
Among the complications of cryptogenic cirrhosis, the following pathologies often develop:
- The development of liver failure.
- The occurrence of hepatic coma.
- The onset of death.
Prophylaxis
Since the causes of cryptogenic cirrhosis have not yet been identified, there is no prevention of this disease. The following general rules are recommended:
- Balanced and eat regularly.
- In every possible way to avoid any contact with people who are sick with viral hepatitis.
- Follow all personal hygiene rules regularly (wash hands, do not eat dirty foods, and so on).
- In no case do not abuse alcohol.
- Do not use drugs.
The prognosis for the survival of patients suffering from cryptogenic cirrhosis, as a rule, is from five to ten years after the development of ascites. True, most often these figures are slightly lower, as this disease progresses rapidly. Immediately after transplantation, patient survival is about ninety-five percent.
Here's a prognosis for treating cirrhosis.
Diet food
Without fail, patients suffering from cirrhosis are prescribed a diet correction, which should correspond to diet table No. 5. It is forbidden to use fried and smoked products, pickles, marinades, spicy dishes, canned meat and fish, muffins, puff pastry, fresh bread, some vegetables (cabbage, legumes, tomatoes, onions), fresh fruits and berries, fatty dairy products, cocoa, sweets, alcohol.
The most effective way of treating cryptogenic cirrhosis is considered to be an operation aimed at organ transplantation, that is, a liver transplant. This allows you to extend the life of a person for several more years.
We examined the prevention and treatment of cirrhosis.