Tumors of the liver

Liver tumors can be non-cancerous (benign) or cancerous (malignant). Cancer tumors can occur in the liver and can spread to the liver (metastasize) from other parts of the body. Cancer that occurs in the liver is called primary liver cancer, cancer that arises elsewhere in the body is called metastatic cancer. The vast majority of cancers are metastatic liver tumors. 

Non-cancerous liver tumors are relatively common but usually cause no symptoms. Most of them can detect when people do for some other reason, a search-imaging such as ultrasound, computed tomogranja (CT) or magnetic resonance imaging (MRI). However, some of these tumors leads to an increase in liver or bleeding into the abdominal cavity. Liver function is usually normal and blood tests show normal or only mildly elevated levels of liver enzymes.

Hepatocellular adenoma

Hepatocellular adenoma is a common non-cancerous tumor of the liver.

Hepatocellular adenomas occur mainly in women of childbearing age, probably because oral contraceptives increase the risk of this type of neoplasm. These tumors usually cause no symptoms, so most of them remain undetected.

There was rarely an adenoma suddenly bursts and bleeds into the abdominal cavity, which requires an urgent surgical procedure. Adenomas that cause oral contraceptives often disappear when a woman stops taking the drug.In extremely rare cases, an adenoma can become cancerous tumor.

Hemangioma

Hemangion a non-cancerous liver tumor composed of clusters of abnormal blood vessels.

It is estimated that 1% - 5% of adults have small liver hemangiomas that cause no symptoms. These tumors are usually discovered only if the person happens to be subjected to search UZ-mail or CT. Not require treatment. In young children a large hemangioma sometimes cause symptoms that are detected, such as widespread (diffuse) clotting and heart failure. May require surgery.

HEPATO

Hepatotoxicity (hepatocellular carcinoma) is cancer that begins in cells of the liver.

Hepatoma are the most common type of cancer that originates in the liver (primary liver cancer). In some areas of Africa and Southeast Asia hepatoma are even more common than metastatic liver cancer and highlight the cause of death. In these areas there is a high prevalence of chronic infection with hepatitis B, which increases the risk of hepatoma in more than 100 times.

Chronic infection with hepatitis C also increases the risk of hepatoma. Finally some substances that cause cancer (carcinogens) created hepatoma. In subtropical areas in which the hepatoma tissue, food is often contaminated with carcinogens called aflatoxins, substances produced by certain types of fungi.

In North America, Europe and other regions of the world, in which the hepatoma rare, most people with hepatoma were alcoholics with liver cirrhosis, long-term. Additional types of cirrhosis are also associated with hepatoma, although in conjunction with primary biliary cirrhosis risk is lower than with other types of cirrhosis.

Fibrolamelarni carcinoma is a rare type of hepatoma, which usually affects young adults. It is not caused by the preceding cirrhosis, hepatitis B or C or other known risk factors.

Symptoms

Usually the first symptoms of hepatoma abdominal pain, weight loss and large clusters that can be felt in the upper abdomen. Another possibility is that a person who has long had cirrhosis may unexpectedly become sick. It is a common fever. Sometimes the first symptoms of acute abdominal pain and shock caused by rupture or bleeding of the tumor.

Diagnosis

In people with hepatoma are typically elevated levels of alpha-fetoprotein levels. Sometimes blood tests show low levels of glucose or high levels of calcium, lipid, or an increased number of red blood cells.

Initially, the symptoms do not give the key to diagnosis. However, once the liver is increased enough to be felt, the doctor may suspect the diagnosis, especially if a person has long-term cirrhosis. Sometimes the doctor may hear loud sounds (hepatic noises) and the sounds of reefs (friction due to rubbing or crepitation) stethoscope placed over the liver.

Ultrasound and CT of the abdomen above can sometimes detect cancer that has not yet caused symptoms. In some countries where hepatitis B virus is common, such as Japan, ultrasound is used for the examinations for the purpose of sifting (screening, screening) infection in people with liver cancer. Hepatic arteriography (Elo made after the hepatic artery radiokonstrastne injectable substances) may indicate the hepatoma. Arteriography of the liver is especially useful prior to surgical removal of hepatoma, because it shows the surgeon the exact accommodation blood vessels of the liver.

A liver biopsy can confirm the diagnosis. The risk of bleeding or other injuries in liver biopsies are generally low.

Prognosis and treatment

Usually the prognosis for people with hepatoma weak, because the tumor is detected too late. Sometimes people with small tumors recovered after the tumor is surgically removed.

Second primary liver cancer

• cholangio cancer that arises from the lining of bile ducts in the liver or bile ducts. In the Orient, infestation of parasitic worms called the liver, may be partly responsible for this cancer. People with long-term ulcerative colitis and sclerosing cholangitis occasionally develop cholangio.

• hepatoblastoma is one of the more common cancers in young children. Sometimes it occurs in older children and can produce hormones called gonadotropins, which results in an early (premature) puberty. Hepatoblastoma is usually detected because of the general deterioration of health and large clusters (formation) in the upper right abdomen.

• angiosarcoma is a rare cancer that occurs in blood vessels of the liver. Angiosarcoma can arise from exposure to vinyl chloride in the workplace.

Diagnosis and Treatment

Holangiokarcinomi, hepatoblastoma and angiosarkomi can be diagnosed only by biopsy of the liver with a needle to take a sample of liver tissue for examination under a microscope.

Usually the treatment is of little value, and most people die within a few months since the discovery of the tumor.However, if cancer is detected very early, the tumor can be surgically removed with the hope of long-term survival.

METASTATIC LIVER CANCER

Metastatic liver cancer is cancer that has spread to the liver from elsewhere in the body.

Metastatic liver cancer most commonly occurs in the lung, breast, colon, pancreas and stomach. Can affect the liver and leukemia and other blood cell cancers such as lymphoma. Sometimes the discovery of metastatic liver tumors first indication that a person has cancer.

Symptoms

Often the first symptoms include weight loss and poor appetite. Typically, the liver is enlarged and hard, and may be sensitive to the touch. There may be an increased body temperature. Sometimes the enlarged spleen, especially if the cancer comes from the pancreas. Abdominal cavity can be expanded due to the presence of free fluid, a condition called ascites.

Initially there is mild jaundice or until the cancer is not clogged bile ducts. For weeks before his death, jaundice becomes stronger. A person can also become confused and sleepy with an accumulation of toxins in the brain, a condition called hepatic encephalopathy. ®

Diagnosis

In later stages of the disease, the doctor can usually diagnose metastatic liver cancer rather easily, but the diagnosis is difficult in the early stages. Cancer may indicate U.S., CT and MRI, but these imaging results can not always detect small tumors or to distinguish tumor from liver and other abnormalities.

Tumors often cause poor liver function that can detect a blood test.

Liver biopsy confirmed the diagnosis in 75% of cases. A biopsy can be performed under control with a chance to get to the cancerous tissue was higher. Another way of taking a biopsy sample is laparoscopy (fiber optic viewing tube that is inserted into the abdominal wall).

Leukemia is usually diagnosed based on results of blood tests and bone marrow. Typically, liver biopsy is not needed.

Treatment

Depending on the type (type) of cancer, cancer drugs can temporarily reduce the tumor and prolong life, but they do not cure cancer. Drugs against cancer can be injected into the hepatic artery, which then dispatches a high concentration of drugs directly into cancer cells in the liver. This technique will likely reduce the tumor and produce fewer side effects, but has not been proven to prolong life. Radiation therapy of the liver can sometimes reduce the severe pain, but brings little improvement.

If the liver is found in only one tumor, the surgeon can remove it, especially if it stems from colon cancer. However, not all experts believe such an operation worth taking.

For most people with varicose cancer, all the doctor can do is relieve the symptoms,

Symptoms of liver disease

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) caused by 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.

Portal hypertension

Hypertensio PORTALIS

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 liquid can escape from 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 fluid 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). 

Deficit alpha 1 - antitrypsin

Introduction

Alpha1-antitrypsin deficiency is a hereditary disease in which lack of alpha1-antitrisina can cause lung disease and liver.

Alpha1-antitrypsin, an enzyme that produces the liver, is in saliva, duodenal fluid, lung secretions, tears, nose and recrement liquor. This slows the enzyme activity of other enzymes that break down proteins. Alpha1-antitrypsin deficiency to other enzymes that damage tissue in the lungs. Deficiency in the blood indicates liver failure to secrete the enzyme. Its retention in the liver cells can cause damage, fibrosis (scar changes) and cirrhosis.

Symptoms and prognosis

Up to 25% of children with alpha1-antitrypsin deficiency will develop cirrhosis and the portal hypertension and died before he turns 12 years of age. About 25 to 20% die in the year. The remaining 25% had only minor abnormalities of liver and experience adulthood. The remaining 25% have disease that progresses.

In adults, alpha1-antitrypsin deficiency is not common and does not cause cirrhosis, even if it is present. More often than adults with this disorder get emphysema, lung disease that results in shortness of breath all the stronger.Finally, one can develop liver cancer.

Treatment

Some hope was given replacement therapy with synthetic alpha1-antitrypsin, but liver transplantation remains the only successful therapy. In the liver, which produces transplantiranoj alpha1-antitrypsin usually do not show damage.

Treatment for adults is usually focused on lung disease. Measures of treatment include prevention of infection and smoking cessation in smokers. 

Cholestasis

Cholestasis

Cholestasis is to reduce or halt the flow of bile. Obstruction of bile flow can lead to various factors.

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 originating from the liver and those who cause outside 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. 

Fatty liver

Fatty liver, alcoholic liver disease, cirrhosis, primary sclerosing cholangitis and alpha1-antitrypsin deficiency are all disorders that occur as a result of any damage to the liver. Liver damage can be many factors, but some of these disorders is not known how damage.

STEATOSIS hepatis

(Fatty liver)

Fatty liver is excessive accumulation of fat (lipid) inside liver cells.

Sometimes the cause of fatty liver is not known, especially in infants. Generally, the known causes of liver damage in some way.

Fatty liver usually causes no symptoms. Rarely causes jaundice, nausea, vomiting, abdominal pain and tenderness.

Physical examination shows that the increased liver without any symptoms suggests fatty liver. Diagnosis can be confirmed by liver biopsy, with a long hollow needle is used to obtain a small tissue sample under a microscope to search.

The mere presence of excessive fat in the liver is not a serious problem. Treatment is directed removal of the causes and treatment of the causal disorder. Repeated damage to the liver to toxic substances such as alcohol may eventually lead to transition fatty liver to cirrhosis.

Known causes of fatty liver

• Thickness

• Diabetes mellitus (diabetes)

• Chemicals and drugs (such as alcohol, corticosteroids, tetracycline, valproic acid, methotrexate, carbon tetrachloride and yellow phosphorus)

• Poor nutritional status and food with enough protein

• Pregnancy

• Vitamin A poisoning

• Surgical intervention in the small intestine in terms of creating a bypass (the bypass)

• Cystic fibrosis (probably coupled with poor ishranjenošću)

• Inherited defects of glycogen metabolism, galactose, tyrosine, or homocysteine

• Lack of medium-long chain arildehidrogenaze

• Lack of cholesterol esterase

• storage disease fitanske acid (Refsumova disease)

• A-betalipoproteinemija

• Reyeov syndrome

Cirrhosis of the liver

Cirrhosis is a process of destruction of normal liver tissue, leaving scar tissue that is no longer able to perform its previous function, and the surrounding areas of liver tissue that still functions.

Most of the major causes of liver cirrhosis ends. In the U.S. the most common cause of cirrhosis of the misuse of alcohol. Among people aged 45-65 years, cirrhosis is the third leading cause of death after heart disease and cancer.In many parts of Asia and Africa, a major cause of cirrhosis is chronic hepatitis.

Causes of cirrhosis

• misuse of alcohol

• Taking certain medications

• Exposure to some chemicals

• Infection (including hepatitis B and hepatitis C)

• Autoimmune diseases (including autoimmune chronic hepatitis)

• blockage of the bile times (bile duct)

• Permanent fault flow of blood from the liver (as in Budd-Chiari syndrome)

• disturbance of the heart and blood vessels

• Lack of alpha-antitrypsin

• High levels of galactose in the blood

• High levels of tyrosine at birth (congenital tirosinosis)

• glycogen storage disease

• Diabetes mellitus (diabetes)

• Poor nutritional status (malnutrition)

• Inheritance accumulation of excessive amounts of copper, Wilson's disease)

• iron overload (hemochromatosis)

Symptoms

Many people with mild cirrhosis have no symptoms and appear healthy for years. Others are weak, have poor appetite, feel sick and lose weight. If bile flow is constantly clogged, a person has jaundice, itching, and small yellow skin nodules, especially around the eyelids. Poor nutritional status is usually the result of poor appetite and impaired absorption of fats and fat soluble vitamins (liposoluble vitamins) which is caused by a reduced formation of bile salts.

The person may cough or vomit a large amount of blood due to bleeding from varicose veins in the lower esophagus (esophageal varices). These enlarged blood vessels caused by high blood pressure in the veins that go from the gut to the liver. Such high blood pressure, called portal hypertension, with poor liver function may also lead to accumulation of free fluid in the abdomen (ascites). May occur and renal failure and hepatic encephalopathy.

May develop other symptoms of liver disease as long as the deterioration of muscle, red palms (palmar erythema), the curvature of the fingers (Dupuytren's contracture palmar), small veins in the skin like a spider, breast enlargement in men (gynecomastia), increased salivary glands in the cheeks , hair loss, dwarfing the testicles (testicular atrophy), and abnormal function of nerves (peripheral neuropathy).

Diagnosis

UZ can be shown that the liver is increased. Radioactive isotope liver scan creates an image that shows which areas of the liver are functioning and that the scar changed. Liver function test results are often normal, because the performance of basic chemical functions require only a small percentage of liver cells to function. The final diagnosis is microscopic examination of liver tissue samples.

Prognosis and treatment

Cirrhosis is usually progressive. If someone with early cirrhosis stops drinking, the process of changes of the liver scars are usually stopped, but scar tissue remains forever. Generally, the prognosis is worse if there were serious complications such as vomiting blood, ascites, abnormal brain function (encephalopathy).

Liver cancer (hepatocellular carcinoma) is more common in people with cirrhosis, which is a consequence of chronic infection with hepatitis B or hepatitis C, due to iron overload (hemochromatosis) due to long-term illness and storage (storage), and glycogen. In people with cirrhosis due to alcohol abuse can occur and liver cancer.

Cirrhosis can not be cured. However, the state seeks to improve elimination of toxic factors such as drinking alcohol, taking proper nutrition including vitamin and treatment of complications that occur.

A person with advanced cirrhosis of the liver transplant can help. But if a person continues to abuse alcohol or if you can not remove the causative agent of cirrhosis will eventually develop in the transplanted liver.

Primary biliary cirrhosis

• Introduction • Symptoms • Diagnosis and Treatment and Prognosis

Introduction

Primary biliary cirrhosis is an inflammation of the final scar changes and blockage of bile ducts in the liver.

Primary biliary cirrhosis is most common among women aged 35-60 years, although it can occur in men and women of any age. The cause is unknown, but the disease often occurs in people with autoimmune diseases such as rheumatoid arthritis, scleroderma, or autoimmune thyroiditis.

Primary biliary cirrhosis begins with inflammation of the bile ducts in the liver. Inflammation prevents the flow of bile from the liver so bile remains in the liver cells, or overflows into the bloodstream. Spread of infection to the rest of the liver, all the liver develops scar tissue trellis.

Symptoms and diagnosis

Primary biliary cirrhosis usually begin gradually. Itching and fatigue sometimes are the first symptoms in 50% of people with primary biliary cirrhosis, and these symptoms may precede other symptoms for months or years. At physical examination the doctor may feel for the people increased 50%, solid liver in about 25% increased spleen.About 15% have a small yellow deposits in the skin (xanthoma) or eyelids (xantelasma). About 10% have increased skin pigmentation. Less than 10% have only jaundice. Other symptoms may include an increase over the toes (toes batićasti) and abnormalities of the bones, nerves and kidneys. The diarrhea may be pale and fat and have a disgusting smell. Later you could have all the symptoms and complications of cirrhosis.

Diagnosis is at least 30% of people placed before the development of symptoms based on abnormalities detected during routine blood browsing. Antibodies against mitochondria (tiny structures within the cells) are found in the blood of more than 90% of people with the disease.

When jaundice and liver abnormalities Search apparent, effective diagnostic tool for the endoscopic retrograde cholangiopancreatography (ERCP). In the process, after the injection of radiocontrast material endoscopy in bile ducts, make the roentgenogram. It will show that within the bile duct is unobstructed and allow doctors to better establish the liver as the site of the problem. Diagnosis can be confirmed by microscopic examination of liver tissue samples obtained hollow needle (liver biopsy).

Treatment and Prognosis

Progression of primary biliary cirrhosis is very different. Initially, the disease does not reduce the quality of life of people with this disorder has a moderately good prognosis. It seems that the longer people live with the slow deterioration of the disease. For some the disease progresses relentlessly for several years, culminating in severe cirrhosis. The prognosis is poor in people with increased levels of bilirubin in the blood (jaundice). In most develop metabolic bone disease (osteoporosis).

Healing is not known. Itching can be combated by taking the medicine cholestyramine. May require supplements of calcium and vitamins A, D and K, because a lack of bile nutrients you absorb not satisfactory. The drug ursodiol (urso-deoksicholic acid) appears to be somewhat slow disease progression and is generally well tolerated.

The best treatment for those who enter the final stages of the complications of a liver transplant. Forecast for liver transplant is very good, it is less clear whether the transplanted primary biliary cirrhosis of the liver re-appear.

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Ascites

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 creates 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 the excessive ascites fluid 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, 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 infected ascites fluid, especially in people with alcoholic cirrhosis. This infection is called spontaneous bacterial peritonitis treated with antibiotics. 

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Liver failure

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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