Symptoms of cirrhosis in women. Abdominal water buildup

Date: 25.04.2019

In the 21st century, vascular disasters — heart attacks and strokes — which are largely the result of hypercholesterolemia, atherosclerosis, and hypertension, are considered the main cause of death. It would seem that cirrhosis almost never appears in large-scale reviews on population health, but it only seems. If we take the mortality of the active population, aged 35 to 65 years, then cirrhosis of the liver will be in sixth place. So, in the United States, it is the fourth leading cause of death for people over 40 years old.

To imagine the global scale, it is enough to say that 40 million people die from cirrhosis on our planet every year - these are three Moscow cities along with the suburbs! Moreover, mortality is constantly growing. What is this insidious disease, what are its causes, how does it manifest and how is it treated?

Cirrhosis - what is it?

Gradual replacement of hepatocytes with fibrous tissue

A supernova exploded in the constellation Cygnus eight thousand years ago, and a nebula arose in its place. It is called poetically “veil”, “fishing net”, or simply cirrus, cirrus. Cirrhosis and cirrus are cognate words. Cirrhosis is the proliferation of the reticular structure in the liver.

Normally, the liver consists of cells - hepatocytes, which are penetrated by blood capillaries, and at the exit from them bile is formed, which also collects in the bile ducts. These cells are arranged in tiers, in orderly rows that are clearly visible under the microscope. These rows are called hepatic slices, which are strictly organized. Lobules consist of larger segments, lobes of the liver, and the organ itself.

Hepatocytes make up the liver parenchyma. Parenchyma is a specific tissue of an organ, which makes up its “meaning", distinguishing it from others. For example, the parenchyma of the liver and pancreas are different, since the function of these organs is different.

In addition to intensively working liver cells, there is supporting (skeleton) tissue, or stroma - it looks like a network, or veil. Consists of connective or fibrous tissue. And this frame in any organ is the same in cellular composition. The main role of the stroma is to be a "skeleton" for glandular tissue. With cirrhosis of the liver, all the working tissue (parenchyma) gradually dies, and in return there is an overgrowth of fibrous tissue. She does not "know how" to do anything, and cannot replace dead hepatocytes. Essentially, in cirrhosis, the entire liver is a rigid mesh, “washcloth”, from an expanded stroma, into which the remains of working tissue are interspersed.

Since the liver is a vital organ, cirrhosis of the liver leads to irreversible chronic liver failure, and the death of the patient. The only chance to survive is a liver transplant.

Causes of Cirrhosis

Of course, as with any disease in general, the causes of cirrhosis can be hidden even after a thorough and comprehensive examination. In this case, a diagnosis of cryptogenic cirrhosis is made. But this is very rare. More often, the causes of cirrhosis are more prosaic in both men and women. Here are the most likely “candidates”:

The presence of viral hepatitis, with B, C, D. Very rarely, acute hepatitis can transform into cirrhosis, but still the main role belongs to the chronic course, with medium or high activity. In women with hepatitis B and C, with such activity in 25% of cases, the outcome of hepatitis in cirrhosis is possible;
Regular drinking, alcoholism. If women daily intake of alcohol in terms of ethyl alcohol is 60 - 110 g, then 10% of patients will develop cirrhosis, after many years of drinking. This corresponds to approximately 1.5 liters of strong beer per day (100 g of 96% alcohol). It is important that women alcoholics have recently increased the number of patients with cirrhosis of the liver at a young age;
Hereditary metabolic diseases (antitrypsin deficiency, hemochromatosis, Wilson-Konovalov disease and others);
As a side effect on medications (methotrexate, anti-TB drugs);
Hepatotoxic poisons (carbon tetrachloride);
Processes that lead to obstruction of the biliary tract (in this case, women develop secondary biliary cirrhosis). This is gallstone disease, strictures of the ducts, cholangitis, as well as incomplete obstruction, with the presence of partial patency. Usually, under such conditions, cirrhosis forms in a year;
In the presence of venous stagnation in the tissues of the liver (with Budd syndrome - Chiari). The cause may lie far beyond the organ - for example, with valvular defects of the tricuspid valve, with adhesive and constrictive pericarditis.

What are the first signs of cirrhosis of the liver?

Unfortunately, this disease does not always occur with a vivid clinical picture. The first signs of liver cirrhosis in women largely depend on the degree of activity of the process. Hepatologists distinguish the following options for the course of cirrhosis:

The vast majority of women (60%) have a bright clinic, and it is simply impossible not to notice it;
In 20% of cases, the disease proceeds latently, and there are not enough complaints to detect it in a targeted way. Often signs are detected in analyzes, like random finds, or on examinations;
Finally, another 20% of patients “did not wait” for intravital diagnosis. In this case, this diagnosis is determined only at autopsy.

However, there are a number of symptoms that are characteristic of the initial stages of cirrhotic degeneration of the liver. It is only a pity that they are easy to “miss”, since they can indicate a very wide range of diseases. Judge for yourself, the early symptoms of liver cirrhosis include:

flatulence, or bloating;
pain and a feeling of heaviness in the epigastrium;
decreased performance;
weight loss.

If the patient is examined by a doctor, then it is possible to detect both an increase in the size of the liver, and a densification of its edge, the appearance of tuberosity, the disappearance of elasticity. Its free edge will be pointed and dense.

Then, over time, the clinical manifestations of cirrhosis will be diverse and specific. This will often make a clinical diagnosis, even at first glance at the patient.

Additional manifestations of the disease

In the expanded stage of clinical manifestations, the symptoms of cirrhosis add up, like a mosaic, of the following main violations:

Manifestations of liver failure (reduced protein synthesis, including for blood coagulation);
Portal hypertension syndrome (increased pressure in the portal vein, which absorbs all the blood flowing from the intestines with absorbed food). This blood enters the liver for “checking” and neutralization, but with cirrhosis there is a problem with its normal duct through the liver.

These conditions progress, and lead to a characteristic clinical picture. Symptoms of liver cirrhosis in women at the advanced stage are as follows:

Hepatosplenomegaly (enlarged liver and spleen). In the later stages of cirrhosis, on the contrary, there is a decrease in the size of the liver;
The appearance of telangiectasias, or "spider veins" on the skin;
Palmar erythema, or severe redness of the palms;
The appearance of jaundice - at first transient, and then - constant;
Pain and heaviness in the right hypochondrium;
With an increase in the activity and progression of cirrhosis, periods of fever are possible, which are accompanied by jaundice and a deterioration in well-being;
A terrible symptom of portal hypertension is varicose veins of the internal organs (stomach, intestines, esophagus) - wherever there are "divisions" of the portal system and vena cava. Increased pressure in the portal vein system causes shunting, or dropping blood to other pools, and this leads to bleeding.

For example, bleeding from varicose veins of the esophagus in patients with cirrhosis often leads to death, because it occurs against the background of anemia and a marked decrease in blood coagulation.

Ascites, or accumulation of free fluid in the abdominal cavity. This is a common symptom of decompensated, advanced cirrhosis.

The abdomen is large, tense like a ball, its skin is stretched like a drum and glistens: the umbilical impression is not visible, it has disappeared. When striking on the side of the abdomen, if you put your palm on the other side, you can feel how a wave of liquid rolls up to it. Often ascites is accompanied by varicose veins of the anterior abdominal wall, which resemble snakes on the head of the Gorgon Medusa.

Laboratory symptoms of cirrhosis are characterized by the fall of all sprouts of red bone marrow (anemia, thrombocytopenia, leukopenia). After all, a declining healthy liver synthesizes a little protein, and there is simply nothing to build blood cells from. As a result of leukopenia, purulent processes occur, due to a drop in the synthesis of antibodies, a woman begins to become infected with infectious diseases. Since “there is no money” for platelet synthesis, a characteristic sign of the low protein synthesizing function of the liver in cirrhosis is the appearance of bleeding (uterine, nasal from the gums), prolonged flowering of bruises and their appearance due to any minor injuries.

In the biochemical analysis of blood levels of ALT and AST increase. Normally, these enzymes are located inside the liver cells, but with their intensive decay, they enter the bloodstream, forming syndromes of cytolysis and necrosis.

"Merry bellied leopard", or what is the disease dangerous?

If the activity of cirrhosis increases, then the pain intensifies, the temperature rises, skin itching and jaundice appear, spider veins appear. For a long time, the process can flow with compensation, but if ascites, bleeding, swelling, fever, jaundice increases, and encephalopathy develops, then this indicates a catastrophic decrease in liver function.

The patient’s appearance, which is close to a sad outcome, is characteristic: it is a “merry pot-bellied leopard,” as one of the resuscitators christened it. This means that the patient is in a state of euphoria and lack of criticism, and in the intensive care unit he is tied to the bed. A tense, fluid stomach, which can hold more than 20 liters of ascitic fluid, rises above the body. The skin color of such severe patients is lemon yellow, because jaundice "overlays" on severe anemia and pallor of the skin, and bruises and hemorrhages are scattered all over the body, which from afar really resembles a leopard skin.

From this “one step” condition to profuse bleeding from varicose veins of the esophagus and intestines. Ascitic fluid in conditions of reduced immunity can easily become infected with the development of peritonitis, and hepatic encephalopathy and insufficiency can progress to coma.

Do not underestimate the appearance of heptocellular carcinoma, or liver cancer, the occurrence of thrombosis in the portal vein system, and septic complications.

Principles of treatment for cirrhosis

The main objective of treatment at the initial stage of cirrhosis is to prevent an increase in activity, decompensation, and complications. We list the basic principles of patient management:

Compliance with the gentle regime, with load limitation, with decompensation - bed rest;
A diet for cirrhosis of any etiology completely eliminates alcohol, and proceeds as a table number 5;
If the stage is compensated, and the activity is low, then medications are not needed: they also harm the liver;
If decompensation occurs, then vitamins, “essentials”, “heptral” and “ursofalk” are indicated. The use of "berlition" is shown;
With decompensation, a daily infusion of glucose, vitamins, calcium gluconate is indicated;
In the case of ascites and a marked decrease in protein, albumin 20% and concentrated plasma are transfused.

Each variant of cirrhosis has its own specific treatment: viral forms require the appointment of interferons and antiviral therapy, autoimmune decompensation is stopped by hormones.

In the event that there is a high risk of bleeding, then portocaval anastomoses are artificially created, thus, surgical prevention of fatal bleeding is carried out.

How many live with cirrhosis, and what should one strive for?

Despite the fact that the course of cirrhosis in women and men is irreversible, modern hepatology can slow down, and even “freeze” this process. The main thing is not to bring the matter to decompensation, since with it the three-year survival does not exceed 40%. With the late diagnosis of cirrhosis, at the stage of detailed symptoms, survival does not exceed 5 years. If the patient has expressed ascites, then the usual life expectancy after this sign of decompensation also does not exceed 5 - 6 years.

But in the event that, for example, a patient is diagnosed with alcoholic cirrhosis in the initial stages, when an adequate person pays attention to his complaints and symptoms, then with a complete refusal of alcohol, you can live on compensated cirrhosis for ten years or more. And then prepare for a liver transplant, which will extend the patient's life for many years.

In exactly the same way, if you closely monitor chronic viral hepatitis, observing all medical prescriptions and keeping its activity low, you can feel good for many years, maintaining a high level of quality of life.

Modern medicine also has resources that have not yet been studied, such as stem cell autotransplantation. It is known that in experiments in vitro, cells took root, and turned into healthy liver tissue, which in experiments on mice helped to reduce the symptoms of experimental cirrhosis. Therefore, in the future, perhaps, even throughout the life of the younger generation, it will be possible to re-create a healthy, or artificial liver.

This disease belongs to the category of chronic and is characterized by damage to the liver tissue, as a result of which the organ loses some of its functions. Cirrhosis is widespread and is in sixth place on the list of the most frequently diagnosed fatal diseases in people aged 35-60 years.

Cirrhosis of the liver, causes

This disease causes extremely negative processes - a disorder of brain functions, accumulation of fluid in the peritoneum, blood clotting, development of hypertension, etc. What causes liver cirrhosis? The main cause of the pathology is the excessive consumption of alcoholic beverages, however, not only alcohol causes increasing fibrosis. Other possible causes of liver disease are:

autoimmune hepatitis (while the body perceives its cells as foreign);
biliary cirrhosis (impaired functioning of the bile ducts);
viral hepatitis type C, B, delta (the first in 97% of cases leads to cirrhosis, while the disease may not manifest for a long time);
prolonged stagnation of veins in the liver;
diseases of the biliary tract (blockage);
hemochromatosis and other metabolic disorders;
long-term use of medications (this is due to the presence of toxic substances in their composition).

Classification

There are several types of classifications of the disease. Depending on the cause of the development of pathology, it is divided into the following types:

alcoholic cirrhosis of the liver;
alimentary (develops due to lack of proteins, due to rigid diets, starvation);
hemochromatous (in violation of iron absorption);
appeared with heart failure;
cirrhosis due to viral hepatitis;
cholestatic (as a result of stagnation of bile - cholestasis syndrome);
syphilitic.

Child-Pugh classification is used to determine the severity of pathology in a patient. Based on this scale, a risk assessment is carried out, the patient's chance to survive after surgery is determined. The need for organ transplantation is also assessed. The system involves the separation of all patients into 3 classes - A, B, C. The first is characterized by a minimum severity and a predicted life expectancy of 15-20 years. Patients belonging to class B live about 10 years, and representatives of the latter group have a disappointing prognosis, their life expectancy is a maximum of 3 years.

Stages of liver cirrhosis

At the initial stage (it is called the compensation stage), an inflammatory-necrotic process occurs in a patient in the liver. Early cirrhosis is characterized by rapid fatigue of a person, general weakness, decreased concentration, loss of appetite. As a rule, patients do not pay attention to such symptoms, explaining it with vitamin deficiency, excessive workload, or intense training. However, pathology progresses and exacerbates the human condition.
What is liver cirrhosis of the second stage? Serious inflammatory processes occur in the cells of the organ during the period of subcompensation, as a result of which the functional dead tissue is replaced by the connective organism. With the course of pathology, the latter occupies an increasingly large area of \u200b\u200bthe organ, which upon palpation is felt as a densification of the surface of the liver. Often, fluid accumulates in the peritoneum in patients (ascites occurs), with a strong protrusion of the abdomen on the right side.
In the third stage, which is also called decompensation, the disease causes a number of complications. These include hepatic coma, sepsis, pneumonia, venous thrombosis, hepatocellular carcinoma. Based on complicated cirrhosis, a patient may be assigned a disability. Some patients suddenly have bleeding from the anal, nose, etc. The third degree of severity of the disease has a high probability of death, so the patient is placed in hospital. In this case, the doctor may recommend a liver transplant as an emergency measure to save the patient's life.
At the terminal stage, a person is in a coma, his liver is deformed, greatly decreasing in volume, and the size of the spleen, on the contrary, is growing. Cirrhosis of the liver, the last stage of which causes leukopenia and anemia, affects the brain. As a rule, the patient does not come out of a coma and dies.

Symptoms

It is not always possible to suspect a pathology at an early stage of its development, since signs of cirrhosis of the liver in 20% of cases are not pronounced. Nevertheless, in some patients, the disease makes itself felt, causing certain symptoms. How is cirrhosis manifested:

growing pains in the right hypochondrium (exacerbations occur after eating fatty foods, alcohol or physical activity);
a person loses weight, gets tired faster, gets irritated more easily;
in the morning, dryness and bitterness in the mouth may be observed;
sometimes digestive upset, increased gas formation can occur;
the skin with a post-necrotic form of the disease turns yellow (jaundice begins).

The period of subcompensation is characterized by more pronounced symptoms. The patient is tormented by skin itching, the temperature rises to 38 degrees, the skin acquires a yellow tint, nausea, bouts of vomiting with bile often occur. A person loses the desire to eat, so his weight is rapidly reduced, feces become discolored or lighter, and urine acquires a more saturated color.

The doctor can determine cirrhosis by other signs, however, the specialist does not make a diagnosis without a preliminary examination, including various tests, ultrasound and other procedures. As the pathology develops, the following may be added to the list of symptoms:

severe exhaustion, weight loss;
expansion of veins on the stomach;
angiomas cover the corners of the eyes and the edge of the nose (as in the first photo);
amyotrophy;
blood is mixed with vomiting (this indicates bleeding of the esophagus or stomach);
colic, a feeling of heaviness in the liver;
the appearance of spots in the region of the upper eyelids;
joints swell, begin to hurt;
fingers look like drumsticks (their ends thicken, as shown in the second photo);
spider veins appear on different parts of the body;
the limbs become thinner, and the stomach, on the contrary, begins to bulge more;
swelling of the tongue begins, it is painted in a bright color, etc.

In men

The main reason for the development of liver disease in men is alcoholism, while cirrhosis develops 10-15 years after the onset of alcohol abuse. Other factors can serve as a stimulating factor in the disease. Regardless of what caused the pathology, it is important to recognize the symptoms in a timely manner and begin treatment. The first signs of cirrhosis in men are:

decreased performance, concentration, fatigue;
pain in the right hypochondrium (occurs / worsens after a fatty or fried meal, excessive physical exertion);
the man becomes more irritable, quick-tempered;
problems with stools begin: it becomes frequent and fluid;
body weight quickly decreases for no apparent reason;
there are problems with the skin, it becomes dry, acquires a yellow tint, itching occurs;
impotence begins;
a man’s breast enlarges, while the genitals, on the contrary, decrease.

Among women

The disease of cirrhosis of the liver in women is manifested by weakness, sharp weight loss, inability to withstand the usual physical activities. In addition to the general signs of the disease listed above, the fair sex has specific symptoms - menstrual irregularities, sudden mood swings, decreased libido. Such symptoms of liver cirrhosis in women are periodic, therefore, at an early stage of the development of pathology, patients rarely seek qualified help.

Diagnostics

In addition to conducting a general and biochemical blood test, with suspected liver cirrhosis, instrumental diagnostic methods are carried out. These include invasive and non-invasive methods. If the signs of cirrhosis indicate an early stage of the disease, the diagnostician makes an ultrasound, so that you can determine the increase in echogenicity of the liver tissue, organ enlargement, the formation of nodules of increased density. To assess the extent of the lesion, computed tomography is used. Some patients are prescribed a liver biopsy, which involves the collection of organ cells.

Is liver cirrhosis treated

Can liver cirrhosis be cured? Since an irreversible process of the death of organ cells occurs with this disease, it is impossible to restore the liver. Nevertheless, modern medicine allows you to stop the development of pathology with its early diagnosis and adequate treatment. Using folk remedies at home, you will not achieve results, so you need to entrust your life to a qualified doctor.

The specialist will not give guarantees for the complete cure of the patient, but the chances of extending his life will be much greater if you contact the hospital in a timely manner. Cirrhosis requires complex therapy, which includes not only taking prescribed medications, but also changing the patient’s lifestyle, abandoning addictions, and observing the basics of a healthy diet.

Prevention

To prevent the development of this dangerous disease, you should follow some recommendations. Prevention of cirrhosis includes the following measures:

a complete rejection of alcoholic beverages, nicotine products;
high-grade, balanced nutrition;
timely treatment of any diseases, especially hepatitis and cardiovascular pathologies;
maintaining an active lifestyle.

How many live with cirrhosis

Survival rates are higher in patients with biliary and alcoholic forms of the disease. So, a person who has cirrhosis due to excessive consumption of alcoholic beverages can survive 10 or more years if they are abandoned. With the biliary type of pathology, the life expectancy of a person who complies with the doctor's prescriptions is more than 6 years. The viral form of the disease is considered the most aggressive, death from cirrhosis of the liver at the same time occurs several years after the first symptoms.

Find out what are the treatments.

Video

Cirrhosis is a severe damage to the liver, which if untimely detection and treatment can cause serious complications, up to the death of the patient. More often it is diagnosed in men, although the fair sex is no exception. Symptoms of liver cirrhosis in women do not appear immediately. At an early stage of the development of pathology, the patient may not even suspect that she has such a problem.

With cirrhosis in a sick person, the functionality of the liver deteriorates and its structure changes. Most often, lesions are diagnosed in women aged 36-50 who are addicted to alcohol, medications, or hepatitis. If the treatment is done correctly and on time, then the prognosis of cure is favorable.

At an early stage of cirrhosis, a woman has the following symptoms:

fatigue, a constant lack of strength - the patient can not perform their labor duties in full;
poor appetite or its complete absence - a minimal amount of bile is secreted, so the food does not digest normally;
sleep disturbance - a woman can sleep long during the day and stay awake at night;
impaired attention, distraction - it is difficult for the patient to concentrate on performing everyday tasks;
malaise.

At the initial stage of the development of the disease, the most informative is a blood test, in which an elevated level of transferases is detected. This allows you to make the correct diagnosis.

However, a woman rarely visits a doctor, as she attributes these symptoms to workload, stress, or other causes. The intensity of the symptoms is so small that the patient cannot even imagine that she has cirrhosis. At this stage, the disease is detected by chance at a routine examination.

How is the stage of subcompensation

If untreated, the pathology will progress, and in women this happens faster than in men. Healthy cells try to take on the functions of the diseased. Manifestations of cirrhosis become more intense, but it can be confused with another disease. The stage of subcompensation is characterized by the following symptoms:

the appearance of a metallic and bitter taste in the mouth;
a feeling of heaviness in the upper right abdomen. Here the reason is an enlargement of the liver, which begins to put pressure on the walls of the abdominal cavity, pushing away other organs. This pathological condition provokes a malfunction of other systems;
intolerance to odors;
the appearance of painful cramps in the lumbar region and ribs. Localized discomfort mainly on the right;
dry skin, as well as a decrease in its elasticity;
excessive gas formation;
periodic nausea and bloating;
too rapid weight loss. This condition is caused by poor digestion and assimilation of food. Metabolic processes get worse and tissues get poor nutrition;
violation of the stool. A woman has persistent constipation or diarrhea. This pathological condition develops due to the production of insufficient bile;
problems with the menstrual cycle caused by a violation of the synthesis of estrogen precursors. There is a deterioration in the functionality of the endocrine system.

At this stage, the woman is already going to the doctor, but an inexperienced specialist is able to make the wrong diagnosis. The survey must necessarily be differential.

Features of the manifestation of the late stage of cirrhosis

It is characterized by a complete irreversible change in the organ. At this stage, the patient is recommended surgery, which, unfortunately, does not always help. The terminal stage of cirrhosis provides only supportive treatment. It manifests itself with the following symptoms:

the patient’s abdomen is greatly enlarged. The changed organ can be palpated during palpation. An enlarged organ can be seen even with the naked eye;
a large amount of fluid accumulates in the abdominal cavity. Along with this, pathogenic bacteria multiply in it, which lead to the appearance of peritonitis;
due to the high level of bilirubin in the blood, the skin turns yellow. The same shade appears in the sclera of the eyes, and in women this symptom manifests itself earlier than in men;
the skin color of the palms of the hands changes - they become bright red. This symptom is provoked by changes in the composition of the blood;
lightening of feces is observed, urine becomes darker;
sharp jumps in body temperature;
the patient often has a febrile state, a significant decrease in immunity occurs;
spider veins can be seen on the skin of the face. Their development is provoked by an increase in pressure in the veins;
in the evenings, the woman's feet swell;
there is increased bleeding of the gums, menstruation becomes abundant, which leads to anemia. Bruising appears under the skin;
an enlarged liver can make it difficult for the patient to breathe, as the organ compresses the lungs.

With cirrhosis, the patient may develop hepatic encephalopathy, in which the brain is affected due to exposure to toxins circulating in the crude liver blood. A woman shows a decrease in mental activity, serious memory problems are noted. The behavior and nature of the patient varies greatly. Often are disorders of the nervous and muscular systems. A woman is not able to lead a normal social life. At the last stage of development, hepatic encephalopathy provokes a coma.

Specific symptoms of the disease

There are special signs of liver cirrhosis in women who speak of this pathology:

severe itching on the skin, which appears due to the ingress of bile acid into small subcutaneous vessels;
deterioration of blood coagulability, provoking the formation of bruising for no apparent reason;
rejection of fatty foods, as well as alcoholic beverages;
frequent nosebleeds, vomiting with impurities of blood;
complication of varicose vessels.

If the symptoms of cirrhosis are detected on time, then it can be cured. What drugs the patient will have to use to restore the functionality of the organ, and what lifestyle to lead, the doctor will determine. If the first signs are missed, the general condition of the woman will worsen. The more the disease is started, the more difficult it is to get rid of it.

Other signs of pathology

Already at the stage of subcompensation, a woman seeks medical help. She is prescribed a comprehensive examination to determine the causes of the onset of the disease. During ultrasound and radiological diagnostics, other signs of pathology are detected:

the body has blurry and uneven edges;
the right lobe and the left medial portion of the liver are significantly reduced compared with the normal indicator;
parenchymal tissue has a different structure, which increases its echogenicity during examination;
in the liver there are pronounced round seals. They respond with signals of different intensities, but more often high-amplitude ones.

MRI or CT can accurately determine the disease. If the first signs of liver dysfunction appear, you should contact your doctor. Procrastination with treatment leads to the rapid progression of the disease. As a result, the patient may die. In this case, it is better not to engage in self-medication, since no herbs can completely restore the functionality of the organ if a tissue change has already occurred. Timely qualified help of doctors is the key to quality life.

According to the etiological principle, it is classified as:

viral - provoked by hepatitis viruses of types B, C, D;
toxic (drug, alcohol) - the result of acute or chronic poisoning with hepatotropic poisons or an overdose of hepatotoxic drugs;
(primary, secondary) - is accompanied by damage to the biliary system;
stagnant - occurs with pathology of the blood supply system;
cryptogenic - the cause of development is unknown.

Causes and pathogenesis

Both men and women suffer from cirrhosis of various etiologies. It is believed that as a percentage of the population this disease is more susceptible to the strong half of humanity. The exception is primary - a disease that affects mainly women. Its reliably unknown, there is only a theory of trigger (trigger) factors:

An infection of a bacterial or viral nature (mycoplasmas, chlamydia, E. coli, reoviruses).
The use of chlorpromazine, a drug presumably triggering autoimmune (aggression of the immune system against one's own body) damage to the bile ducts.
Hyperestrogenism (excess hormones-estrogen).
Heredity (cases of illness in relatives increase the risk of developing the disease).
The influence of xenobiotics (substances contained in cosmetics and food flavor enhancers can stimulate antimitochondrial antibodies, the production of which leads to primary biliary cirrhosis).

Other types of cirrhosis have a common developmental mechanism. In a healthy liver, Ito stellate cells store fat.

With the onset of the inflammatory reaction, they change, becoming similar to fibroblasts (connective tissue cells) and producing collagen, a connective tissue building protein. Fibrous nodes are formed that compress blood vessels and bile ducts. Ischemia develops (circulatory disorders), accompanied by hypoxia (lack of oxygen), and (stagnation of bile). The more pronounced hypoxia, the more actively collagen is produced. Damaged hepatocytes die, liver failure develops.

Clinical picture

The first symptoms of liver cirrhosis in women are weakness, decreased exercise tolerance, and sharp weight loss. Malfunctions of the menstrual cycle, mood swings, headaches and dizziness may occur. But they are transient in nature, such complaints are difficult to put together into a single picture, therefore, at the initial stage, patients do not seek medical help or are examined for another pathology - gynecological or neurological.

Signs of cirrhosis in women are more common after 35 years and develop very slowly. Primary biliary cirrhosis begins with itching, which is several years ahead of the appearance of clearly defined symptoms of liver damage.

The clinical picture of cirrhosis implies a combination of the following symptoms:

Persistent severe weakness, decreased severity of attention, excessive tiredness, drowsiness, or insomnia.
Anorexia, nausea, less often vomiting, weight loss.
A feeling of heaviness in the right hypochondrium, followed by a dull aching pain.
Yellowing of the skin and sclera of the eyes, itching of the skin, worse at night.
Enlarged liver (hepatomegaly) and spleen (splenomegaly).
Acholia (discoloration) of feces, dark urine.
Deposition of cholesterol on the eyelids, palms, elbows, buttocks (xanthelasma).
The appearance of bruises (hematomas) on the skin and spot hemorrhages on the mucous membranes.
Ascites (fluid accumulation in the abdominal cavity), “jellyfish head” (expansion of the veins of the anterior surface of the abdomen).
Menstrual irregularities, decreased libido.

Cirrhosis in women manifests itself as a severe disease that is difficult to treat.

In primary biliary cirrhosis, joint and muscle pain is added to the indicated list of symptoms, melasma is a dark brown color of the skin. Fragility of bones (osteoporosis) increases. A skin rash appears: papular (nodular) or vesicular (nodular), depigmentation sites (spiders).

Women are more susceptible to the toxic effects of alcohol. The daily dose of ethanol, which leads to a fibrous process in the liver, is 20 grams. This is three times less than the critical dose for men (60 grams). In this regard, the symptoms of cirrhosis of the liver in women alcoholics manifest themselves especially severely - the regenerative capacity of the organ is exhausted very quickly.

Diagnostics

To select the right treatment regimen, one should know the reason that led to the cirrhosis and severity of the patient's condition. This will help laboratory tests and instrumental methods of research. Symptoms of liver cirrhosis in women are the basis for a comprehensive examination, which includes:

general clinical analysis of blood, urine, feces;
biochemical blood test, coagulogram;
ultrasound, computed and magnetic resonance imaging of the abdominal cavity;
determination of antibodies to hepatitis B, C, D viruses, antimitochondrial antibodies;
serological diagnosis of syphilis;
puncture biopsy of the liver followed by histological examination.

Treatment

The first signs of cirrhosis in women imply the need for dieting. Alcohol, fatty, salty, spicy foods are completely excluded from the diet. It is recommended to eat fresh fruits and vegetables, lean meat and fish. The basis of drug therapy is hepatoprotectors (silymarin, essentiale, ursodeoxycholic acid, B vitamins) and antioxidants (tocopherol acetate). With vascular thrombosis, anticoagulants (heparin, acenocoumarol), thrombolytics (streptokinase) are used. Hepatic insufficiency requires emergency medical attention. Glucocorticoids (prednisone, dexamethasone), diuresis stimulants (furosemide), crystalloids (isotonic sodium chloride solution, glucose solution) are administered intravenously.

Indication for surgical treatment - bleeding from varicose veins of the esophagus, obstruction (overlapping) of the biliary tract, vascular thrombosis with ineffective thrombolysis.

Forecast

Signs of cirrhosis in women regress slowly. To stabilize the condition, therapy should be long and take into account concomitant pathology. The development of portal hypertension and liver failure accelerates the progression of the disease, the risk to life increases significantly.

Liver cirrhosis in women and men has similar causes and clinical manifestations. This disease is the terminal stage of many pathologies of infectious or non-infectious origin, which occur with the defeat of hepatocytes. As a result of such changes, tissues lose their ability to perform their functions, which are associated with disturbances in the work of other systems and progressive intoxication of the body. The outcome depends on the stage of cirrhosis and the implementation of the doctor’s prescriptions, but the treatment is not aimed at recovery, but at prolonging the life span and improving its quality.

What is cirrhosis?

The main mechanism for the development of cirrhosis is the appearance of cicatricial connective (fibrous) tissue. Such disorders can occur as a result of prolonged inflammation or the constant intake of toxins in the body. Connective tissue fibers form nodes in the hepatic parenchyma, gradually changing its structure. The clinical picture of the disease depends on their size and localization.

The danger of cirrhosis is that changes in the liver tissue are irreversible. Despite the fact that the organ regenerates very quickly and is completely restored after hepatitis and other diseases, this does not happen in this case. For the division of hepatocytes, new intact cells are needed, and with cirrhosis they are replaced by dense scar tissue.

Main reasons

Cirrhosis is considered a disease of alcoholics and people with a low level of social responsibility, but it can be diagnosed in absolutely any person. Its development is also influenced by the patient’s occupation, his lifestyle, place of residence and hereditary factors.

The main causes of cirrhosis include:

hepatitis of various origin - viral, toxic (including alcohol and medication);
acute and chronic poisoning with drugs (steroid and others), salts of heavy metals, toxic fumes in industrial enterprises;
metabolic disorders (congenital and acquired);
malnutrition, the predominance of fatty, fried, salty foods, sodas and alcohol;
diseases of the digestive tract and gall bladder (cholecystitis, gallstone disease);
hereditary liver pathologies (hemochromatosis, autoimmune hepatitis, Wilson-Konovalov disease and others).

REFERENCE! According to statistics, men are more likely to suffer from cirrhosis. However, women are more often diagnosed with alcoholic liver disease, which is one of the most common causes of cirrhosis. Mostly the age of patients is 40 years or more.

Symptoms

The disease develops gradually, so in the early stages of its manifestation, it may go unnoticed. Symptoms of cirrhosis are associated with. This organ plays an important role in the body, participates in digestive, secretory, metabolic processes. Clinical signs of the disease manifest themselves in a complex, a combination of even several of them may be the basis for making a final diagnosis.

Signs of cirrhosis of the liver in women and men are a complex of symptoms that directly indicate organ destruction and disruption of other systems associated with liver failure.

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Pain in the right hypochondrium is a symptom of inflammation of the liver and its increase in volume. If there are no pain receptors in the organ parenchyma, then they are present in the capsule.
Losing weight or, conversely, rapid weight gain are the first symptoms of cirrhosis. Also, patients complain of nausea and vomiting (sometimes with blood impurities). They are accompanied by swelling due to circulatory disorders.
Characteristic signs are the appearance of vascular asterisks under the skin, staining of the distal extremities with a red tint. In women - the appearance of heavy bleeding, malfunctions of the menstrual cycle.
Jaundice is a phenomenon that occurs when the biliary system is disrupted and the outflow of bile is difficult. The skin and mucous membranes of a person turn yellow. At the same time, darkening of urine and lightening of feces are observed.
Ascites is one of the first complications of cirrhosis. Due to insufficient blood circulation and weakening of the walls of blood vessels, free fluid accumulates in the abdominal cavity. This symptom accompanies decompensated stages of the disease when the body cannot adapt to new conditions.
Intoxication is another complication that manifests itself in patients with cirrhosis. Since the liver cannot neutralize poisons and toxins, they accumulate in the internal organs, in the blood, and are released through the skin. The process is manifested by itching and rash. In the last stages, intoxication of the brain occurs, which becomes the cause of hepatic coma and death.

Features of how cirrhosis manifests itself depend on its cause and the general condition of the patient. To make an accurate diagnosis, it is necessary to conduct clinical and biochemical blood tests, do an ultrasound of the abdominal cavity, if necessary - CT or MRI. Analyzes will indicate an increase in the activity of liver enzymes while reducing the amount of albumin and bilirubin. In the parenchyma of the liver, foci of compaction with uneven edges can be found. In the early stages, the organ will be increased in size, in the latter - it will decrease sharply. At the same time, the spleen grows and becomes inflamed - it is she who takes over part of the functions of the liver when it is damaged.

Classification and stages

To determine the severity of the disease and to predict life expectancy in cirrhosis, classification is used. It is based on several factors that gradually develop at different stages of the disease. Depending on the presence of complications and symptoms, there are 4 stages of cirrhosis, the first of which is considered relatively favorable, the fourth is fatal in a short time.

One of the methods for predicting cirrhosis is the international Child-Pugh classification. The table shows the parameters by which the severity of the patient and possible indicators are evaluated (in columns A, B and C). For each parameter, a certain number of points is assigned, from 1 to 3. Then they are summed up, and the total number is used to determine the forecast:

up to 5–6 - one-year survival is 100%, two-year - 85% (class A);
7–9 - up to 81% of patients survive in the first year, 57% in the second;
10–10 - during the first year, 45% of patients remain likely to survive, the second - up to 35%.

You can determine the result only after passing all the analyzes and conducting an instrumental study. The main values \u200b\u200bare blood counts, ultrasound data and the response of the body to drug treatment of symptoms.

In the photo - a schematic representation of the generally accepted Child-Pugh classification of liver cirrhosis, which is used by doctors around the world when making a diagnosis

Stage 1

At the initial stage, cirrhosis occurs almost without clinical signs. Stage 1 is called compensated, because the body uses all possible mechanisms to compensate for liver failure. Symptoms that may indicate liver damage are periodic pain and heaviness in the right hypochondrium. Basically, they occur when a diet is violated (eating large amounts of fatty foods), drinking alcohol, or physical exertion. The prognosis is favorable, you can maintain the patient’s condition with proper nutrition and medications of the hepatoprotector group.

2 stage

The second stage is subcompensated cirrhosis. With the help of medications, you can return the disease to the stage of compensation, but liver damage is already more extensive. The patient is concerned about constant pain in the right hypochondrium, digestive disorders, there may be a slight accumulation of fluid in the abdominal cavity. Blood tests indicate a decrease in bilirubin and albumin levels.

3 stage

The terminal stage of cirrhosis is characterized by the development of complications. At this stage, ascites is practically not amenable to medical treatment, serious metabolic failures occur. There is a risk of hepatic encephalopathy. What complications are diagnosed in the third stage and how much the patient can live depends on the accompanying diagnoses. The prognosis worsens with HIV infection, liver cancer or peritonitis, which can develop due to ascites.

Stage 4

The fourth stage of cirrhosis is associated with irreversible changes in the liver that cannot be treated. Pain can only be stopped with potent analgesics. The disease quickly ends in death, the cause of which is hepatic encephalopathy, sepsis or other complications.

Diagnostic Methods

Cirrhosis of the liver must be distinguished from its other diseases that can be treated. The basis for the diagnosis will be the detection of tissue scarring and the development of fibrosis, as well as a change in blood counts. If fibrosis is suspected, a set of instrumental and laboratory studies is prescribed:

clinical and biochemical blood analysis;
serological studies to detect a viral pathogen;
angiography;
Ultrasound of the abdominal cavity;
CT, MRI;
if necessary, a liver biopsy.

REFERENCE. The main difficulty in diagnosing liver diseases is associated with the features of the location of the organ. Most of the parenchyma is hidden behind the costal arch, therefore it is not visualized on ultrasound. However, using CT or MRI, you can get a high-quality image of the liver in three-dimensional projection.

Treatment regimen

Cirrhosis is a dangerous disease that cannot be cured completely. However, patients are prescribed a complex of medicines to maintain the condition. A balanced diet is also necessary, the violation of which can quickly lead to an exacerbation of the disease. Therapeutic methods focus on several factors.

Cell recovery. For this purpose, hepatoprotective drugs are used. They protect intact hepatocytes and promote their regeneration. On sale there are funds of natural and synthetic origin with a similar mechanism of action.
Normalization of the balance of bile acids. For this, compounds of cholic acids in the form of tablets are prescribed. These can be preparations of ursodeoxycholic, chenodeoxycholic acid and combination agents.
Strengthening the immune system. The immunomodulators contain components that stimulate the formation of specific protective cells.
Removal of excess fluid in ascites. For this, you can take diuretics.
Additional funds are aimed at eliminating the cause or symptoms of cirrhosis. So, antiviral drugs, as well as drugs against nausea and vomiting, skin itching and other manifestations, may be included in the treatment regimen.

Ultrasound of the liver is not a very informative method of diagnosis due to the peculiarities of the location of the organ

It is equally important to follow a sparing diet.Fatty, fried foods, spices, sauces, convenience foods, salt and sugar in large quantities should not be present in the diet of a patient with cirrhosis. Be sure to exclude alcohol. Boiled meat and fish, first courses, vegetables and fruits should become the basis of nutrition. It is useful to adhere to fractional nutrition, eating food at least 5-6 times a day in small quantities.

Prevention and prognosis

It cannot be argued that cirrhosis is treatable. However, with proper selection of drugs, maintaining a healthy lifestyle and giving up bad habits, the patient's life span can be extended to 10-15 years or more. The presence of complications in the form of HIV infection or specific forms of viral hepatitis (B or combined), the prognosis is less favorable - up to 2-3 years.

It is impossible to prevent the disease with a full guarantee. However, there are several recommendations that will reduce the likelihood of its development:

give up bad habits - alcohol is dangerous for the liver even in small doses;
use caution in any manipulation of blood (injections, in manicure and tattoo parlors) - this is how viral hepatitis is transmitted;
periodically donate blood for diagnosis - in the early stages, the likelihood of recovery is much higher.

Cirrhosis in women occurs as a complication of other liver diseases. This is a complex condition in which the liver tissue is destroyed and cannot fulfill its function. There are several reasons why cirrhosis occurs, among which congenital and acquired pathologies should be distinguished. The treatment is aimed at eliminating the pain syndrome and preserving the functional areas of the organ. Subject to all recommendations and subject to the absence of complications with such a diagnosis, you can live up to 10 years or more.