I still remember when I was practicing, an old professor often nagged [Chinese liver, foreigners’ lung], which means that the incidence rate of lung disease in the west is high, while that in China is high. Later, I happened to choose the direction of liver and gallbladder and had more experience. Today, I will talk about liver cirrhosis, which is familiar to everyone, in combination with a patient who has just been [sent away] recently.
Typical symptoms of cirrhosis
Two days ago, Corey admitted a liver cancer patient. He is a soldier. Call him a soldier.
At the first sight of the soldier, his face was dry and grayish yellow, which was a typical [liver disease face];
Stretch out your hands, visible palm root ruddy, this is the so-called [liver palm];
Lifting up the clothes, it can be seen that there are red dots on the front chest and back, similar to small spiders, which are medically called [spider moles];
Look at the swollen belly again. Like frogs, medical students all know that nine times out of ten there is ascites in the frog-shaped belly.
All of the above are typical symptoms of patients with severe liver cirrhosis. Therefore, although he was admitted to hospital because of liver tumor at this time, we preliminarily judged that in the short term, it was not tumor but liver cirrhosis that could kill him.
The figurative metaphor of liver hardening
The word “cirrhosis” should be well understood, which literally means that the liver has hardened. Regarding the hardness of the liver, we can use three points on the face to vividly illustrate it:
Normal liver feels like [lips], soft and elastic.
Hardened liver feels like [nasal tip], tough but not elastic.
If there is a mass on the liver that is as hard as [forehead], it is most likely liver cancer.
When there was no B-ultrasound CT and other examination methods in the early stage, surgeons really judged this way when performing exploratory laparotomy.
Formation Mechanism of Liver Cirrhosis
In short, it is the result of various factors causing liver cell rupture and death, triggering the body’s spontaneous repair mechanism.
This repair mechanism is not perfect. For example, if we make a deep incision in our skin, there will be scars. If we cannot do [seamless repair], the liver will only [scar repair], which is manifested as a large proliferation of fibrous tissue, namely [liver fibrosis]. If liver fibrosis continues to develop, eventually the liver loses elasticity and hardens, this is liver cirrhosis.
Common triggers of cirrhosis include: Viruses (especially hepatitis B and hepatitis C virus), alcohol and parasites. About 10% of the people in our country are infected with hepatitis B virus, so the most common is hepatitis B cirrhosis. The soldiers mentioned earlier belong to this category. Alcoholic cirrhosis is more common in the west. Of course, the number of patients with alcoholic cirrhosis in China has been increasing in recent years.
Treatment of cirrhosis
Liver cirrhosis cannot be reversed, let alone cured. Unlike liver cancer, which is confined to a certain part of the liver, liver cirrhosis is diffuse and cannot be removed like liver cancer.
Since cirrhosis cannot be reversed, there are no drugs. So far, FDA has never approved any drugs to treat cirrhosis. Without curable drugs, cirrhosis treatment has only two directions: one is etiological treatment, and the other is liver transplantation.
Etiological treatment
The above mentioned several common factors leading to liver cirrhosis, as long as they can be blocked in time, the liver will not continue to develop fibrous tissue hyperplasia. The human liver has a strong reserve, as long as the overall liver function can be maintained at more than 25%, it is enough for the body.
Therefore, the etiological treatment of liver cirrhosis means: under the condition that liver function is sufficient, hepatitis B patients should resist the virus and suppress the virus at the lowest level; Alcoholic hepatitis gives up drinking.
However, if the liver function is less than 25%, it will enter the so-called [liver function decompensation period], and only the second method-liver transplantation can be considered.
Liver transplantation
Since the first human liver transplantation in 1963, many patients with decompensated liver cirrhosis have been reborn through this method. Like soldier, his liver cirrhosis is complicated with liver cancer. Liver transplantation can treat both liver cancer and liver cirrhosis, killing two birds with one stone.
Late Hazards of Liver Cirrhosis
Ascites
Soldier ascites, It is a major manifestation of decompensation. I have previously introduced the causes of liver ascites in Dr. Clove’s column [Doctor Teach You to Read Liver Function Test Form]: [If the liver function is damaged and the liver’s ability to synthesize protein decreases, the protein content in the blood will decrease. The blood protein content decreases, the osmotic pressure decreases, and water will run from the blood circulation to the tissue.]
As doctors, all we can do is to give him intravenous protein to increase blood protein content and reduce ascites while letting his family find liver source.
Hepatic encephalopathy
But within a few days, the soldiers began to fall into a coma. This is also caused by serious damage to liver function, which is medically called [hepatic encephalopathy]. Simply put, it is because the liver has lost its [detoxification] function, and toxic substances (blood ammonia) in the blood act on the central nervous system, causing the patient to fall into a coma or have consciousness disorders.
At this level, surgeons have no effective what method and have to send soldiers to ICU for close monitoring.
Coagulation dysfunction
Soon, subcutaneous bleeding appeared near the needle and intubation site on the soldier’s body, This is another manifestation of the decompensation period, Coagulation dysfunction. Because the liver also has the function of producing coagulation factors, liver function damage will also affect the production of coagulation factors, therefore, any minor trauma, may cause capillary damage, causing uncontrollable hemorrhage. Because of coagulation dysfunction, soldiers’ coma is not only due to hepatic encephalopathy, but also likely accompanied by cerebral hemorrhage.
A few days later, the soldier died.
Celebrities who have suffered from liver cirrhosis
The course of disease of soldiers is a typical course of disease of patients with advanced liver cirrhosis, and the most famous one among patients with liver cirrhosis should be Sun Yat-sen.
People generally believe that Sun Yat-sen died of liver cancer, but the medical profession tends to think that he died of liver cirrhosis. Sun Yat-sen was a carrier of hepatitis B virus for many years. He found liver cancer more than 40 days before his death. Surgeons opened their stomachs and found the liver [hard as wood] and tumors at the same time.
Before his death, Sun Yat-sen had typical symptoms of patients with advanced liver cirrhosis: liver disease face (as can be seen from his photos and even portraits), ascites and subsequent temporary coma. The same is true of writer Lu Yao, who died of liver cirrhosis caused by hepatitis B and was only 42 years old.
Early detection and treatment
In writing this article, besides introducing the relevant knowledge of liver cirrhosis to everyone, I also want to remind everyone that liver cirrhosis does not sound so terrible compared with cancer that we turn pale at the smell. But when it reaches a certain stage, doctors may be more helpless than cancer.
Like this, asymptomatic fashion is not terrible, the more it develops, the more dangerous it is, and even there are many diseases that are better than cancer. Therefore, regular physical examination, early detection and early treatment are advocated: in the early stage of such diseases, when there are no symptoms or symptoms are mild, the disease progression is controlled by improving living habits and taking drugs to prevent it from developing to an irreversible point.