malnourished cirrhosis
Introduction
Introduction to dystrophic cirrhosis Malnutrition cirrhosis is caused by chronic nutritional deficiencies, leading to malnutrition. Except for insufficient intake of individual patients, most of them are due to other diseases that limit food intake and absorption, such as small bowel bypass surgery. basic knowledge The proportion of illness: 0.05-0.08% Susceptible people: no special people Mode of infection: non-infectious Complications: hepatic encephalopathy upper gastrointestinal bleeding liver and kidney syndrome
Cause
The cause of dystrophic cirrhosis
Malnutrition cirrhosis is caused by long-term nutritional deficiencies. Animal experiments have confirmed that simple malnutrition, especially protein, anti-fatty liver factors and B vitamin deficiency, can cause fatty liver, liver cell necrosis, degeneration to cirrhosis, nutrition. The mechanism of dysfunction caused by cirrhosis may be: 1 When the protein containing cystine is lacking, the source of cysteine and glutathione is reduced, so that the production and activity of enzymes in hepatocytes are affected, and the liver cells are affected by Degenerative necrosis occurs due to damage of various factors. 2 Choline is a fat-producing substance. In the liver, it can synthesize phospholipids with neutral fat, so that the liver fat is easily oxidized and used. If the amino acids necessary for choline or synthetic choline are serious, Lack of fat will accumulate in liver cells and become fatty liver. The fatty degeneration of liver cells can reduce the resistance of liver cells to various harmful factors, or they can squeeze each other and compress the hepatic sinus due to the increase of cell volume. Ischemia, necrosis, fibrous tissue hyperplasia until cirrhosis.
The causes of malnutrition, except for the lack of intake of individual patients, are mostly due to other diseases that limit food intake and absorption, such as after small bowel bypass surgery.
Like other types of cirrhosis, dystrophic cirrhosis precedes the formation of hepatocyte injury such as steatosis, accompanied by inflammatory cell infiltration in the portal area and hepatic lobule, granuloma formation, and later development of liver fibrosis, and Alcoholic liver injury is similar. Hepatic fibrosis around the small vein is a sign of cirrhosis. The liver is repeatedly damaged for a long time, which eventually leads to cirrhosis. The lesions and liver lesions are similar to alcoholic liver injury.
Prevention
Malnutrition cirrhosis prevention
Actively supplement nutrition, high protein, low fat, can also give intravenous nutrition, improve liver function and histological changes in patients with liver cirrhosis.
Complication
Malnutrition cirrhosis complications Complications, hepatic encephalopathy, upper gastrointestinal bleeding, hepatorenal syndrome
Steatosis of hepatocytes can reduce the resistance of hepatocytes to various harmful factors, and can also squeeze and compress the hepatic sinus due to the increase of cell volume, gradually causing ischemia, necrosis, fibrous tissue hyperplasia and cirrhosis. Can be complicated by hepatic encephalopathy, upper gastrointestinal bleeding, liver and kidney syndrome.
Symptom
Malnutrition cirrhosis symptoms Common symptoms Hepatic leaf atrophy Hepatic cells Fatty small bile ducts Distorted liver Mild steatosis Nausea Second sex changes Amenorrhea Severe fake large scale... Abdominal pain Ascites
Changes in sexual characteristics can occur after 12 to 18 months of nutritional small bowel bypass surgery, such as decreased sexual desire, male breast development, female amenorrhea and secondary sexual characteristics changes, and loss of appetite, weakness, abdominal pain, nausea, vomiting, signs Astragalus, hepatosplenomegaly, ascites, spider mites, test with elevated serum bile acid, elevated AST, normal ALT, prolonged prothrombin time, hypoalbuminemia, liver biopsy visible liver steatosis and hepatitis performance .
Cirrhosis can occur in patients more than 7 years after small bowel bypass surgery. The formation of cirrhosis is hidden, clinical manifestations are not prominent, and occasionally die of cirrhosis and liver failure.
Examine
Malnutrition cirrhosis
Laboratory inspection:
1. Blood routine: When the spleen is hyperactive, the whole blood cells are reduced. Leukopenia, often below 4.0 × 109 / L (4000). Platelets are mostly below 50 × 109 / L (50,000). Most cases are normal cell anemia, and a few cases can be large cell anemia.
2. Urine test: urinary bilirubin/urobilinogen positive in jaundice.
3. Ascites routine examination: ascites is leakage, the density is below 1.018, the Lee's reaction is negative, the number of cells is below 100/mm3, and the protein is less than 25g/L.
4. Liver function test
Film degree exam:
Ultrasound examination
In cirrhosis, due to fibrous tissue hyperplasia, ultrasound shows a uniform, diffuse dense point echo, and late echo enhancement. Liver volume may shrink. If there is portal hypertension, the portal vein is widened and the spleen thickens.
2. Liver biopsy
This method can be used to determine the diagnosis and the histological type of liver cirrhosis and the extent of hepatocyte damage and connective tissue formation. However, if the material is too small, there may be a false negative. At present, the rapid puncture method is adopted, the operation is simple, and the complications are small and safe.
3. Laparoscopy
It is one of the reliable methods for diagnosing cirrhosis and can directly observe the liver surface. Typical cases of nodular hepatic surface, abdominal varicose veins and splenomegaly. A biopsy can also be performed under direct vision liver puncture. For cases that cannot be diagnosed clinically, this test can confirm the diagnosis and early lesions can be found.
4. Esophageal X-ray barium meal examination
In the esophageal varices, the varicose veins are higher than the mucosa, and the sputum is unevenly distributed on the mucosa, and there is a worm-like or sputum-like filling defect, and the longitudinal mucosal folds are widened. When the varicose veins are present, the peony is filled with chrysanthemum-like filling defects.
5. Esophagoscopy or gastroscopy
It can directly observe the varicose veins of the esophagus and stomach, and understand the extent and extent of the varicose veins, which is helpful for the differential diagnosis of upper gastrointestinal bleeding. The correct rate of varicose veins by gastroscopy is higher than that of esophageal X-ray barium meal examination.
6. Radionuclide scanning
Liver scans were performed with colloidal 198 gold or other nuclide. The liver area of patients with cirrhosis was generally sparsely radioactive, uneven or spotted with reduced radiation. The size and morphology of the spleen were visualized by scanning with 99 m and 113 m indium. In cirrhosis, the liver shadow is enlarged during the compensatory period, the late liver shadow is reduced, and the spleen is enlarged.
Diagnosis
Diagnosis and differentiation of dystrophic cirrhosis
According to the medical history, clinical manifestations and laboratory data is not difficult to make a diagnosis.
Note the differentiation with other types of cirrhosis.
