تعريف

Cirrhosis is a disease in which the liver becomes permanently damaged and the normal structure of the liver is changed. Healthy liver cells are replaced by scarred tissue. The liver is not able to do its normal functions, such as detoxifying harmful substances, purifying blood, and making vital nutrients. In addition, scarring slows down the normal flow of blood through the liver, causing blood to find alternate pathways. This may result in bleeding blood vessels known as gastric or esophageal varices.

التليف الكبدي

أسباب

Causes of cirrhosis include:

  • Excessive consumption of alcohol
  • Hepatitis C, B, and D
  • Autoimmune hepatitis
  • Inherited diseases:
    • Glycogen storage disease
    • الجالاكتوز في الدم
    • Fructose intolerance
    • Tyrosinemia
    • داء ترسب الأصبغة الدموية
    • Wilson’s disease
    • Alpha1-antitrypsin deficiency
    • تليّف كيسي
  • Nonalcoholic steatohepatitis (NASH), associated with:
    • مرض السكري
    • السمنة
    • مرض قلبي
    • ارتفاع نسبة الدهون الثلاثية في الدم
    • Steroid use
  • Bile duct blockages, associated with:
    • التليف الكبدي
    • العيوب الخلقية
    • Scarred ducts—sometimes related to inflammatory bowel disorders
    • Gallbladder surgery
    • التهاب البنكرياس
  • Drugs and toxins:
    • الزرنيخ
    • Isoniazid
    • الميثوتريكسيت
    • Excess vitamin A
  • Infections:
    • Schistosomiasis
    • داء البروسيلات
    • Echinococcosis
    • Advanced or congenital syphilis
  • Heart failure, causing blood to repeatedly back up into the liver

عوامل الخطر

عامل الخطر هو الشيء الذي يزيد من فرصتك في الإصابة بمرض أو حالة. تشمل عوامل الخطر ما يلي:

  • مدمن كحول
  • Hepatitis infection
  • Use of drugs toxic to the liver
  • Being overweight or gaining weight
  • Diabetes that is poorly controlled
  • Ingestion of too much iron

الأعراض

Cirrhosis often does not cause symptoms early in the disease process. Symptoms start when the liver begins to fail, as scar tissue replaces healthy cells. Symptom severity depends on the extent of liver damage.

Early symptoms include:

  • تعب
  • ضعف الشهية
  • Abdominal swelling, tenderness, and pain
  • الغثيان
  • فقدان الوزن
  • ضعف
  • Enlarged breasts in men

Later symptoms, some due to complications, include:

  • Yellowing of the skin or eyes (jaundice)
  • Reddened palms
  • Loss of body hair
  • Shrunken testicles
  • تضخم الكبد
  • Enlarged spleen
  • Appearance of thin, purplish-red, spidery looking blood vessels on the skin, especially around the navel
  • Dark urine
  • Water retention and swelling in the legs and abdomen
  • نزيف وكدمات
  • يتقيأ الدم
  • مثير للحكة
  • Menstrual problems
  • Abdominal infections
  • ضعف جنسى
  • Forgetfulness
  • ارتباك
  • التحريض
  • الارتعاش
  • غيبوبة
  • Inability to fully process drugs
  • Enlarged, twisted, thin-walled blood vessels called varices that bleed easily and sometimes catastrophically (usually located in the esophagus)
  • سرطان الكبد
  • هشاشة العظام
  • حصوات المرارة
  • عدم انتظام ضربات القلب
  • Sleep disturbances
  • Ulcers
  • مشاكل في التنفس
  • مقاومة الأنسولين

التشخيص

The doctor will ask about your symptoms and medical history and perform a physical exam.

قد تشمل الاختبارات ما يلي:

  • Blood tests—to assess how well the liver is working and determine a cause
  • CT scan, ultrasound, or liver/spleen scan—to identify changes in the liver
  • Liver biopsy—analyzing a sample of liver tissue removed via a thin needle inserted through the abdomen and into the liver
  • Laparoscopy—looking at the liver via a thin tube with a lighted tip inserted through a small incision near the belly button

قد تشمل الاختبارات الأخرى ما يلي:

  • Inserting a catheter into the liver vein and measuring the pressure within that vein; rarely necessary
  • Removing fluid from the abdomen and examining it
  • Other tests to determine what caused the cirrhosis and what complications may occur

العلاج

There is no cure for cirrhosis. The goals of treatment are to keep the condition from getting worse, including:

  • Control the cause
  • Treat underlying medical conditions
  • Prevent additional damage
  • Treat symptoms and complications
  • Liver cancer screenings

تشمل العلاجات ما يلي:

الدواء

Doctors prescribe drugs to:

  • Treat hepatitis and complications that arise
  • Reduce the absorption of waste products and toxins in the digestive system
  • Reduce the risk of a blood vessel breaking
  • Fight infections
  • Shed excess fluids

جراحة

Liver transplant—may be done if:

  • Complications can no longer be controlled using medical therapy
  • The liver stops functioning

Endoscopy—This is used to tie off bleeding blood vessels (varices) or to inject drugs to cause clotting. A thin tool with a lighted tip is inserted down the throat to help the doctor see and access the varices, which are located in the esophagus.

رعاية ذاتية

  • Stop drinking alcohol completely.
  • Do not take any medicines without your doctor’s approval, including over-the-counter drugs.
  • Eat a balanced diet. Choose a variety of fruits and vegetables, as well as lean proteins, like beans and poultry.
  • If your liver disease is more advanced, you may need to limit protein intake, because your weakened liver will not be able to process it properly.
  • You may need to limit salt in your diet, because it increases water retention.
  • Take any vitamin supplements your doctor recommends.
  • Put your feet and legs up to decrease swelling.
  • Due to increased risk of infections, doctors recommend:
    • Getting vaccines for flu, pneumonia, and hepatitis
    • Avoiding raw seafood
    • Avoiding people who are sick with communicable diseases, like the flu or common cold
    • Washing your hands often

If you are diagnosed with cirrhosis, follow your doctor’s instructions.

الوقاية

To decrease the risk of cirrhosis:

  • Drink alcohol in moderation. Moderate alcohol intake is no more than two drinks per day for men and one drink per day for women.
  • Get hepatitis vaccines.
  • Practice safe sex to lower your chance of getting hepatitis B.
  • If you use IV drugs, do not share needles, which can spread hepatitis B, C, or D.
  • الحفاظ على وزن صحي.
  • Follow your doctor’s recommendations about blood tests when taking medications that may damage the liver.
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