Nodular cirrhosis

　　(1) Hepatitis viruses: The most common are infections caused by hepatitis B virus, hepatitis C virus, and hepatitis D virus. Some hepatitis B virus carriers may develop chronic hepatitis, and a small portion of chronic hepatitis B may progress to nodular cirrhosis. Approximately half of acute hepatitis C cases may develop into chronic hepatitis, with 10% to 30% of them developing into nodular cirrhosis.

　　(2) Alcohol factors: Long-term excessive alcohol consumption leads to liver cell damage, causing fatty degeneration, necrosis, liver fibrosis, and in severe cases, nodular cirrhosis.

　　(3) Biliary stasis: Long-term chronic biliary stasis leads to inflammation of liver cells and biliary duct reaction, and even necrosis.

　　(4) Congestive factors: Chronic heart failure, restrictive pericarditis, and hepatic vein obstruction can cause liver congestion, leading to hypoxia and necrosis or变性 of liver cells, eventually leading to nodular cirrhosis.

　　(5) Drug or chemical toxin factors: Long-term use of certain drugs, such as diclofenac, fenoprofen, methyldopa, etc., can lead to drug-induced hepatitis, which eventually develops into nodular cirrhosis. Long-term exposure to certain chemical toxins, such as carbon tetrachloride, arsenic, phosphorus, etc., can cause toxic hepatitis, which develops into nodular cirrhosis.

　　(6) Metabolic disorder: Copper metabolism disorder, seen in hepatolenticular degeneration. Iron metabolism disorder, seen in hemophilia, galactosemia, cystic fibrosis, alpha-antitrypsin deficiency, glycogen storage disease, tyrosine metabolism disorder, hereditary hemorrhagic telangiectasia, the above conditions are related to genetic metabolic defects, and can all lead to nodular cirrhosis.

　　1. Hepatic encephalopathy

　　Hepatic encephalopathy is caused by acute or chronic liver disease or various reasons of portal-systemic shunt, which is an abnormality in the nervous and mental aspects based on metabolic disorder. Clinical manifestations can be mild abnormalities detectable only by intelligence tests or electrophysiological detection methods, or can manifest as abnormal behavior, consciousness disorders, or even coma.

　　2. Upper gastrointestinal hemorrhage

　　Mostly caused by the rupture of esophageal varices at the fundus of the stomach, but it should be considered whether there is concurrent peptic ulcer, acute hemorrhagic erosive gastritis, or cardiospasm syndrome, etc. The bleeding from varices is often due to rough, hard, or angular food causing trauma, and if there is a large amount of bleeding, it can cause shock. Under the condition of ischemia and hypoxia of the liver, liver function often deteriorates, and bleeding causes the loss of plasma protein, which can lead to the formation of ascites. Blood in the intestines is decomposed by bacteria, producing ammonia, which is absorbed by the intestinal mucosa and can induce hepatic encephalopathy or even death. After bleeding, the previously enlarged spleen can shrink or even cannot be felt.

　　3. Infection

　　Due to the decline in immune function of the body, hyperactivity of the spleen, and the establishment of collateral circulation between the portal and systemic veins, there is an increased opportunity for pathogenic microorganisms to enter the systemic circulation, thus making it prone to various infections, such as bronchitis, pneumonia, tuberculous peritonitis, primary peritonitis, biliary tract infection, and Gram-negative bacillary sepsis, etc. Primary peritonitis refers to acute peritoneal inflammation in the abdominal cavity of patients with nodular cirrhosis without organ perforation, with an incidence rate of 3% to 10%, which often occurs in patients with a large amount of ascites, mostly caused by Escherichia coli. The reason is that the phagocytic function of phagocytes is weakened during nodular cirrhosis, bacteria in the intestines are abnormally proliferated, enter the peritoneal cavity through the intestinal wall, and due to the change in vascular structures inside and outside the liver, bacteria can also cause bacteremia or carry bacteria through collateral circulation, leaking into the peritoneal cavity from under the liver capsule or the portal lymph node, causing infection.

　　1. Gastrointestinal symptoms. There are often symptoms such as loss of appetite, accompanied by nausea, vomiting, abdominal distension, diarrhea, etc., caused by liver dysfunction and portal hypertension, which lead to obstructive congestion of the gastrointestinal tract and a disorder of secretion and absorption. In the late stage, ascites or gastrointestinal bleeding may occur.

　　2. Manifestations of malnutrition. Weight loss, anemia, various vitamin deficiencies, such as night blindness, rough skin, follicular keratosis, smooth tongue, cheilitis, scrotal inflammation, seborrheic dermatitis, pale or spoon-shaped nails, polyneuritis, etc.

　　1. Control alcohol intake: It is necessary to control one's own alcohol intake, reduce the quantity and frequency of drinking, which is helpful for effectively preventing nodular cirrhosis caused by chronic alcoholism.

　　2. Vaccination against hepatitis B: Since chronic hepatitis is the main cause of the occurrence of nodular cirrhosis in China, it is necessary to do a good job of proper protection when contacting hepatitis B patients. Timely vaccination against hepatitis B virus, preventing the infection of hepatitis B virus. At the same time, attention should be paid to public health safety when entering and leaving public environments and when dining out or attending gatherings.

　　3. Keep away from unknown waters: Due to the occurrence of schistosomiasis infection caused by schistosomiasis in the Yangtze River basin in China, schistosomes generally reside in the bodies of snails that are amphibious on land and water. Since snails belong to field organisms, it leads to some groups engaged in field work coming into contact with the schistosome-infected water, resulting in infection with schistosomes, and the long-term residence of schistosomes in the human body gradually leading to the occurrence of nodular cirrhosis. Therefore, people should keep away from unknown waters and prevent the infection of schistosomes.

　　4. Regular physical examination: Regular physical examination is also crucial for preventing the occurrence of nodular cirrhosis. Some patients with hepatitis, due to the prolonged course of the disease, long-term medication, leading to the development of drug resistance to the virus, which cannot effectively suppress the patient's condition, and the patient does not have regular physical examinations, thus leading to the patient not discovering the occurrence of nodular cirrhosis in time.

　　5. Maintain a good lifestyle: To prevent the occurrence of nodular cirrhosis, it is necessary to maintain an optimistic mood, emotional stability, not to be angry, not to stay up late, and not to overwork.

　　1. Blood routine: When there is hypersplenism, the total blood cell count decreases, with leukocyte count often below 4.0×10^9/L (4000), and platelet count often below 50×10^9/L (50000). Most cases present with normal cellular anemia, while a few cases may be macrocytic anemia.

　　Laparoscopic examination: It is one of the reliable methods for diagnosing nodular cirrhosis, which can directly observe the liver surface. In typical cases, nodular liver surface, varicose veins of the abdominal wall, and splenomegaly can be seen.

　　3. Routine examination of ascites: Ascites is a transudate, with a density below 1.018, negative Li's reaction, and a cell count below 100/mm3, with protein quantification less than 25g/L.

　　4. Ultrasound examination: During liver cirrhosis, due to fibrous tissue proliferation, ultrasound shows uniform, diffuse dense punctate echoes, with increased echoes in the late stage. The liver volume may decrease, and if there is portal hypertension, the portal vein may dilate, and the spleen may thicken.

　　5. Liver biopsy: This method can determine the diagnosis and understand the histological type of nodular cirrhosis of the liver, as well as the degree of liver cell damage and fibrous tissue formation. However, if the sample is too small, there may be false-negative results. Currently, rapid biopsy is commonly used, which is simple, has few complications, and is safe.

　　6. Urinalysis: If there is jaundice, the urine bilirubin/urinary biliverdin is positive.

　　One, do not overdo protein supplementation. Eating more protein can increase plasma protein levels, prevent or reduce liver fat infiltration, and promote the recovery and regeneration of liver tissue. However, if an excessive amount of protein produces too much ammonia in the body, the liver cannot convert it into non-toxic substances for excretion, and the ultimate result is to lead to hepatic coma.

　　Two, nodular cirrhosis of the liver patients should advocate for a low-sodium diet. Liver damage weakens the function of antidiuretic hormone, resulting in decreased urine output and salt retention in the body, as well as the appearance of edema or ascites due to the reduction in plasma proteins. Therefore, nodular cirrhosis of the liver patients should strictly control their salt intake. For patients with no edema or mild edema, the daily salt intake should not exceed 5 grams; for those with severe edema, the salt intake should not exceed 1 gram.

　　Three, keep away from spicy and strongly irritating foods. During nodular cirrhosis of the liver, portal hypertension can cause dilatation of the lower esophageal vein, gastric fundus vein, and anal vein, and nodular cirrhosis of the liver often complicates with gastric mucosal erosion and ulcer disease. If patients consume spicy foods such as chili, it will promote hyperemia of the gastric mucosa and increased peristalsis, thus triggering upper gastrointestinal bleeding, causing anal burning and increased frequency of bowel movements, exacerbating hemorrhoids, and causing anal fissure. At the same time, attention should also be paid to not eating overly hard foods, as portal hypertension causes the lower esophageal vein and gastric fundus vessels to become thicker and thinner, and rough foods that are not finely chewed and swallowed may puncture or abrade the vessels, causing massive hemorrhage.

　　Four, nodular cirrhosis of the liver patients must abstain from smoking and drinking. Long-term alcohol consumption can lead to alcoholic cirrhosis. Drinking can also cause upper abdominal discomfort, decreased appetite, deficiency of proteins and vitamin B complex. In addition, alcohol has a direct toxic effect on liver cells, while nicotine has a vasoconstrictive effect, causing a reduction in liver blood supply, affecting the nutrition of the liver, and is not conducive to the stability of liver disease.

　　The clinical differentiation and treatment of nodular cirrhosis of the liver can be divided into seven types, which are described as follows:

　　1. The Qi-stagnation and Damp-obstruction type: The symptoms include abdominal distension, soft to the touch, visible blue veins on the abdomen, distension and pain in the hypochondria, decreased appetite, bloating after eating, fatigue, and oliguria. Treatment involves using Bupleurum chinense, Quercus acutissima, Cyperus rotundus, white peony root, tangerine peel, Chuanxiong, Magnolia officinalis, Atractylodes macrocephala, Alisma orientale, Poria cocos, Pericarpium citri reticulatae, Cinnamon, and Cinnamomum cassia to treat it.

　　2. Qi Stagnation and Blood Stasis: Symptoms include abdominal distension, blue veins exposed, mass and sharp pain in the flanks, dark face, visible thread-like blood spots on the skin, red palm print, dry mouth and thirst, but want to rinse the mouth without wanting to swallow, black stools, purple lips, purple tongue with spots, varicose veins under the tongue, thin and涩 pulse. Treatment with Danggui, Chishao, Chuanxiong, Yuanhu, Yizhu, Sanlie, Dahuang, Qumai, Fuling, Dafupi, Sangpi, Zhike, Honghua.

　　3. Damp-heat Accumulation: Symptoms include abdominal distension, distension and pain in the epigastrium,烦热口苦, thirst without desire to drink, red urine, constipation, red tip and edge of the tongue with yellow greasy fur, wiry pulse. Treatment with Huangqin, Huanglian, Houpu, Zhike, Chenpi, Banxia, Zhuli, Fuling, Zexie, Yinzhen, Dahuang, Zhizi.

　　4. Cold and Dampness Retaining the Spleen: Symptoms include abdominal distension, as if wrapped in water, chest and epigastrium stuffiness, relief with heat, fatigue, aversion to cold, laziness, less urine, loose stools, white greasy tongue fur, slow pulse. Treatment with Fuling, Baizhu, Houpu, Dafupi, Muxiang, Fuzi, Ganjiang, Qingpi, Zhike.

　　5. Deficiency of Spleen and Kidney Yang: Symptoms include abdominal distension, more severe in the evening, not firm to control, accompanied by sallow complexion, aversion to cold, cold limbs, fatigue, less urine and loose stools or edema in the lower limbs, pale and bloated tongue with thin white slippery fur, deep and thin pulse. Treatment with Shudihuang, Shanyao, Danpi, Zexie, Fuling, Fuzi, Rougui, Qianxiezi, Zhuli, Huangqi.

　　6. Deficiency of Liver and Kidney Yin: Symptoms include abdominal distension, even with blue veins exposed, emaciated body, sallow or dark face and lips, dry mouth and heartburn, hot palms and soles, less urine and yellow, short stools, dry stools, or nosebleed, pulse wiry-thin and rapid. Treatment with Shudihuang, Shashen, Gouqizi, Maidong, Chuanlianzi, Danggui, Chuanxiong, Chishao, Yuanhu, Taoren, Honghua, Biejia.

　　7. Deficiency of both Qi and Blood: Symptoms include dizziness, palpitations, pale complexion, fatigue, loss of appetite, hidden pain in the flanks, pale tongue with thin white fur, and weak pulse. Treatment with Taiizi Shen, Huangqi, He Shou Wu, Yun Ling, stir-fried Baizhu, Danggui, Ejiao, Danshen, Yujin, Muxiang, Lianqiao, Sangshen.