Hepatitis, Causes, Symptoms, Diagnosis and Treatment

Hepatitis is a viral inflammation of the liver that can lead to damage or destruction of its cells. It may be short-lived (acute) and long-lasting (chronic). In some cases, acute hepatitis becomes chronic condition, but chronic hepatitis can also develop independently.

Causes of Disease

Most cases of hepatitis caused by viruses that attack the liver, and marked with the letters A through G. It should be noted that sometimes causes hepatitis can not be explained, suggesting that some viruses have not yet discovered.

Hepatitis A, formerly called infectious hepatitis, is always acute and never becomes chronic. The virus is excreted in feces and transmitted by contaminated food and water. Eating shellfish from sewage-contaminated water is a common way of infection with hepatitis A. It can also be obtained by close contact with persons infected with the virus.

The hepatitis B virus, formerly called serum hepatitis, is in semen, blood and saliva. It is usually spread by blood transfusion, contaminated needles and sexual contact. Controls were blood transfusions reduce the risk of infection. The virus does not destroy cells directly, but it seems to activate immune cells that cause inflammation and scarring of the liver. Exceed 5% of the chronic form.

Hepatitis D virus can only reproduce when attached to the hepatitis B virus, hepatitis D so that it can not exist if not present hepatitis B. In 1-10% of patients with hepatitis B subsequently develop chronic hepatitis, and hepatitis B can become chronic without an acute phase

Virus hepatitis CSE can also transfer blood transfusions, infected needles, and sexual contact. Thanks to the control of blood, the risk of infection by blood transfusion is now much smaller. It can be transmitted through skin injuries.About 10% to 60% of patients with acute hepatitis C develop a chronic form, which can occur without prior acute phase.

Who and how are diagnosed with hepatitis?

Hepatitis A hepatitis is that people often encounter when traveling in foreign countries. Water and food contaminated with feces are the main sources of infection, and infected people can transmit it to others if not the strictest hygiene measures. The risk is low if good hygiene measures are applied, especially when changing diapers, child care and sick people ..

Hepatitis B can be transmitted through sexual activity. Pregnant women with hepatitis B virus can be transmitted to the child. It is more likely that children will become chronic carriers of the virus than adults. The virus can enter through cuts, scratches and other skin injuries. The risk exists for the hospital staff exposed to human blood and blood products, police officers, firefighters, employees of the institutions for the mentally ill, prisoners, and immigrants from areas where the rate of infection is high. It is also known to transmit the virus contaminated medical instruments, particularly those used in more than one person. People at high risk are intravenous drug users and homosexuals.

Hepatitis D occurs only in people with hepatitis B.

People at high risk of acquiring hepatitis C include intravenous drug users, intranasal cocaine addicts, people who undergo body-piercing-in, and recipients of transplanted organs. It seems that promiscuity and long-term sexual relationship with an infected partner increases the risk. The risk increases with the frequency of sexual activity and intimate behavior, such as using a common toothbrush. Unless infection in pregnant women with this virus is not strong, is not likely to pass it on to a child. Even with these risk factors, is still 40% of patients do not know how this form of hepatitis infection.

Symptoms

Symptoms of acute viral hepatitis can occur suddenly or gradually. They can be so mild that it is replaced with flu patients. Almost all patients experience some fatigue and often have a mild fever. Indigestion is very common, including nausea and vomiting, general feeling of discomfort in the abdomen or a sharper pain that may be localized in the upper right quadrant. This can lead to loss of appetite, weight loss and dehydration. After about two weeks, dark urine and jaundice (yellowish skin and mucous membranes) develops in some but not all patients. About half of all patients with hepatitis have light colored stools, muscle pain, feeling drowsiness, irritability and itching (usually mild). Diarrhea and joint aches occur in about a quarter of patients. The liver may be enlarged and painful and most patients have mild anemia. About 10% of patients, the spleen is enlarged.

Typical symptoms of acute hepatitis A

Symptoms of hepatitis A is usually mild, especially in children. They usually appear two to six weeks after exposure. In adult patients more likely the occurrence of fever, jaundice and itching that can last from one to several months.

Typical symptoms of acute hepatitis B

Symptoms of hepatitis B occur long after initial infection - usually after 50 to 150 days. Many patients feel no symptoms, or symptoms are mild and flu-like. About 10% to 20% of patients have fever and rash. Nausea is common. Patients with hepatitis B may have a pain in the joints.

Typical symptoms of acute hepatitis C

If it does occur, symptoms can develop over a month or two after a person infected with hepatitis C. They are usually milder than with hepatitis B. About 75% of patients showing no signs of jaundice, and most do not feel any symptoms.

Symptoms of chronic hepatitis

Hepatitis B and hepatitis C can pass into the chronic hepatitis are usually no early acute symptoms. Progressing symptoms of chronic viral hepatitis may be very slight and not stronger than a mild prolongation of acute symptoms during the six months or more. In fact, chronic hepatitis C may be present up to 20 years without causing any apparent difficulty. In some patients develop pain in small joints (eg hands) which may result in an almost indistinguishable from the symptoms of rheumatoid arthritis. In other patients, hepatitis B or C can lead to long-term disability or liver failure before you feel any symptoms.

When should consult their doctor?

Contact your doctor when the first symptoms that could indicate hepatitis, a must if a jaundice (yellow skin color and the whites of the eyes), dark urine or light stools,

What results can I do?

Tests to diagnose the presence of hepatitis

For people that are suspected to have or transmit viral hepatitis, doctors will measure certain substances in the blood. One of the most important factors indicating the hepatitis is bilirubin, a red-yellow pigment that is normally processed in the liver and then excreted in urine. In patients with hepatitis, the liver can not process bilirubin, and bilirubin levels in the blood increases, causing jaundice. Doctors will also look for elevated blood levels of enzymes known as aminotransferases, which are released when the liver is damaged. They usually raise before they develop jaundice and decrease when it occurs.

Tests to determine the cause of hepatitis

In order to detect the virus that caused hepatitis, tests are performed from the blood. Some of these tests can detect antigen of hepatitis, such as certain parts of the virus. But more often reveal specific antibodies, which are molecules in the host immune system that attack specific antigens. The antibodies may not appear for weeks or months after hepatitis developed, so that if the tests are implemented too early, it may not detect antibodies even when the patient is infected. Antibodies are also still present after the patient recovers, so that a positive antibody test may indicate a previous infection, but can not always determine whether the infection is active.

Tests for hepatitis A

The first antibody generated against hepatitis A were IgM antibodies. They appear early in the course of the disease and can usually be detected as soon as symptoms appear. IgM antibodies disappear during recovery, but it retained IgG antibodies, indicating previous infection.

Tests for hepatitis B and D

Test for hepatitis B should be made quickly to identify the antigen, HBsAg, which is in the blood in the early stages, but disappears within four months unless the patient becomes a long-term holder. Antibodies to the antigen encountered during recovery and then can be detected, even if I antigen was not found earlier. In order to diagnose hepatitis D using a test for antibodies, hepatitis B must also be disclosed.

Testing for hepatitis C

Several tests, particularly one known as such. ELISA, are available for the detection of antibodies to hepatitis C.Antibody to hepatitis C need not occur for three to six months after the onset of disease, so the absence of antibodies does not exclude infection. If the doctor still firmly believes that the virus is present, you can spend another study, polymerase chain reaction (PCR). By PCR can detect genetic material.

Search for chronic hepatitis

Blood tests for chronic hepatitis measured the levels of aminotransferase, bilirubin, and the detection of blood clotting problems. We also carried out immunological tests to detect antibodies to the hepatitis virus. If the patient feels the symptoms of chronic active hepatitis six months or longer, a virus can not be detected, then the usual suspects in autoimmune hepatitis. In order to confirm this condition, test results may show high levels of immune factors called serum globulins and specific antibodies to proteins of the liver. It can do a liver biopsy in patients with acute viral hepatitis caught in a late stage, or in severe cases of chronic hepatitis. Some experts now recommend biopsy of all patients with chronic hepatitis C, regardless of the severity of the disease, the risk of liver damage and possible development of cirrhosis even in patients without symptoms. A biopsy helps determine treatment options, the degree of damage and prognosis.

Treatment - self help + GP

Treatment of acute viral hepatitis

In mild cases of viral hepatitis, there is no need drug treatment or other treatment No diet and taking vitamins are not proven to be particularly useful, although it is recommended to lighter food with less fat. Taking several small meals throughout the day, so you are more abundant in the morning can help prevent you from losing weight and reduce nausea. The liver processes many types of drugs, so that as soon as hepatitis is diagnosed, the patient should stop taking any medicines, including medicines obtained without a prescription, except those specifically prescribed by a doctor or recommended. In some cases, your doctor may prescribe drugs that have very little effect on the liver to relieve symptoms of hepatitis, such as nausea or severe itching. All patients should refrain from alcohol and sexual contacts during the acute phase. Although most patients with hepatitis feels tired and need more rest than usual, be physically active as they wish, and that it does not affect recovery. In fact, patients should be encouraged to be active as much as possible. Depression is common, especially in people who are accustomed to an active life. In most cases of hepatitis recovery is complete. Cases of acute hepatitis, requires periodic visits to the doctor for repeated blood tests and their frequency depends on how the patient feels. If symptoms occur even after three months, and laboratory findings and further indicate the presence of the virus, tests should be performed every month. If symptoms are still present after 6 months, a biopsy may be needed to determine possible liver damage.

Treatment - specialist

Hospital treatment is necessary only in patients at high risk of complications, such as pregnant women, the elderly, patients with other chronic illnesses, or who have severe nausea and vomiting, so they need to give fluids intravenously. The main goals of treatment of acute viral hepatitis are the provision of adequate nutrition, to prevent further liver damage, and prevent transmission to others.

Treatment of acute fulminant hepatitis

In patients who develop fulminant hepatitis, ie. liver failure, treatment is directed to the affected organs and systems. No medications, including corticosteroids, have no effect on the status itself. Liver transplantation is currently the only treatment is life saving in fulminant hepatitis and a survival rate to 60%. Without a liver transplant, the probability of survival was only 20%. The goal of treatment of all forms of chronic hepatitis is relieve symptoms, prevent the development of cirrhosis, reducing the level of the virus and facilitate survival.Kroničkog treatment of viral hepatitis is very different from the treatment of chronic autoimmune hepatitis, so that the correct diagnosis is extremely important.

Forecast

Forecast of acute viral hepatitis

In most cases of acute viral hepatitis, the recovery is complete and the liver returns to normal within two to eight weeks. In a few cases of hepatitis B or C, this could be extended to recovery and is out for any one year. In a small number of patients may develop chronic hepatitis. In rare cases, fulminant hepatitis develops. People who are infected with hepatitis continue to produce antibodies to that specific virus. This means that they can not re-infected by the same virus hepatitis. Unfortunately, not protected against other virus types.

Prognosis of chronic hepatitis

Patients with chronic hepatitis who have few symptoms generally have a good prognosis, with little risk of developing cirrhosis. However, in chronic active hepatitis, a liver biopsy often reveals scars suggestive of cirrhosis and liver cell damage. A damaged liver affects almost all bodily processes including digestive, hormonal and circulatory system. Without the treatment eventually may develop a disorder of consciousness, bleeding in the stomach and intestines, or kidney failure with the consequences that result in life in danger.

Prevention

The periods of greatest contamination

Hepatitis A is contagious two to four weeks before symptoms develop and a few days later. People with hepatitis B or C may become carriers of the virus after recovery, even if they do not develop chronic disease and the symptoms are not present.

Life as a preventive measure

Everyday precautions

Patients with viral hepatitis should abstain from sexual activity or take strict precautions if you do not. Hot water and thoroughly cleaning items used by the patients it is important to prevent the spread of infection. Because hepatitis A is usually transmitted through contaminated food, people infected with hepatitis A should not participate in preparing food for others, unfortunately, people are most infectious before symptoms appear.Limitations in food preparation are not required with other types of hepatitis. With all the objects contaminated with the blood of patients with hepatitis B or C must be handled with special care.

Travel to countries with a high risk of hepatitis

Travelers should be vaccinated against hepatitis A if you are traveling for a long time in countries where outbreaks occur. They need to peel yourself and follow all the fresh fruits and vegetables. The diet should avoid crabs and shellfish. Even ice cubes can cause infection, and should only be used in packaged water bottles for brushing teeth and drinking. If you can not buy water, tap water should be boiled for ten minutes.

Vaccinations and preventive measures for certain viruses

Prevention of Hepatitis A

The standard preventive measures against hepatitis A were immunoglobulin injections. Although it is not routinely given to children under two years of age, the vaccine is proven safe for children. People need to be vaccinated are those who live in communities where outbreaks occur, people with chronic liver diseases, health care workers exposed to the virus, and travelers to developing countries. Passengers should also receive immune globulin if you are visiting high risk areas within four weeks after vaccination. Side effects are few, although there may be an allergic reaction.

Prevention of Hepatitis B and D

All blood for transfusions is now tested for viruses hepatitis B and C, which significantly reduces the risk of infection from this source. Several vaccine can prevent hepatitis B, and are effective and safe, including infants and children. It also showed that vaccination programs reduce the risk of liver cancer. Others who should be vaccinated are people who have had sexual contact with an infected health care workers who may come into contact with infected blood or body fluids, and those who travel frequently or are retained for a long time in countries with high incidence of this disease. Three doses applied during the six months are usually required in adults. Alcoholics, who often have a weaker response, must be protected from high doses. A small percentage of people do not develop immunity even when the vaccine is given repeatedly. The vaccine loses its effect after five years with about a third of people who received it, but the value of the additional dose is safe. Preventing hepatitis B also prevents hepatitis D. It seems that testing pregnant women for hepatitis B and then the treatment of children infected mothers immediately after birth is very effective prevention strategy for infants. Treated with immunoglobulin and vaccination series at birth, one and six months of life.

Prevention of Hepatitis C

Although blood transfusion examines the hepatitis viruses B and C, those who have previously received a transfusion - even decades ago - may be at risk. These persons are encouraged to be tested. Avoiding exposure or prevention of transmission, however, is still very important for carriers of hepatitis and for those who are in contact with them. Infected patients should use condoms, perhaps even in relationships that last for years. Partners of persons infected with hepatitis B and C regardless of the duration of the connection, should avoid sharing personal items such as razors or toothbrushes, and to refrain from sexual activity during menstruation or infection caused by bleeding in the urinary or genital area. Injecting drug users should be using disposable needles and do not lend used needles and other drug equipment.

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The clinical symptoms of liver disease

Introduction

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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