1, when it comes to liver disease, many people are not unfamiliar, but for cirrhosis is still somewhat vague, so what is cirrhosis in the end? Also ask Director Li to give us a specific introduction.
Cirrhosis itself is a disease which is the late end of the development of various chronic liver diseases. It has no obvious signs at the beginning of the disease and the pathogenesis is very slow. Only in the late stage does some clinical manifestations gradually appear, mainly in the form of decompensated liver function (such as fatigue, emaciation, darkening, edema, bleeding and dyspepsia) and portal hypertension (splenomegaly, ascites, esophagogastric fundic varices). Further development of the disease leads to serious complications such as gastrointestinal bleeding, hepatic encephalopathy, spontaneous peritonitis, hepatocellular carcinoma and hepatorenal syndrome, and the mortality rate is extremely high once complications occur.
In China, it is a common disease and one of the leading causes of death. Generally speaking, the annual incidence rate is about 100/100,000, and the peak age of incidence is 35-50 years old, with more men than women.
2, cirrhosis of the liver is extremely harmful to the human body, so what are the specific hazards?
First of all, the liver is the main organ of material metabolism in the human body, mainly supplying the body with energy. Once cirrhosis occurs, the energy sources of various human organs and tissues are greatly reduced, and the mental and physical strength declines significantly, thus greatly reducing people’s quality of life.
Secondly, the greatest danger to human life comes from serious complications, such as gastrointestinal hemorrhage, hepatic encephalopathy, spontaneous peritonitis, hepatorenal syndrome and hepatocellular carcinoma, which are very common and, once they occur, are very difficult to deal with and have a very high mortality rate.
It is now believed that cirrhosis ranks fourth or sixth among the major causes of human death and is considered a major killer of human health.
3, when it comes to liver disease we all have a fear of psychology, because like hepatitis B, hepatitis A are contagious, so cirrhosis of the liver will be contagious?
When it comes to liver disease, most people will think of it as a contagious disease, of course, will produce fear psychology. In fact, liver disease only viral hepatitis is contagious, is the people referred to as “infectious hepatitis”, including type A, type B, type C, type E, type D five types, they are in the acute phase or chronic phase of viral replication (referring to type B and C viral hepatitis) is contagious, and as long as the correct response, will not have an impact on The majority of liver diseases are not contagious. Most liver diseases are not contagious.
When it comes to cirrhosis, it has so many causes, of which, only cirrhosis caused by viral hepatitis B and C may be contagious when there is viral replication and abnormal liver function, and most cirrhosis is not contagious.
4, we understand what is cirrhosis, so what exactly are the causes of cirrhosis? What kind of people belong to the susceptible group?
There are many causes of cirrhosis, including chronic infectious liver disease, chronic alcoholism, drug and toxic liver damage, autoimmune hepatitis, chronic bruising, circulatory disorders, and genetic metabolic diseases.
Among them, chronic infectious liver disease, mainly including viral hepatitis (chronic hepatitis B, C caused by hepatitis cirrhosis), schistosomiasis. In China, viral hepatitis B infection is predominant, but studies show that hepatitis C is second only to hepatitis B in the causes of viral hepatitis cirrhosis in China; while hepatitis C is predominant in the causes of viral hepatitis cirrhosis in western developed countries, and hepatitis B is rare.
Chronic alcoholism is common in Western countries, and in recent years, there is also a rising trend in China. Alcoholic cirrhosis is closely related to long-term alcoholism, and its onset depends on the susceptibility and sensitivity of the individual to alcohol. It should be noted that female alcoholics have a significantly higher risk of developing cirrhosis than men.
In recent years, there has been a significant increase in drug and toxic liver damage. Both acute damage and chronic damage from drugs may develop into cirrhosis. These drugs include halothane, muscarinic acid, aflatoxin, yellow phosphorus and arsenic. Clinically used are iron (iron supplementation), paracetamol (antipyretic and analgesic), isoniazid methyldopa (antihypertensive), methotrexate (for psoriasis, rheumatoid arthritis), azathioprine (renal transplant anti-rejection, severe ulcerative colitis), cyclophosphamide (for nephrotic syndrome, thrombocytopenia), propylthiopyrimidine (for hyperthyroidism), diphenhydramine (for intractable constipation), and chlorpromazine (antipsychotic). There is also the use of antineoplastic drugs, long-term exposure to toxic chemical organic solvents in laboratories or factories, such as benzene, ether, formaldehyde, diluent, etc. It should also be noted that herbal medicines containing arsenic and mercury can lead to cirrhosis as well.
Cases of immune hepatitis have also been increasing in recent years. This disease rarely heals on its own and often progresses gradually and can easily progress to cirrhosis.
Cirrhosis caused by chronic bilious diseases can be divided into primary and secondary, the former being called primary biliary cirrhosis and the latter being mostly caused by chronic inflammation of the bile ducts, stones, tumors, cysts, post-surgical strictures and congenital biliary diseases.
The causes of cirrhosis due to circulatory disorders are mainly congestive right heart failure, constrictive pericarditis, and hepatic vein inferior vena cava obstruction syndrome.
There are many types of inherited metabolic diseases, but they are relatively rare. The relatively common clinical causes are hemochromatosis and hepatomegaly.
Who are the vulnerable groups for cirrhosis? It can be deduced from the above-mentioned etiological classification: patients with the above-mentioned etiological factors should pay attention and be treated actively. For viral hepatitis, patients who are often in contact with chronic hepatitis patients or occupations that are susceptible to hepatitis virus infection, such as medical workers and blood recipients, should pay attention to protection.
5.In order to have a deeper understanding of cirrhosis, then please ask Director Li to explain to us what are the early, middle and late symptoms of cirrhosis?
According to the severity of the disease, cirrhosis is generally divided into two categories: compensated cirrhosis and decompensated cirrhosis. Among them, compensated cirrhosis is what people call early cirrhosis, while intermediate and late cirrhosis is classified as decompensated cirrhosis.
In patients with compensated cirrhosis, most of them have no clinical symptoms, and some of them can have non-specific symptoms, mainly indigestion symptoms, such as loss of appetite, reduced eating, abdominal distension, aversion to grease, belching, diarrhea, pain in the liver area, which are mostly associated with exertion, mood swings, lack of sleep or aggravated by infection, and can be improved or temporarily relieved by paying attention to rest or taking appropriate medication. Signs are also not obvious. Generally, the nutritional status is still good, there may be mild liver palms, spider nevus or capillary dilatation, and the liver and spleen may be mildly enlarged. Ancillary tests: blood routine may have a mild decrease in hemoglobin, white blood cells and platelets; liver function is basically normal; ultrasound may suggest diffuse liver injury, mild widening of the internal diameter of the portal vein or mild enlargement of the liver and spleen.
Such patients do not have obvious jaundice, ascites, hypoproteinemia, gastrointestinal bleeding and hepatic encephalopathy, and are mostly found during physical examination, caesarean operation for other diseases or autopsy.
Patients with decompensated cirrhosis mainly present with two types of symptoms: hepatic insufficiency and portal hypertension, characterized by jaundice, ascites, hypoproteinemia, gastrointestinal bleeding and hepatic encephalopathy.
The manifestations of such patients can be summarized as: weakness, weight loss, obvious digestive symptoms, fever, bleeding and anemia, male hypogonadism, menstrual disorders and hyperpigmentation, liver disease face, edema, spider nevus, liver palm and capillary dilation, jaundice, ascites, pleural fluid, splenomegaly, hypersplenism, esophagogastric fundic veins, abdominal wall and periaqueductal veins and varices of hemorrhoids, shrinking liver, enlarged spleen and liver odor.
6.So what tests are needed to confirm the diagnosis of cirrhosis, and are there any areas of disease similar to cirrhosis that are separated during the examination?
First of all, it should be clear that pathological diagnosis by liver biopsy (liver puncture) is the “golden indicator” for the diagnosis of cirrhosis – that is, the pathology suggests diffuse fibrosis, regenerative nodules and pseudolobular formation in the liver. In fact, the clinical diagnosis is based on the patient’s history of liver disease, symptoms and signs, biochemical examinations, imaging examinations (ultrasound, MRI, gastroscopy), etc., to make a comprehensive judgment and arrive at a diagnosis. Only when the diagnosis is difficult, special tests such as liver aspiration will be considered.
When we come across such a patient and suspect cirrhosis, he can be diagnosed as long as he has the following characteristics: (1) Physical examination: the liver is firm or hard, with sharp irregular edges and an uneven surface with nodularity; the face of liver disease is also significant; spider nevus, liver palm and dilated capillaries are of reference significance for diagnosis. (2) Imaging examination: there is portal hypertension – splenomegaly, open collateral circulation (abdominal wall varices and esophageal varices) and ascites, of which, open collateral circulation is the characteristic basis for the diagnosis of portal hypertension. (3) Biochemical examination: there is hypoproteinemia with hypergammaglobulinemia. (4) A clear etiological basis: such as a history of hepatitis B, hepatitis C or hepatitis D virus infection, a history of long-term alcohol abuse, a history of drug intoxication, and a history of related diseases that cause cirrhosis (such as heart failure).
Some diseases have characteristics very similar to cirrhosis, such as chronic hepatitis, prehepatic portal hypertension (portal vein thrombosis), intrahepatic pre-sinusoidal portal hypertension (congenital hepatic fibrosis, hepatic portal sclerosis), posthepatic portal hypertension (hepatic vein inferior vena cava obstruction syndrome, chronic small hepatic vein occlusion), tuberculous peritonitis, abdominal tumors, and lymphoma. As long as they are carefully identified, it is generally not difficult to distinguish them.
7.What are the western medical treatments for liver cirrhosis so far?
For liver cirrhosis, comprehensive treatment measures are generally adopted. (1) Etiological treatment: Once the cause of the disease is clear, active elimination of the cause is the key to stopping the development of the disease and is also a prerequisite for subsequent treatment, which should be given high priority. For example, viral hepatitis with viral replication should be treated with antiviral therapy; alcoholic cirrhosis should be treated with absolute abstinence from alcohol; drug cirrhosis should be discontinued immediately and avoided again; autoimmune hepatitis should be treated with prednisone, etc. (2) Diet therapy. (3) Support therapy: including promotion of hepatocyte regeneration (hepatocyte growth factor), protection of hepatocyte membrane (ezetimibe), antioxidant agents (glutathione, acetylcysteine), correction of coagulation disorders (supplementation of fresh frozen plasma, fibrinogen preparations), correction of hypoproteinemia (supplementation of human albumin), etc. (4) Reduction of portal hypertension (oral propranolol prophylaxis). (5) Treatment of ascites: including salt restriction, addition of diuretics, abdominal puncture for ascites aspiration, and albumin supplementation. (6) Treatment of complications: emphasize early detection, early treatment, and active response. (7) Liver transplantation should be considered when serious complications occur: liver failure, recurrent esophageal variceal bleeding, spontaneous peritonitis with hepatic encephalopathy, refractory ascites or hepatorenal syndrome.
8.What are your Chinese medicine treatment methods for cirrhosis?
Chinese medicine classifies liver cirrhosis as “accumulation” and “bulging”. The cause and mechanism of cirrhosis are both positive deficiency (deficiency of liver, spleen, kidney, qi, blood, yin and yang) and evil (qi stagnation, blood stasis, phlegm coagulation, heat poisoning, damp heat, water drink).
9, many patients are very afraid of such diseases as cirrhosis of the liver, cirrhosis of the disease is extremely dangerous, so if you have early cirrhosis of the liver can be cured?
Liver cirrhosis is certainly a serious disease, but in clinical observation is not so terrible, many patients after regular treatment can mostly improve or control. As for the early stage of cirrhosis (compensated cirrhosis), the prognosis is better. Western medicine treatment is only to be observed by liver preservation treatment, and can be long-term survival. In recent years, Chinese medicine has made significant progress in anti-liver fibrosis treatment, with better efficacy and can be taken for a long time without obvious adverse reactions, which has unique advantages over western medicine. The main drugs are Huang Qi, Tao Ren, Cordyceps sinensis and Yi Mao Cao, etc. The listed Chinese patent medicines are Soft Liver Tablets and Fu Zheng Hua Yu Capsules, etc., which provide effective means for the treatment of early cirrhosis and should be confident.
10.Knowing so much, finally what do we need to pay attention to in the prevention of cirrhosis?
Although there are many causes of cirrhosis, viral hepatitis and long-term alcoholism are always the main causes. For viral hepatitis, we should actively prevent the onset of viral hepatitis, keep the disease from the mouth, and avoid receiving blood as much as possible; once the onset of the disease, we should actively treat it in regular specialized medical institutions in the acute stage; in the chronic stage, we should review it regularly, and once the virus replication or abnormal liver function is found, we should treat it in time and adhere to the medical prescription. For alcoholic hepatitis, alcohol should be strictly abstained from drinking, and the recurrence of drinking should be resolutely avoided. For drug-related hepatitis, the name of the drug should be actively identified and re-use should be avoided.
Chinese medicine believes that the function of the liver is “the main drainage”, “like to transfer”, “evil depression”, and that “the liver is the root of fatigue “Clinical observation also confirms that violent mood swings, long-term depression and fatigue are the direct causes or main triggers of liver disease. Therefore, optimism, regular work and rest, and combination of work and rest play an extremely important role in the prevention and treatment of liver disease and should be given high priority.
11.From the perspective of Chinese medicine, what do you think patients with liver cirrhosis should pay attention to in terms of diet?
In terms of diet, the requirements of Chinese medicine and Western medicine are the same. The diet should be high in calories, less stimulating, not hard and rough, and easy to digest, among which fat and meat should be tolerated. Patients with ascites should limit sodium, those with dilutional hyponatremia should limit water appropriately, and those with obvious liver failure should limit protein intake. Those who cannot eat or eat very little can be fed by nasal feeding or given parenteral nutrition. The only difference between TCM and Western medicine is that although eating is encouraged, it is also emphasized that the patient’s feelings should prevail.
12.What are your suggestions and insights on the treatment of liver cirrhosis?
At present, the treatment of liver cirrhosis has been programmed by both Chinese and Western medicine, and it is very convenient to implement. The general feeling is that Western medicine has overall advantages in the treatment of etiology, treatment of abnormal liver function and portal hypertension, while Chinese medicine has unique specialties in improving self-perception and relieving symptoms, especially in the stage of compensated cirrhosis, which lacks effective treatment in Western medicine. Therefore, the choice of treatment plan for liver cirrhosis is still based on the complementary and optimal selection of Chinese and Western medicine. In the treatment, no matter Chinese medicine or Western medicine, it should be as concise as possible, and intermittent medication can be considered if necessary. If it is taken for a longer period of time, the prescription of Chinese medicine tonics can be considered to be dispensed as a ready-made medicine, which is easy to adhere to and can also reduce the burden on the liver and facilitate recovery.