Cirrhosis is a common chronic progressive liver disease with diffuse liver damage formed by the long-term or repeated action of one or more etiologies. In China, most of them are post-hepatitis cirrhosis, and a few of them are alcoholic cirrhosis and schistosomiasis cirrhosis. The pathological histology has extensive hepatocyte necrosis, nodular regeneration of residual hepatocytes, connective tissue proliferation and fibrous septum formation, leading to structural destruction of liver lobules and pseudobullet formation, and gradual deformation and hardening of the liver to develop cirrhosis. In the early stage, due to the strong compensatory function of the liver, there are no obvious symptoms, but in the later stage, liver function damage and portal hypertension are the main manifestations, and there are multi-system involvement. In the late stage, complications such as upper gastrointestinal bleeding, hepatic encephalopathy, secondary infection, hypersplenism, ascites and carcinoma often appear.
There are many causes of cirrhosis, which can be divided into viral hepatitis cirrhosis, alcoholic cirrhosis, metabolic cirrhosis, biliary cirrhosis, hepatic venous reflux obstruction cirrhosis, autoimmune cirrhosis, toxic and drug cirrhosis, malnutrition cirrhosis, cryptogenic cirrhosis, etc.
Etiology of cirrhotic ascites.
1.Viral hepatitis
At present in China, viral hepatitis, especially chronic hepatitis B and C, is the main factor causing portal cirrhosis.
2.Alcoholism
Long-term heavy alcoholism is one of the factors that cause cirrhosis.
3.Nutritional disorders
Most scholars acknowledge that malnutrition can reduce the resistance of liver cells to toxic and infectious factors, and become an indirect cause of cirrhosis.
4.Industrial toxins or drugs
Long-term or repeated exposure to arsenic-containing insecticides, carbon tetrachloride, yellow phosphorus, chloroform, etc., or long-term use of certain drugs such as diphenhydramine, isoniazid, cinchofen, tetracycline, aminopterin, methyldopa, can produce toxic or drug-related hepatitis, which in turn can lead to cirrhosis. Aflatoxin can also cause toxic damage to liver cells and cause cirrhosis.
5.Circulatory disorders
Chronic congestive heart failure, chronic constrictive pericarditis can cause long-term stasis and hypoxia in the liver, causing hepatocyte necrosis and fibrosis, called stasis cirrhosis, also known as cardiogenic cirrhosis.
6.Metabolic disorders
Such as hemochromatosis and hepatomegaly (also known as Wilson’s disease), etc.
7.Cholestasis
The high concentration of bilirubin in extrahepatic bile duct obstruction or intrahepatic bile stasis has a damaging effect on hepatocytes, and cirrhosis can occur over time.
8.Schistosomiasis
Schistosomiasis can cause significant portal hypertension, also known as schistosomiasis cirrhosis, due to the proliferation of connective tissue stimulated by the eggs in the confluence area.
9.Understood causes
Some of the causes of cirrhosis are unknown, which is called cryptogenic cirrhosis.
The severity of cirrhotic ascites is mostly related to the degree of liver decompensation; the heavier the degree of decompensation, the worse the liver function, and the more difficult it is for ascites to subside. Therefore, the goal of clinical treatment should not focus on regression of ascites.
1.Protect hepatocytes: improve liver function, promote hepatocyte regeneration, maintain electrolyte and alkaline balance.
2, prevention of complications: patients with cirrhotic ascites are often accompanied by an increase in complications and aggravation of the disease clinically. Such as the appearance of upper gastrointestinal bleeding, hepatorenal syndrome, spontaneous bacterial peritonitis.
3, control ascites: glue itself no emergency danger, so it is appropriate to take slow and gradual steps to eliminate ascites. Since it takes considerable time for liver function improvement and renal regulation of water and sodium retention to be effective, consideration must also be given to relieving the patient’s symptoms as soon as possible in cases of massive ascites. In patients with underlying spontaneous bacterial peritonitis, active control of inflammation is required for ascites to subside.