Liver Cirrhosis

　　Liver cirrhosis patients often die of complications, and the treatment of liver cirrhosis complications cannot be ignored. Upper gastrointestinal bleeding is the most common complication of liver cirrhosis, while hepatic encephalopathy is the most common cause of death in liver cirrhosis.

　　1. Hepatic encephalopathy:Hepatic encephalopathy is the most common cause of death.

　　2. Large-scale upper gastrointestinal bleeding:Upper gastrointestinal bleeding is the most common complication, which often occurs suddenly, with a large amount of bleeding, usually more than 1000ml, and it is very difficult to stop bleeding spontaneously. In addition to vomiting blood and blood clots, there is often black stool. The factors related to portal hypertension include six types, with the most common being bleeding from esophageal and gastric fundus varices. Other bleeding causes include acute hemorrhagic erosive gastritis, Mallory-Weiss syndrome, etc.

　　3. Infection:Including bronchitis, pneumonia, tuberculous peritonitis, biliary tract infection, intestinal infection, spontaneous peritonitis, and Gram-negative bacillary sepsis, etc.

　　4. Primary liver cancer:Primary liver cancer often occurs on the basis of liver cirrhosis. The possibility of concurrent liver cancer should be considered under the following conditions: ① The condition still develops and worsens rapidly despite active treatment. ② Progressive liver enlargement. ③ Liver pain that cannot be explained by other causes. ④ The appearance of bloody ascites. ⑤ Unexplained fever. ⑥ Persistent or increasing alpha-fetoprotein levels. ⑦ The detection of a mass lesion in B-ultrasound or liver scanning with radioactive isotopes.

　　5. Hepatorenal syndrome:When liver cirrhosis is complicated with refractory ascites and is not appropriately treated, hepatorenal syndrome may occur. Its characteristics are oliguria or anuria, azotemia, hyponatremia or low urinary sodium, without organic lesions in the kidneys, so it is also called functional renal failure. This complication has a very poor prognosis.

　　6. Portal vein thrombosis:The slow blood flow in the portal vein, portal vein sclerosis, and portal vein endometritis are related to the formation of thrombosis and portal vein obstruction. If the thrombosis forms slowly, is localized to the extrahepatic portal vein, and is organized, or if there is a rich collateral circulation, there may be no obvious clinical symptoms. If a complete obstruction occurs suddenly, symptoms such as severe abdominal pain, distension, hematochezia, hematemesis, and shock may appear.

　　7. Respiratory system injury:In recent years, some scholars have collectively referred to various pulmonary changes caused by liver disease as liver-pulmonary syndrome. Its essence is the abnormal expansion of pulmonary vessels and arterial oxygenation during liver disease, which can cause hypoxemia.

　　8. Ascites:Normal people have a small amount of fluid in the abdominal cavity, about 50ml. When the amount of fluid exceeds 200ml, it is called ascites. Ascites is a common complication of decompensated liver cirrhosis.

　　The most important point in preventing liver cirrhosis is the prevention and treatment of various primary diseases, specifically as follows:

　　1. Reduce pathogenic factors:Actively prevent and treat chronic hepatitis, schistosomiasis, gastrointestinal infections, avoid contact with and application of toxic substances to the liver, and reduce pathogenic factors.

　　2. Emotional stability:The relationship between the liver and mental and emotional factors is very close. Poor mood, depression, and sudden anger and excitement can affect liver function and accelerate the development of lesions.

　　3. Use simple medication:The blind and excessive use of general drugs will increase the burden on the liver and is not conducive to liver recovery.

　　4. Diet adjustment:It is advisable to have a diet low in fat, high in protein, high in vitamins, and easy to digest. Make sure to have regular meals, fixed portions, and self-control.

　　5. Combine activity with rest:Chronic liver cirrhosis patients should absolutely rest in bed when compensatory function decreases and complications such as ascites or infection occur. During the period of sufficient compensatory function and stable condition, some light work or appropriate activities can be done, such as walking, doing health exercises, Tai Chi, Qigong, etc. The amount of activity should be moderate so as not to feel tired.

　　6. Quit smoking and drinking:Alcohol can stimulate fire and blood, and long-term alcohol consumption, especially strong alcohol, can lead to alcoholic chronic liver cirrhosis. Therefore, drinking can worsen the condition of chronic liver cirrhosis patients and easily cause bleeding. Long-term smoking is not conducive to the stability and recovery of liver disease, can accelerate the progression of chronic liver cirrhosis, and has the risk of triggering liver cancer.

　　The initial diagnosis of liver cirrhosis mainly involves a general physical examination. If liver enlargement is suspected as cirrhosis, some auxiliary examinations are needed.

　　1. Laboratory examination

　　1. Blood routine: Decreased hemoglobin, platelets, and white blood cells.

　　2. Liver function tests: Mild abnormalities in the compensatory phase, decreased serum protein, increased globulin, and A/G inversion in the decompensatory phase. Prolonged prothrombin time, decreased prothrombin activity. Increased transaminases and bilirubin. Decreased total cholesterol and cholesterol esters, ammonia may increase. Disordered amino acid metabolism, imbalance of branched/essential amino acid ratio. Increased blood urea nitrogen and creatinine. Electrolyte disturbance: hyponatremia, hypokalemia.

　　3. Pathogenic examination: HBV-M or HCV-M or HDV-M positive.

　　4. Immunological examination: Immunoglobulins, IgA, IgG, IgM may increase; autoantibodies, anti-nuclear坑 body, anti-mitochondrial antibody, anti-smooth muscle antibody, and anti-hepatolipid membrane antibody may be positive; other immunological examinations. Complement reduction, rate of roseola formation and lymphocyte transformation rate decrease, CD8(Ts) cells decrease, and function decreases.

　　5. Fibrosis examination: The levels of PⅢP, prolyl hydroxylase (PHO), monoamine oxidase (MAO), and serum laminin (LM) increase.

　　6. Abdominal fluid examination: Patients with newly appeared ascites or those with rapid increase of ascites without clear cause should undergo abdominal puncture for routine examination of ascites, determination of adenosine deaminase (ADA), bacterial culture, and cytological examination. To improve the positive rate of culture, ascites culture should be performed at the bedside using blood culture bottles, and aerobic and anaerobic bacterial cultures should be conducted separately.

　　Second, imaging examination

　　1. X-ray examination: Barium esophagogram, showing worm-eaten or earthworm-like varices in the esophageal and gastric fundus.

　　2. B-type and color Doppler ultrasound examination: Thickened liver capsule, rough liver surface, enhanced liver parenchyma echo, uneven and rough, widened portal vein diameter, enlarged spleen, and ascites.

　　3. CT examination: Abnormal proportions of liver lobes, reduced density, nodular changes, widened portal, enlarged spleen, and ascites.

　　Third, endoscopic examination

　　It can determine whether there is varices of the esophageal and gastric fundus, with a higher positive rate than barium meal X-ray examination. It can also understand the degree of varices and assess the risk of bleeding. Varices of the esophageal and gastric fundus are the most reliable indicator for diagnosing portal hypertension. In cases of concurrent upper gastrointestinal bleeding, emergency gastroscopy can identify the bleeding site and etiology, and perform hemostasis treatment.

　　Fourth, laparoscopic examination

　　It can directly observe the abdominal cavity organs and tissues such as the liver and spleen, and biopsy can be performed under direct vision, which is valuable for diagnosis in difficult cases.

　　Patients with liver cirrhosis need to pay special attention to their diet due to the damage to liver function.

　　1. Rational application of protein

　　The liver is the site of protein synthesis, with 11 to 14 grams of albumin synthesized by the liver daily. When liver cirrhosis occurs, the liver cannot synthesize proteins well. At this time, it is necessary to arrange the intake of protein rationally to prevent the occurrence of hepatic encephalopathy. Protein foods from various sources can be chosen. To help the patient adapt better, a diet based on casein can be eaten, with cheese mixed into moderate amounts of chicken, fish, lean meat, and eggs, and a little bit of it should be consumed daily to balance the protein diet.

　　2. Provide an appropriate amount of fat

　　Some patients with liver cirrhosis are afraid to eat fat, but in fact, fat should not be restricted too strictly. Due to incomplete pancreatic function, reduced bile salt secretion, and congestion of lymphatics or portal veins, nearly half of the patients with liver cirrhosis have steatorrhea, which is poor fat absorption. When the above symptoms occur, the fat intake should be controlled. However, if the patient does not have the above symptoms and can adapt to the fat in the food, fat should not be restricted too strictly to increase calories. For bile cirrhosis, a low-fat, low-cholesterol diet should be adopted.

　　3. Provide adequate carbohydrates

　　Sufficient carbohydrates can enable the body to fully store glycogen, prevent damage to liver cells by toxins, and consume 350 to 450 grams of starchy foods daily.

　　4. Limit water and sodium in the diet

　　Patients with edema or mild ascites should be given a low-salt diet, with the daily salt intake not exceeding 3 grams; in cases of severe edema, a salt-free diet is recommended, with sodium intake limited to about 500 milligrams.

　　5. Increase the intake of foods rich in zinc and magnesium

　　Patients with liver cirrhosis generally have low blood zinc levels, increased urinary zinc excretion, and reduced zinc content in liver cells. When drinking alcohol, the blood zinc level will continue to decrease, and alcohol should be strictly prohibited. It is appropriate to consume foods rich in zinc, such as lean pork, beef, eggs, fish, etc. To prevent magnesium ion deficiency, it is recommended to eat more green leafy vegetables, peas, dairy products, and grains, etc.

　　6. Supplement with vitamin C

　　Vitamin C directly participates in liver metabolism, promoting the formation of glycogen. Increasing the concentration of vitamin C in the body can protect the resistance of liver cells and promote the regeneration of liver cells. The concentration of vitamin C in ascites is equal to that in the blood, so a large amount of vitamin C should be supplemented during ascites. The skin of fruits should be peeled or juiced before consumption.

　　Untreated liver cirrhosis can lead to many complications. Common treatment methods are as follows:

　　1. Supportive treatment, intravenous infusion of hypertonic glucose solution to supplement calories, vitamin C, insulin, and potassium chloride can be added to the infusion. Attention should be paid to maintain water, electrolyte, and acid-base balance. For patients with severe illness, albumin and fresh plasma can be infused.

　　2. Patients with active hepatitis can be treated with liver protection, enzyme reduction, jaundice relief, etc. Medications such as Gancai, Vitamin C. Intravenous fluid therapy may be necessary.

　　3. Oral medications to reduce portal pressure, such as Propranolol, Isosorbide Dinitrate, and Nifedipine.

　　4. Supplement with B vitamins and digestive enzymes, such as Weikangfu.

　　5. Treatment of hypersplenism can include medications that increase white blood cells and platelets, such as Erythropoietin, Squalene, and Aminopeptidase. If necessary, splenectomy or splenic artery embolization can be performed for treatment.

　　6. Treatment of ascites, including general treatment, diuretic therapy, paracentesis, and reinfusion of ascites.

　　7. Surgical treatment for portal hypertension, indications include esophageal and gastric fundus varices破裂出血，after non-surgical treatment is ineffective; massive spleen with hypersplenism; high-risk patients with esophageal varices bleeding. It includes: portal-caval shunt, portal-paraumbilical shunt, and splenectomy, etc. Postoperative complications include hepatic encephalopathy and postoperative rebleeding, etc.

　　8. Liver transplantation surgery is applicable to end-stage liver disease that is unresponsive to conventional medical and surgical treatment. It includes: intractable ascites; portal hypertension with bleeding from the upper gastrointestinal tract; severe liver dysfunction; liver-kidney syndrome; progressive and severe hepatic encephalopathy; liver cirrhosis with concurrent liver cancer.