Drug-induced liver cirrhosis

　　There are many types of drugs that can cause different liver damage, with over 200 types, including non-steroidal analgesics such as acetaminophen, muscle relaxants, anesthetics, anticonvulsants, antibiotics, antifungal drugs, and antiparasitic drugs, antituberculosis drugs, anticancer drugs, immunosuppressants, hormone drugs, oral hypoglycemic agents, antithyroid agents, H2-receptor blockers, psychiatric drugs, and so on. According to statistics, patients with drug-induced liver damage account for about 10% to 15% of all drug reaction cases, with an incidence rate second only to skin and mucosal damage and drug fever.

　　Damage caused by drugs can be divided into predictable (usually dose-related) and non-predictable (or idiosyncratic, often dose-independent). Predictable damage can be replicated in animal models and often damages specific areas of the liver lobules, as it is related to dose, hence such drugs are called 'direct liver toxic' drugs. Non-predictable damage is often diffuse, and it is speculated to be an allergic reaction to the drug, with the immune mechanism being the direct cause of liver cell injury. Non-predictable damage cannot be replicated in corresponding animal models.

　　The current view is that non-predictable injury is caused by certain drugs producing toxic metabolites in the process of biotransformation, which then lead to liver lesions. Due to the differences in individual drug metabolism pathways and rates, especially the variability of P450 activity, the detoxification mechanism differences, etc., toxic metabolites increase in the liver, making some individuals more susceptible to liver damage.

　　Drugs can cause several types of liver cirrhosis: ① Macroscopic nodular or postnecrotic cirrhosis, usually developing from drug-induced chronic active hepatitis or subacute liver necrosis. ② Liver cirrhosis with fatty degeneration, morphologically characterized by small or large nodules. ③ Biliary cirrhosis. ④ Congestive cirrhosis, caused by occlusion of hepatic veins or small hepatic veins.

　　1, Hepatic encephalopathy is defined as an increase in blood ammonia caused by liver disease, affecting the energy metabolism of the central nervous system, known as hepatic encephalopathy, which is usually accompanied by abnormal behavior and consciousness disorders.

　　2, Upper gastrointestinal hemorrhage due to liver cirrhosis, most of which is caused by the rupture of esophageal varices or fundic varices, but it should be considered whether there are concurrent gastric mucosal lesions such as peptic ulcers, acute hemorrhagic erosive gastritis, or esophageal tear syndrome. Hemorrhage from varices is often due to rough, hard, or angular food trauma, erosion of the esophagus by gastric acid reflux, or severe vomiting. Hemorrhage may result in vomiting blood and black stools. If the amount of bleeding is not much, only black stools may appear. 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. Bleeding also causes the loss of plasma protein, which can lead to the formation of ascites. After bacteria decompose the blood in the intestines, ammonia is produced and absorbed by the intestinal mucosa, which can induce hepatic encephalopathy and even death. After bleeding, the enlarged spleen can shrink or even cannot be felt.

　　13. 3. Infection is more likely to occur due to decreased immune function of the body, splenic hyperfunction, and the establishment of collateral circulation between the portal and systemic veins, which increases the opportunity for pathogenic microorganisms to enter the systemic circulation. Therefore, various infections are more likely to occur, 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 liver cirrhosis patients without organ perforation, with an incidence rate of 3% to 10%. It often occurs in patients with a large amount of ascites, mostly caused by Escherichia coli. The reason is that the phagocytic action of phagocytes is weakened during liver cirrhosis, bacteria in the intestines are abnormally proliferated, and enter the peritoneal cavity through the intestinal wall. Also, due to the changes in vascular structures inside and outside the liver, bacteria can also cause sepsis or carry bacteria through collateral circulation, and the bacteria can leak into the peritoneal cavity from under the liver capsule or the lymph nodes around the hilum of the liver, causing infection. The clinical manifestations include fever, abdominal pain, distension, abdominal wall tenderness and rebound pain, increased ascites, increased blood leukocytes, cloudy ascites, which is between exudative and transudative fluid. Ascites culture may show bacterial growth. A few patients may not have abdominal pain or fever, but present with hypotension or shock, refractory ascites, and progressive liver function failure.

　　10. 1. History of taking drugs that damage the liver, especially drugs that can cause chronic active hepatitis, such as diclofenac, methyldopa, acetaminophen, aspirin, amiodarone, sulfonamides, etc. Some drugs may progress covertly to liver cirrhosis, such as methotrexate.

　　9. Clinical manifestations of liver cirrhosis, such as portal hypertension and its complications, upper gastrointestinal bleeding, ascites, hepatic encephalopathy, etc.

　　8. Liver biopsy confirmed as liver cirrhosis.

　　7. Exclude liver cirrhosis caused by other reasons, such as various viral hepatitis, all serum markers are negative, and exclude cardiogenic liver cirrhosis, etc.

　　The focus of drug-induced liver cirrhosis is on prevention. Prevent early drug-induced injury, such as regular liver function tests during the period of drug treatment. For patients with existing liver disease or kidney disease, liver function changes during the period of drug use should be monitored more. For those with a history of drug-induced liver damage, it should be avoided to use the same or structurally similar drugs again. For drug-induced chronic active hepatitis or liver fibrosis, anti-fibrotic drugs such as Salvia miltiorrhiza and Angelica sinensis should be used early.

　　In addition, according to the mechanism of liver injury caused by drugs, targeted drugs can be selected in combination with therapeutic drugs to prevent the occurrence of liver injury, such as mercaptopropionyl glycine can inhibit the activity of cytochrome P450, acetylcysteine can promote the synthesis of GSH, acetylsalicylic acid can reduce the concentration of calcium ions, and so on.

　　In the diagnosis of drug-induced liver cirrhosis, in addition to relying on its clinical manifestations, auxiliary examinations are also needed. Abdominal ultrasound, nuclear magnetic resonance (MRI) or computed tomography (CT) are used for preliminary diagnosis, and liver biopsy is performed to confirm the diagnosis.

　　1. Dietetic recipe for liver cirrhosis-induced kidney damage

　　(1) Breakfast: Congee (50 grams of rice), steamed bun (75 grams of flour), pork floss (15 grams of pork floss)

　　(2) Snack: Sweet milk (250 grams of fresh milk, 10 grams of sugar), 150 grams of apple

　　(3) Lunch: Rice (150 grams of rice), fried hairtail (200 grams of hairtail), stir-fried Napa cabbage (150 grams of Napa cabbage)

　　(4) Snack: Cudgel powder (30 grams of cudgel powder, 10 grams of sugar)

　　(5) Dinner: Rice (150 grams of rice), fried chicken pieces (100 grams of chicken pieces), stir-fried tofu with tomatoes (50 grams of tofu, 100 grams of tomatoes)

　　The total daily oil intake is 25 grams. The above diet contains 2422 kilocalories (10120 kilojoules) of energy.

　　2. Foods that are good for the body in liver cirrhosis-induced kidney damage

　　(1) It is advisable to eat high-protein, high-sugar, high-vitamin, low-fat, and easily digestible foods, such as lean meat, fish, eggs, vegetables, and fruits;

　　(2) For patients with advanced liver cirrhosis and hepatic coma, a low-protein diet should be followed. For those with severe edema or ascites, a low-salt or salt-free diet should be adopted;

　　(3) For those with constipation, eating more sesame oil, honey, sesame seeds, and bananas can help keep the bowels open, reduce ammonia accumulation, and prevent hepatic coma.

　　3. Foods to avoid for liver cirrhosis-induced kidney damage

　　Avoid spicy and刺激性 foods. Quit smoking and drinking, eat less fried food, and it is best not to eat eel, because eel has a very high protein content, is difficult to digest after eating, and will increase the metabolic burden on the liver.

　　1. Immediately stop using related or suspected drugs.

　　2. Strengthen nutrition, such as high-protein, vitamin B complex, and vitamin C.

　　3. Liver-protecting drugs, such as Gan Tai Le, can be used for patients with significantly elevated transaminases, such as reduced glutathione and Ganlixin.

　　4. Symptomatic treatment, such as upper gastrointestinal bleeding, ascites, hepatic encephalopathy, etc., should be carried out according to the specific examination results and clinical symptoms.