Liver disease is expressed in many different ways. Indicators of liver diseases that are of particular importance as jaundice, cholestasis, increased liver, portal hypertension, ascites, hepatic encephalopathy and liver failure.
Liver disease doctor diagnosed based on symptoms described by patients and physical examination.
The main clinical symptoms of liver disease
Jaundice (icterus)
Enlarged liver (hepatomegaly)
The fluid in the abdomen (ascites)
Confusion because of encephalopathy
Gastrointestinal bleeding due to varices
Portaina hypertension
Skin
• Varicose veins like spider
• Red palms
• ruddy appearance
• Itching
Blood
• Reduced number of red blood cells (anemia)
• Reduced number of white blood cells (leukopenia)
• Reduced number of blood platelets (thrombocytopenia)
• A tendency to bleed (coagulopathy)
Hormones
• High levels of insulin, but the weak response to it
• Cessation of menstruation and decreased fertility (in women)
• Impotence and effeminate appearance (in men)
Heart and blood vessels
• The acceleration of heart rate and amount of blood ejected
• Reduced blood pressure (hypotension)
General symptoms
• Fatigue
• Weakness
• Weight loss
• Poor appetite
• Nausea
• Fever
Icterus
(Jaundice)
• Introduction • Symptoms • Diagnosis and Treatment
Introduction
Jaundice is a yellow discoloration of the skin and scleral (white of the eye) prouzročeno abnormally high levels of bile pigment bilirubin in the blood stream.
Old or damaged red blood cells (erythrocytes) from the circulation largely removes the spleen.During this procedure, hemoglobin, red blood cells of which carries oxygen, is decomposed into
bilirubin. Bilirubin is transferred to the liver and excreted into the intestine as a component of bile. If the excretion of bilirubin is disabled, the excess bilirubin passes into the bloodstream, which results in the formation of jaundice.
High levels of bilirubin in the blood may be due to inflammation or other abnormalities of liver cells, which prevents the excretion of bilirubin in the bile. Alternatively, bile ducts outside the liver may be blocked gallstone or tumor. Less frequently high levels of bilirubin may result from destruction of a large number of red blood cells, as sometimes occurs in newborns with jaundice.
In Gilbert's syndrome, the bilirubin level was slightly elevated, but usually not enough to cause jaundice. It is sometimes hereditary condition usually discovered during a routine search results (screening) of liver function, the state has no other symptoms or causes problems.
Symptoms
In jaundice the skin and whites of the eyes yellow. The urine is often dark because of bilirubin excretion by the kidneys. There are also other symptoms depending on the cause of jaundice, for example. liver inflammation (hepatitis) can cause loss of appetite, nausea and vomiting, and fever. Stopping the bile can cause symptoms of cholestasis.
Diagnosis and Treatment
To determine the cause of jaundice doctor uses laboratory tests and imaging tests. If the problem is the disease of the liver, for example. viral hepatitis, jaundice will usually disappear as the state of liver repair. If the problem is in the common bile duct occlusion, it is usually as quickly as possible to do surgery or endoscopy (a procedure using flexible tubes to observe the surgical connections) to be blocked bile path to reopen.
Cholestasis (cholestasis)
• Introduction • Symptoms • Diagnosis • Treatment
Introduction
Cholestasis is to reduce or halt the flow of bile.
The flow of bile can be weakened at any point between the liver cells and duodenum (upper small intestine). Even when the bile does not flow, the liver continues to adapt the bilirubin, which escapes into the bloodstream. Then the bilirubin deposited in the skin and comes into the urine, causing jaundice.
For the purpose of diagnosis and treatment of causes of cholestasis are divided into two groups: those
derived from the liver and those who cause beyond the liver.
Causes within the liver include hepatitis, alcoholic liver disease, primary biliary cirrhosis, the effects of drugs and the effects of hormonal changes during pregnancy (a condition called cholestasis maternity).
Causes outside the liver are gall stones in the water, a narrowing (stricture) duct, common bile duct cancer, pancreatic cancer and pancreatitis.
Symptoms
Jaundice and dark urine originate from the large amounts of bilirubin in the skin and urine. The chair is sometimes pale due to lack of bilirubin in the intestine. Stool may contain too much fat (a condition called steatorrhea) because bile in the intestine there to help digest fat from food.
Lack of bile in the intestine also means that calcium and vitamin D is not absorbed properly. If cholestasis persists, the lack of these nutrients can cause bone loss, which can lead to pain and fractures. Poorly absorbed substances that are necessary for blood clotting, which creates a tendency to bleed easily.
Retention of bile products in the circulation can cause itching (with resultant scratching and skin damage). Due to prolonged cholestatic jaundice created a dirty color and yellow fatty deposits in the skin. The causal agent of cholestasis determines whether people have other symptoms such as abdominal pain, loss of appetite, vomiting or fever.
Diagnosis
To determine whether the cause is within the liver, the doctor examines the symptoms of hepatitis, abundant intake of alcohol or taken drugs shortly that can lead to cholestasis. Small, spider-like blood vessels visible in the skin (called spider nevi), enlarged spleen and free fluid in the abdominal cavity (ascites) means the disease of liver cells. If the cause is outside the liver, the person may have chills, pain from the biliary system or pancreas, and gall bladder increased (the doctor can detect palpable or imaging tests).
For people with cholestasis is typical that their levels of an enzyme called alkaline phosphatase in the blood is very high. Blood test that measures the level of bilirubin indicates the severity of cholestasis, but not its cause.
If the results of blood tests were abnormal, almost always for U.S., CT, or both. This helps the doctor distinguish between liver disease and bile duct closure. If it appears that the cause in the liver, can do a liver biopsy (taking a sample of tissue for microscopic examination). Biopsy usually establishes the diagnosis. If it appears that the cause of the blockage of bile ducts, often this is an endoscopic procedure (using a flexible viewing tube) to clarify the nature of the blockade.
Treatment
The blockade outside the liver can usually be treated with surgery or therapeutic endoscopy (a procedure that involves the use of flexible pipe connections with surgery). Blockage within the liver can be treated in different ways depending on the cause. If the suspected cause of a medication, a person should stop taking it. If the blockade is responsible for hepatitis, then cholestasis and jaundice usually disappear when you stop hepatitis.
For the treatment of pruritus can be taken orally (by mouth) cholestyramine. This drug binds with certain bile products in the intestine, so they can re resorbirati and cause skin irritation.
As long as the liver is severely damaged by vitamin K intake can improve blood clotting. If cholestasis persists, often taking extra calcium and vitamin D, but they are not very effective in preventing bone disease. If too much fat in the stool extract, a person may give further triglycerides.
HEPATOMEGALIA
(Increase in liver)
Increase in liver (hepatomegaly) indicates liver disease. Although so many people with liver disease have normal liver size or even skvrčenu liver. Enlarged liver usually causes no symptoms. However, if the increase is strongly expressed, can cause an upset stomach or feeling of fullness. If the increase occurs rapidly, the liver may be sensitive to the touch. The doctor usually assesses the size of the liver during the physical examination, blindly through the abdominal wall.
Touching the liver, the doctor notes, and its structure (structure). Increased liver is usually soft in acute hepatitis, fatty infiltration, the delays (congestion), or blood in the early stages of narrowing (obstruction) of bile tract. Liver ječvrsta and illegal, if cirrhosis is the cause of its increase. Express nodes usually indicate cancer.
Hypertensio PORTALIS
(Portal hypertension)
• Introduction • Symptoms • Diagnosis and Treatment
Introduction
Portal hypertension is abnormally high blood pressure in the portal vein, large vein that carries blood from the intestines to the liver.
The portal vein receives blood flowing out of the whole intestine and the spleen, pancreas and gall bladder. After entering the liver, blood, forming a small ducts circulating liver. When blood leaves the liver, flows back through the hepatic vein into the general circulation.
In the portal blood vessels can increase blood pressure, two factors: the volume of blood flowing through blood vessels and increased resistance to blood flow through the liver. In Western countries, the most common cause of portal hypertension is increased resistance to blood flow caused by cirrhosis.
Portal hypertension leads to the development of venous blood vessels (called collateral vessels) that connect the portal system to the general bloodstream, thus bypassing the liver. Because of this detour, the substances that are normally removed by the liver from the blood can enter the general circulation. Collateral vessels develop in special places, most of which is the lower end of the esophagus. There vessels become swollen and sinuous, ie. become varicose veins (called esophageal varices). These swollen veins are very fragile and sometimes prone to bleeding. The other collateral vessels can develop around the navel and the rectum.
Symptoms and diagnosis
When portal hypertension is often an enlarged spleen. The fluid may come out of the liver and expand the abdominal cavity, and that the free fluid in the abdomen called ascites. Varicose veins in the lower end of the esophagus and gastric mucosa bleed easily, sometimes a lot.Varicose veins in the rectum may also bleed, although this is much rarer.
The doctor can usually palpable spleen increased through the abdominal wall. The liquid in the abdominal cavity can be detected by observing and listening to the abdomen nateknutog muklih sounds during tapping (percussion) of the abdomen. Rtg UZ and provide considerable information on the portal hypertension. UZ can be used to examine blood flow in the portal blood vessels and can detect the presence of fluid in the abdomen.
To test the increased vein can be used, and CT. The pressure in the portal system can be directly measured with a needle which pierces the abdominal wall to the liver or spleen.
Treatment
In order to reduce the risk of bleeding from esophageal varices, the doctor tries to reduce the pressure in the portal vein. One way is by giving propranolol, a drug used to treat high blood pressure.
Bleeding from esophageal varices is a medical emergency. Drugs such as vasopressin or octreotide can be given intravenously to constrict the veins that bleed, and blood transfusions are given to replace blood lost.
Endoscopic examination is usually done to confirm bleeding varices. Veins can clog rubber bands or giving chemical substances through the endoscope. If bleeding continues, through the person's nose and down into the esophagus can be brought into the catheter with a balloon on the end. Balloon inflation pressures are varicose veins and usually stops the bleeding.
If bleeding continues or occurs again, we can make a surgical bypass procedure (called a shunt) between the portal venous system and the general (systemic) venous system. This lowers the pressure in the portal vein, because the pressure in the general venous circulation is much lower. There are different types of operations portal-systemic shunt, including those that can be done in the radiological department using special devices under the control of X-rays. Shunt surgery is usually successful in stopping the bleeding, but are relatively dangerous. They also increase the risk of disruption of brain function due to liver failure (hepatic encephalopathy).
ASCITES
• Introduction • Causes • Symptoms • Diagnosis and Treatment
Introduction
Ascites is the accumulation of free fluid in the abdominal cavity.
Ascites occurs more often in long-term (chronic) than in short-term (acute) conditions. It most often occurs in cirrhosis, especially if caused by alcoholism. Ascites can also occur in conditions that do not affect the liver such as cancer, heart failure, kidney failure and tuberculosis.
In patients with liver disease, fluid leaks from the surface of the liver and intestines. Responsible is a combination of factors including the portal hypertension, decreased ability of blood vessels to retain fluid, fluid retention in the kidneys and changes of various chemical substances and hormones that control body fluids.
Causes of ascites
Liver Disease
• cirrhosis, especially cirrhosis caused by alcohol
• Alcoholic hepatitis without cirrhosis
• Chronic hepatitis
• Blockage of hepatic vein
Extrahepatic
• Heart failure
• Kidney failure, nephrotic syndrome, especially
• constrictive pericarditis
• carcinomatosis in which the cancer has spread to places in the abdominal cavity
• Tuberculosis, which affects the abdominal membrane
• Reduced active thyroid
• Inflammation of the pancreas
Symptoms and diagnosis
Small amounts of fluid in the abdomen do not usually make the symptoms, but large quantities causing abdominal distension and discomfort and dyspnea. When the doctor perkutira (bitch) the abdomen, the fluid makes a dull sound. When the stomach contains large amounts of fluid, the abdomen is tense, and the belly button (umbilicus) straight or even convex. In some people with ascites when excessive tekućini swollen ankles (edema).
If the existence or cause of ascites is not clear, it can be used with. Alternatively one can take a small sample of fluid penetration of the needle through the abdominal wall, a diagnostic procedure called paracentesis. In identifying the causes can help laboratory fluids.
Treatment
Thorough treatment of ascites is bed rest in bed and no salt diet, usually combined with drugs called diuretics, which cause more fluid excretion in the urine. If ascites is causing difficulty in breathing or eating the food, the fluid can be removed with a needle, a procedure called therapeutic paracentesis.
If the person does not take diuretics, the fluid tends to accumulate in the stomach again. Often the blood into the abdominal cavity are losing large amounts of albumin (the most frequent protein in the blood), and albumin may be given intravenously.
For unclear reasons, sometimes infects tekućina ascites, especially in people with alcoholic cirrhosis. This infection is called spontaneous bacterial peritonitis treated with antibiotics.
ENCEPHALOPATHIA hepatis
(Hepatic encephalopathy)
• Introduction • Symptoms • Diagnosis and Treatment
Introduction
Hepatic encephalopathy (also called portal-systemic encephalopathy, hepatic encephalopathy or hepatic coma) is a disorder in which brain function deteriorates because they accumulate in the blood of toxic substances, which would normally remove the liver.
Substances absorbed into the bloodstream from the intestine pass through the liver, where toxins are removed. In hepatic encephalopathy toxins are not removed, because the damaged liver. In addition, since the connections are created between the portal system and the general blood circulation (as a result of liver disease), some poisons can completely bypass the liver.The same effect can have bypass surgery that is built to improve portal hypertension (porto-systemic shunt). Whatever the cause, the outcome is the same: to get the poisons can damage the brain and its functions. What substances are toxic to the brain is not fully known, however, seems to be a role with high levels of degradation products of proteins, such as ammonia.
In people with long-term liver disease trigger encephalopathy is usually an event, eg. acute infection or a party where the drinking large quantities of alcohol, which increases the already existing liver damage. The trigger may be taking a lot of foods rich in protein which increases the level of their degradation products in the blood. The accumulation of degradation products of proteins, which can directly damage the brain, can cause bleeding in the digestive system such as that from esophageal varices. Some medicines, especially some sedatives, analgesics and diuretics, can also be a trigger for the formation of encephalopathy. When the causative factor is removed, the encephalopathy may disappear.
Symptoms and diagnosis
Symptoms of hepatic encephalopathy as a result of reduced brain function, particularly impaired consciousness. In the earliest stages appear slight changes in logical thinking, personality and behavior. There may be changes in the patient's mood disorder and judgment.
With the disorder progresses, the person usually becomes drowsy and confused, a speech and movements become sluggish. It is a common confusion. A person with encephalopathy may be agitated and excited, but not often. Epileptic seizures are also rare. Finally, a person can lose consciousness and fall into a coma.
Symptoms of the damaged brain function in people with liver disease provide a strong key to the diagnosis. Person's breath can have a sweet smell. When a person stretched out arms, hands can not keep still, but shows a rough shaking (tremor).
The early diagnosis of hepatic encephalopathy may aid EEG (electroencephalogram). It shows abnormal brain waves, even in mild cases. Blood tests usually show abnormally high levels of ammonia.
Treatment
The doctor asks and seeks to remove the cause, such as infection or medication that a person takes. The doctor is also trying to remove the hose from toxic substances. Removed from the diet is protein, a major source of carbohydrate calories become taken orally (by mouth) or given intravenously. Synthetic sugar (lactulose), taken orally (by mouth), has three beneficial effects: it removes the acidity of the intestine by changing the type of bacteria present, reduces the absorption of ammonia and acts as a laxative.
They can be given and enema to clean. Sometimes a person instead of lactulose may take an antibiotic, neomycin. Neomycin reduces the intestinal bacteria that normally help to digest protein.
Hepatic encephalopathy is often the treatment can recover. In fact a full recovery is possible, especially if the encephalopathy was precipitated some fixable cause. However, the difficult people in a coma, which is the result of an acute inflammation of the liver, a condition in spite of intensive treatment in 80% of fatalities.
Liver failure
• Introduction • Symptoms • Diagnosis and Prognosis and treatment
Introduction
Liver failure is difficult to deterioration of liver function.
Hepatic failure may be due to any kind of liver disorders including viral hepatitis, cirrhosis and liver damage by alcohol or drugs such as acetaminophen. To lead to liver failure has to be damaged by its substantial part.
Symptoms and diagnosis
A person with liver failure usually has jaundice, tendency to bruising or bleeding, ascites, damaged brain function (hepatic encephalopathy) and generally poor health. Other common symptoms include fatigue, weakness, nausea and loss of appetite.
In liver failure strongly suggests clinical indicators alone. Blood tests usually show a severely damaged liver function.
Prognosis and treatment
Treatment depends on the cause and specific clinical indicators. The person is usually placed on the restricted diet. Carefully controlled protein intake: too much protein can cause damage to brain function and cause weight loss too.
Intake of sodium should be reduced to a small amount to affect the accumulation of fluid in the abdomen (ascites). Alcohol should be completely avoided because it can worsen liver damage.
Liver failure is fatal if untreated or if the liver disease progresses. Hepatic failure may be impossible to repair, even after treatment. In terminal cases, the exhaustion of the liver, a person can die of kidney failure (hepatorenal syndrome). Liver transplantation, if done early enough, the person can return to normal, but is acceptable only for small number of patients with liver failure.
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