Hepatic purpura

　　The etiology of hepatic purpura is not very clear, and it may be related to some diseases such as severe tuberculosis, malignant tumors, acquired immunodeficiency syndrome (AIDS), taking certain drugs (such as corticosteroids, azathioprine, tamoxifen), long-term hemodialysis, and the application of immunosuppressants after organ transplantation. It is reported that in the population with human immunodeficiency virus (HIV) positivity, a kind of bacterial purpura of the liver or spleen (bacillary peliosis, BP) may occur, which is related to the infection of R.henselae genus bacteria and belongs to zoonotic parasitic diseases, mainly seen in those who have close contact with cats or infected with R.henselae genus and related bacteria.

　　Hepatic purpura disease is mainly characterized by massive intraperitoneal hemorrhage due to spontaneous rupture of the cystic cavity, which is its main complication. Due to massive blood loss, when the blood loss exceeds 1000ml, shock-like symptoms may occur. Whether shock occurs after blood loss not only depends on the amount of blood loss but also on the speed of blood loss. It can manifest as a decrease in cardiac output, despite the vasoconstriction of peripheral blood vessels, the blood pressure still decreases. Reduced tissue perfusion promotes anaerobic metabolism, leading to increased lactic acid and metabolic acidosis.

　　Most patients with hepatic purpura are asymptomatic, and a few may present with liver enlargement and mild elevation of transaminases. Occasionally, splenic purpura may occur, and in rare cases, liver failure may occur due to extensive hepatic purpura and severe complications due to extensive damage to liver cells. Patients with bacillary purpura may present with fever, weight loss, anorexia, diarrhea, abdominal pain and distension, enlargement of the liver and spleen, and a decrease in various blood cells.

　　Patients with hepatic purpura should pay attention to diet and keeping warm in daily life, and they should also pay attention to rest and avoid infection after the disease.

　　1. Pay attention to whether there is any suspicious food or foreign body contact before the rash, which may cause an allergic reaction, and avoid re-exposure. Avoid ingesting seafood and other heterologous proteins to prevent recurrence of allergies and exacerbation of the condition.

　　2. Pay attention to keeping warm and preventing colds, and pay attention to physical exercise to enhance physical fitness and improve the body's ability to resist diseases.

　　3. After being diagnosed with the disease, patients should rest in bed, avoid overexertion, and avoid smoking and drinking. The diet should be rich in nutrition and easy to digest, with an emphasis on fresh vegetables and fruits. Spicy, pungent, and seafood should be avoided. Attention should be paid to not overeating high-quality protein foods. In terms of nursing care, attention should be paid to colds. Pay attention to whether there is any suspicious food or foreign body contact before the rash, which may cause an allergic reaction, and avoid re-exposure. Avoid ingesting seafood and other heterologous proteins to prevent recurrence of allergies and exacerbation of the condition.

　　4. Pay attention to prevent infection.

　　If patients with hepatic purpura have secondary immunodeficiency disease, they may have decreased immunoglobulins IgA, IgC, IgE, and IgM, decreased complement and lymphocytes. However, this is mostly theoretical, and clinical application and promotion are still under study. It is common to see moderate elevation of serum transaminases, alkaline phosphatase, and gamma-glutamyl transpeptidase, and most patients may have increased bilirubin levels.

　　1. Imaging examination

　　B-ultrasound can detect uneven hyperechoic areas, but there are no characteristic changes. CT can show localized or diffuse hypodense or hyperdense lesions in the liver, which are also mostly non-characteristic. During hepatic venography, if the contrast agent directly enters the cystic cavity, it is a strong basis for the diagnosis of hepatic purpura. Selective hepatic artery angiography shows the accumulation of contrast agent from the late arterial phase to the venous phase, but the characteristics are not strong and it is difficult to distinguish from hepatic cell adenoma and regenerative nodules.

　　2. Histological examination

　　Under laparoscopy, the liver is often enlarged, with purple or blue-black macules on the surface. Under direct vision, needle biopsy is performed, which is highly targeted, and appropriate hemostatic measures can be taken for bleeding from the needle tract. It is a simple, safe, and minimally invasive examination method. During laparotomy, a wedge-shaped liver tissue can be taken for pathological examination. For patients with localized lesions and bleeding, appropriate hemostasis or partial liver resection can be performed, followed by pathological examination.

　　For patients with liver disease, nutrient-rich foods can help repair liver cells, but some foods are not easy to eat in large quantities. It is important to control the amount, as eating too much can actually affect the recovery of liver disease.

　　1. Chocolate, sugar, and various sweets should not be eaten in large quantities in one day. Eating too much can disrupt the secretion of digestive enzymes in the gastrointestinal tract, affecting appetite; sugar is easy to ferment, can exacerbate bloating, and is also easy to convert into fat, accelerating the liver's storage of fat and promoting the occurrence of fatty liver.

　　2. Eat less sunflower seeds, as sunflower seeds contain unsaturated fatty acids. Eating too many of them can consume a large amount of choline in the body, making it easier for fat to accumulate in the liver and affecting the function of liver cells.

　　3. Duck eggs contain a certain amount of lead, and lead can replace calcium in the human body. Regular consumption of duck eggs can lead to calcium deficiency and osteoporosis, and can also cause lead poisoning.

　　4. Monosodium glutamate is a good seasoning, but if liver disease patients take it in large quantities or in excessive amounts, they may experience symptoms such as transient headache, palpitations, and even nausea.

　　5. Instant noodles, sausages, and canned foods often contain food dyes and preservatives that are harmful to the human body, and frequent consumption will increase the burden on the liver's metabolic and detoxification functions.

　　6. Various pickled foods have too much salt, and eating too much can affect water and sodium metabolism in liver disease patients, and it should be禁忌 for decompensated liver cirrhosis patients.

　　7. It is not advisable to eat wheat and potato foods.

　　There is no effective treatment for hepatic purpura, but once the diagnosis is established, it should be immediately discontinued with drugs related to the disease, such as hormones, immunosuppressants, etc. The treatment of the primary disease is particularly important, such as various serious infections, malignant tumors, diabetes, tuberculosis, hemopathy, etc. For those with bleeding or spontaneous liver rupture, comprehensive measures should be taken to stop bleeding, and for those with localized lesions, liver partial resection can be considered; for those with severe liver lesions, liver transplantation can also be seriously considered.

　　For bacillary purpura, the correct use of antibiotics such as erythromycin and doxycycline (doxycycline) can make the purpura disappear. The specific usage is erythromycin 0.5g, 4 times a day, orally; doxycycline 0.1g, 2 times a day, orally, for at least 3 months, to prevent recurrence. For severe patients or those who cannot take oral medication, intravenous administration can be used instead, erythromycin 0.5-1.0g, 4 times a day; doxycycline 0.1g, 4 times a day. It should be noted that in the early stage of medication, the condition may worsen and fever may occur, and the application of antipyretics in advance can prevent this.