Symptoms of the disease - violations of liver function. Severe liver dysfunction what is it

The liver is an organ that works like a filter. He stands guard over the purity of the blood from toxins and harmful substances, so liver dysfunction is considered a very dangerous phenomenon for health, because it threatens the normal functioning of all body systems and can lead to serious irreversible consequences. Therefore, it is important to recognize violations as early as possible and begin therapy.

What is dysfunction

This is not any specific pathology, but the designation of any violation of liver function. A large number of chemical reactions take place in this organ, each of which has its own characteristics. The wrong course of at least one of them is liver dysfunction. The blood ceases to be cleansed normally, decay products are not completely removed from the body, or, even worse, dangerous substances enter the circulatory system and provoke dysfunction of other organs.

The liver is "silent" to the last

The reasons

Violation of liver function occurs for various reasons, which are divided into two large groups: external and internal.

External causes include:

the unfavorable ecological environment in which most people are forced to live - today this is one of the fundamental causes of liver problems;
maintaining an unhealthy lifestyle;
irrationally built power algorithm;
the predominance in the diet of food that is harmful to the body;
uncontrolled medication;
alcohol abuse.

Internal factors that affect the functioning of the liver are:

violation of the functions of other internal organs (most often the gallbladder, pancreas and the stomach itself);
mental disorders and frequent stress;
infectious diseases;
serious physical activity.

It is better to diagnose any pathology at an early stage.

Symptoms of liver dysfunction

Violation of each of the functions of the body will manifest itself in a special way, so you need to carefully listen to your body. This task is complicated by the fact that there are no nerve endings in the liver, so it does not bother with pain. But gradually the liver increases significantly in size, its parenchyma swells, and the organ begins to put pressure on the rest, and this is already an obvious and very serious problem.

early stages

During this period, a sick person, as a rule, does not notice anything. He continues to lead a normal life and thereby aggravates his condition. Unusual symptoms are attributed to stress, allergic reactions, poor environmental conditions. As a result, a person gets to the doctor, having missed a lot of time and the opportunity to reverse the process until it becomes life-threatening.

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The following symptoms indicate that something is wrong with the liver:

permanent unexplained fatigue;
causeless depression, depression, sleep disturbance;
lack of appetite;
metabolic failure;
heartburn and nausea, uncharacteristic belching;
nocturnal (usually) pruritus without visible reasons;
yellowish complexion;
sudden onset of spots or rashes on the skin;
the formation of angiomas - "spider veins". They usually appear on the face, neck, hands and feet.

During pregnancy, liver dysfunction is highly likely to cause a woman to vomit constantly.

Unfortunately, in some cases, saving the organ and health is not possible.

Late stages

People, noticing such disorders, rarely go to the doctor. Time passes, the disease progresses until it acquires pronounced signs of poor liver function, which include:

pain in the right side (may be aching, pulling or sharp). This indicates that the pathological process has affected the liver capsule, or that due to an increase in the organ, it is stretched and becomes a source of pain.
a special, "liver" smell from the oral cavity - it is always sweetish;
yellowness of the skin as evidence of a violation of the metabolism of bilirubin and increased work of the kidneys to remove its excess;
pallor - occurs as a result of a decrease in the number of red cells in the blood (anemia);
the formation of age spots on the skin due to hemochromatosis of the liver;
an increase in the number of spider veins due to an increase in the level of estrogen in the blood and fragility of blood vessels;
manifestation of veins in the abdomen, similar to varicose veins. It is provoked by portal hypertension;
"liver" palms - red spots on them, which are formed due to an increased level of estrogen;
crimson color of the tongue;
dysmenorrhea in women is a cyclic pathological condition characterized by severe pain in the lower abdomen, nausea and weakness, and headaches. These symptoms occur during menstruation;
in males, the level of the hormone estrogen rises, which leads to an increase in the size of the mammary glands, loss of body hair, sexual dysfunction;
dyspeptic syndrome, expressed by loss of appetite, nausea and vomiting, a feeling of heaviness in the pancreas, bloating, constipation. These severe features occur in human cirrhosis and various types of hepatitis;
weight loss;
endocrinological and psychoneurological disorders;
fever;
xanthoma and xanthelasma - adipose tissue, which, due to a violation of lipid metabolism, is deposited on the eyelids, hands, elbows, feet and buttocks.

Cirrhosis is one of the most dangerous complications

Effects

These symptoms do not go away on their own. Moreover, over time, skin diseases will begin to actively develop. Most often, psoriasis is manifested, as well as eczema (seborrheic, microbial or others).

If the signs and symptoms of liver dysfunction are ignored, dysfunction will lead to the development of chronic diseases. In the case of portal hypertension, the patient will not only feel bad - in such cases, the probability of death is very high.

Prevention

To reduce the risk of liver dysfunction, you must follow simple preventive rules:

observe the diet - this is a very important condition for the normal production of bile;
try to make the menu varied and do not forget about the balance of nutrients;
exclude junk food from the diet (fried, too salty and fatty, smoked and pickled);
do not go on diets, especially strict ones. If you want to lose weight, you should contact a nutritionist for a menu. A good specialist will first send the patient to take the necessary tests and only then will he undertake to draw up a diet for a particular person;
give up alcohol, especially beer;
do not abuse medication for any reason (for example, with a minor headache).

Following these tips reduces the likelihood of liver disease by about 20%.

Liver dysfunction is a violation in the functioning of the organ, which, without timely treatment, results in serious health problems, since all vital systems gradually cease to fully function. By ignoring problems with the liver, a person deprives his body of the defense system. As a result, one after another, dangerous diseases fall upon him, which can cause disability or death. Therefore, it is important to check the liver for pathologies in time and seek medical help if there are suspicious symptoms.

Ascites. It is characterized by the accumulation of free fluid in the abdominal cavity. Occurring in liver diseases, portal hypertension is not the only factor in the formation of ascites. Its formation is accompanied by excessive accumulation of sodium in the body. Hypernatrigistia with a significant accumulation of sodium in the intercellular space occurs even when the concentration of this cation in the blood is reduced. Despite hypernatremia, renal function is aimed at conserving sodium and its daily excretion in the urine is reduced.

Sodium retention in liver diseases, preceding the accumulation of ascitic fluid, predisposes to fluid retention in the body and the formation of edematous syndrome. The subsequent predominant accumulation of fluid in the abdominal cavity is associated with portal hypertension. Sinusoidal portal hypertension leads to increased lymph production in the liver. Lymph from the vessels of the liver perspires into the abdominal cavity, and a dynamic balance is established with the process of its absorption into the intestinal capillaries. The total amount of protein in ascitic fluid is less than in plasma, but the ratio of protein fractions is maintained. The protein content in the ascitic fluid may increase with the development of peritonitis in such patients. It should be borne in mind that ascitic fluid can become infected for no apparent reason. Thus, the analysis of the amount of protein and the qualitative ratio of protein fractions in ascitic fluid is a diagnostic criterion for peritonitis in patients with ascites.

The main theory explaining the accumulation of sodium in the body in ascites is the theory of "insufficient filling of the vascular bed". In accordance with it, the effective BCC, i.e., that part of the BCC that is actually involved in the circulation and has a regulatory effect on the function of volomoreceptors, is reduced during the formation of ascites. The decrease in effective BCC is due to increased venous pressure in the portal system, expansion of visceral and peripheral vessels with the opening of arteriovenous shunts, and hypoalbuminemia. This process is accompanied by the activation of volumoreceptors. As a result, the renin-angiotensin-aldosterone system is activated, an increased activity of the sympathetic nervous system is observed with an increase in the concentration of nor-adrenaline, and the formation of a vasodilator of the renal vessels - prostaglandin E 2 - also decreases. The consequence of activation of the sympathetic nervous system and a decrease in the formation of prostaglandin E 2 is an increase in the tone of the kidney vessels,

and as a result of the activation of aldosterone, there is an increased reabsorption of sodium in the tubule of the nephron.

Pain. A feeling of heaviness, pressure and aching pain in the right hypochondrium arise due to stretching of the fibrous membrane of the liver and are mainly characteristic of viral hepatitis, congestive heart failure, extrahepatic cholestasis. Pain in the right hypochondrium can also be associated with an inflammatory lesion of the liver capsule, adhesions between the fibrous membrane and the parietal peritoneum, cancer, liver abscess.

Hemorrhagic diathesis. May be due to a deficiency of vitamin K-dependent coagulation factors

the effect of intra- and extrahepatic cholestasis (cholemic hemorrhagic diathesis) and insufficiency of the hepatocyte itself. Usually, a tendency to form petechiae appears first, which is associated with a deficiency of prothrombin complex factors. Later, there is a tendency to form hematomas. This is caused by an aggravation of the deficiency of prothrombin complex factors, a deficiency of other blood coagulation factors, and in some cases, the development of DIC.

hepatorenal syndrome. It is characterized by a decrease in urine output, azotemia. In this case, often there is hyponatremia, reduced total vascular resistance, sometimes with the development of hypotension. Morphological disorders in the kidneys are usually not detected by studies, which indicates the functional nature of renal failure. This is also confirmed by the facts of restoration of kidney function after liver transplantation.

The pathogenesis is based on the limitation of the glomerular filtration rate due to vascular vasoconstriction. Due to underlying renal vasoconstriction, slight blood loss or redistribution of blood, even without a significant decrease in systemic blood pressure (eg, blood loss from esophageal varices, diuretics, paracentesis for ascites, diarrhea, vomiting) can lead to rapid progression of hepatorenal syndrome.

The mechanism of renal vasoconstriction is not fully understood. It is associated with a decrease in effective BCC in the same way as it occurs with ascites. But the replenishment of BCC with infusion media with an increase in renal blood flow gives a short-term effect. Therefore, a decrease in effective BCC is not the only mechanism of hepatorenal syndrome. Its implementation is also due to an imbalance between the vasoconstrictor prostaglandin thromboxane A 2 and the vasodilator prostaglandin prostacyclin E 2 produced in the kidneys. In the development of hepatorenal syn-

Droma involves such vasoconstrictor > compounds as endothelium-1, endothelin-2,

leukotrienes, NO, and from the side of the vessels: an increase in sensitivity to the vasoconstrictive effect of adenosine was revealed.

Imbalance between vasoconstrictors; and vasodilators

causes the predominance observed in patients, along with renal vasoconstriction, of the expansion of arteries in the out-of-pocket

: renal vessels and a tendency to hypotension.

Jaundice. One of the most important symptoms of liver damage is jaundice. It can be found at

The level of bilirubin in the blood serum is 34 µmol / l and becomes apparent when bi-

Lirubinemia 120 µmol/l. First of all, it is detected on the sclera and mucous membrane of the soft palate. In some cases, icteric staining is partial - in the area of the nasolabial triangle, forehead, palms. With intense jaundice with the presence of direct bilirubin

; skin color becomes greenish-yellow over time due to oxidation of biliru-

Bina to biliverdin. Differential diagnosis of various types of jaundice is given below.

Jaundice occurs predominantly

Due to the inability of hepatocytes to metabolize bilirubin. Therefore, this disease is to some extent a marker of hepatocyte insufficiency. If the main mechanism for the formation of liver failure is the development of a porto-caval shunt, then jaundice may be absent altogether.

Exhaustion. It is caused by a violation of metabolism in the liver, protein synthesis in tissues, as well as anorexia and improper diet.

xanthomas. These are intradermal yellow plaques, usually located in the palmar folds, under the mammary glands, on the neck, chest or back. Varieties of xanthoma are xanthelasma - flat or slightly raised soft yellow formations around the eyes. In the later stages of liver damage, the appearance of tuberose xansvolume. They are usually localized on the extensor surfaces, especially in the area of the wrist, elbow, knee joints, ankles, buttocks, in places subject to pressure, in scars. In this case, the tendon sheaths are rarely affected, but bones and peripheral nerves can be affected. The origin of xanthomas is associated with an increase in blood lipids, especially with prolonged cholestasis. Xanthomas can also be observed in other diseases accompanied by hyperlipidemia: atherosclerosis, diabetes mellitus, hypothyroidism, essential hyperlipidemia.

Cutaneous itching. Cholestasis is accompanied by skin itching. For many months and years, itching may remain the only symptom of the disease. Its occurrence is associated with the deposition of bile acids in the liver. However, recently there have been reports that refute this idea: with the help of accurate biochemical tests, it is not possible to reveal a correlation between the degree of itching and the concentration of endogenous bile acids in serum and skin; in the end stage of liver failure, pruritus may disappear, while the concentration of bile acids in the serum remains elevated. It is assumed that the onset of itching is associated with compounds synthesized in the liver and excreted into the bile, which affect the central neurotransmitter mechanisms, in particular, endogenous opioid peptides.

Fever. In many cases of liver damage, fever develops. It can be caused by such factors: 1. Direct infection of the liver. So, the temperature can rise in the preicteric stage of acute viral hepatitis. 2. Translocation of microorganisms into the systemic circulation in cholangitis. In such cases, the temperature increase may be remittent or hectic with chills. 3. Translocation of microorganisms into the systemic circulation from the intestinal lumen in severe liver damage. Causes of bacteremia in hepatocellular insufficiency may be as follows: impaired function of Kupffer cells; the penetration of microorganisms from the portal vein into the systemic circulation through the portosystemic collaterals; often associated with liver failure, impaired function of polymorphonuclear leukocytes; a decrease in the serum content of protective factors - fibronectin, opsonins and chemoattractants, including components of the complement cascade. 4. Formation of distant foci of infection in patients with liver failure. In this case, urinary tract infections and pneumonia are especially common.

Crimson tongue. This symptom is characterized by a bright red color of the tongue, which has a smooth, as if varnished surface. Caused by a violation of the metabolism of vitamins.

Hepatic encephalopathy. Pechenochcoma. Hepatic encephalopathy is a neuropsychiatric syndrome manifested by impaired consciousness and behavior, mood swings, intellectual disorders, and neurological disorders that develop as a result of the progression of liver diseases, portal hypertension, or the artificial creation of portocaval anastomoses. As a clinical description of hepatic encephalopathy, a clinical classification of neuropsychic abnormalities in liver pathology can be used, according to which the following stages are distinguished: first stage manifested by confusion, behavioral disorders, mood swings, intellectual disorders. Confusion of consciousness at this stage is characterized by sleep disorders, a decrease in the number of spontaneous movements, a fixed gaze, lethargy, apathy, and brevity of answers. Personality changes are manifested by childishness, playful mood, euphoria, irritability. They are associated with the involvement of the frontal lobes of the brain in the process. Intellectual disorders are characterized by a disturbance in optical-spatial activity, including a violation of the gnostic component (recognition of a spatial figure or stimulus) and the constructive component (reproduction of a figure). At the initial stage, such deviations can be detected by applying special psychometric tests, which reveal a violation of the lettering, the inability to copy a simple pattern, etc.

Second stage characterized by drowsiness, inappropriate behavior. Drowsiness in liver pathology appears relatively early. With the progression of the pathology, an inversion of the normal rhythm of sleep and wakefulness develops. Inadequate behavior can manifest itself in such extreme deviations as urination and defecation in inappropriate places.

Third stage characterized by stupor, dysarthria, severe confusion.

As the disease progresses, it develops fourth stage the main symptom of which is hepatic coma. Sometimes the term "hepatic coma" is used in a broad sense, covering all clinical manifestations of cerebral insufficiency in liver pathology. In this case, the following stages of hepatic coma are distinguished: precoma, developing coma, stupor, coma.

Hepatic encephalopathy can be episodic, with spontaneous resolution, or chronic, with steady progression. There are hepatic encephalopathy with acute and gradual onset. Difficult to diagnose is an acute course, which is also characterized by a high probability of death. In such cases, neuropsychiatric deficit may develop within a few hours after the action of the damaging factor.

The mechanism of occurrence of hepatic encephalopathy has not been fully investigated. It is associated with impaired metabolism of cerebral neurotransmitters. The reason is a metabolic disorder due to hepatocellular insufficiency, a violation of the detoxifying function of the liver in relation to substances coming from the intestines, and also due to shunting of the blood flowing from the intestines. Neurotransmitters, the dysfunction of which was detected in hepatic encephalopathy, are shown in Table. 6.4.

The mechanism of portocaval encephalopathy, the role of ammonia and glutamine, false neurotransmitters, the tryptophan/serotonin system in the development of brain dysfunction in liver pathology are described above. The development of hepatic encephalopathy is also associated with impaired metabolism of γ-aminobutyric acid (GABA K) in the central nervous system. GAM K is the main inhibitory neurotransmitter in the brain. It is synthesized in pre-synaptic endings from glutamate by glutamate dehydrogenase and accumulates in vesicles. GAM K binds to a specific

GABA receptor on the postsynaptic membrane. As part of the GABA receptor, the GABA subunit proper, the subunit of binding to barbiturates, and the subunit of binding to benzodiazepines are isolated. Holy

The binding of the receptor with any of the ligands is accompanied by the opening of chloride channels, after the entry of chloride ions into the cell, hyperpolarization of the postsynaptic membrane develops and inhibition of nerve impulses occurs. It is assumed that GABA, synthesized by intestinal bacteria, enters the portal circulation in liver pathology, reaches the central nervous system and takes part in the development of encephalopathy. There is evidence that in liver failure, endogenous benzodiazepines can accumulate, which also cause the development of encephalopathy. The latter explains the increased sensitivity of patients with liver cirrhosis to benzodiazepines, and also serves as a rationale for attempts to use the benzodiazepine antagonist flumazenil for the treatment of hepatic encephalopathy. Unfortunately, the resulting effect is temporary.

Factors potentially contributing to the development of hepatic encephalopathy are alkalosis and hypokalemia. In this regard, the use of saluretics in patients with severe liver damage requires caution.

The possibility of developing encephalopathy and coma due to porto-caval shunting is the basis for distinguishing three clinical and pathogenetic variants of hepatic coma: 1. Endogenous hepatocellular (acute liver dystrophy, true coma). 2. Exogenous (portocaval, shunt, bypass, secondary, false coma). 3. Mixed.

Endogenous hepatocellular coma is caused by severe dystrophic and necrotic changes in the liver parenchyma. Its causes are viral hepatitis, poisoning with hepatotropic poisons (carbon tetrachloride, tetrachloroethanol, toluene nitrates, poisonous mushrooms, sulfonamides, halothane). Exogenous coma most often develops as a result of porto-caval anastomosis in patients with cirrhosis of the liver. In this case, usually resolving factors are increased protein intake, gastrointestinal bleeding, irrational treatment with diuretics, evacuation of ascitic fluid, and the presence of acute alcoholic hepatitis. Isolated clinical and pathogenetic variants of encephalopathy are rare. Usually, only the predominant mechanism for the development of neuropsychic deficit can be identified.

"Liver smell". Has a sweet personality. This smell forms the air exhaled by the patient. Sweat and vomit may also have this odor. Liver odor is predominantly intestinal in origin, as it subsides after defecation and enteral antibiotics. Its occurrence is due to a violation of the metabolism of amino acids and aromatic compounds, in particular, the accumulation of the product of the conversion of methionine-methyl-mercaptan. This substance is formed when the normal demethylation of the damaged liver is suppressed.

"Liver palms". Palmar erythema is a symmetrical patchy redness of the palms and soles, especially pronounced in the thenar and hypothenar regions, sometimes the flexor surfaces of the fingers. The spots turn pale when pressed and quickly restore color when the pressure stops. Palmar erythema is most often observed in patients with diffuse liver diseases, but also occurs during pregnancy, septic endocarditis, thyrotoxicosis. It is assumed that hepatic palms (as well as spider veins) are caused by arteriovenous anastomoses due to hyperestrogenemia and/or an imbalance in the ratio of estrogens and androgens.

Expansion of the veins on the anterior wall of the abdomen. Dilated veins on the anterior abdominal wall in liver pathology are anastomoses between the portal vein systems and the inferior and superior vena cava. Anastomoses around the navel are called the "head of a jellyfish." With portal hypertension, blood from the portal vein through the collaterals in the abdominal wall located above the navel enters the superior vena cava, through the collate

rales below the navel - into the inferior vena cava. With difficulty in the flow of blood through the inferior vena cava, collaterals develop between the systems of the inferior and superior vena cava, located in the lateral sections of the abdominal wall.

Vascular stars. Also known as "spiders", "telangiectasias", "stellate angiomas". They consist of a pulsating central part and radial ramifications of vessels resembling spider legs. The central artery of the stellate angioma expands in an ampulla-like manner under the epidermis, protrudes above the skin and spreads in the form of a star. Vascular asterisks are located in the vascular basin of the superior vena cava and very rarely below the line connecting the nipples. Most often they are detected on the neck, face, forearms, back of the hand. Quite often they can be found on the mucous membrane of the upper palate, mouth, pharynx, less often - the nose. The size of the spider veins ranges from 1 mm to 1 - 2 cm. With a sufficiently large size of the asterisk, you can observe or palpate its pulsation.

Spider veins are found mainly in active liver lesions: acute and chronic active hepatitis, cirrhosis of the liver, cirrhosis-cancer. Sometimes single spider veins occur in healthy people, most often at 2-5 months of pregnancy, and after childbirth they disappear within two months. Improving the functional state of the liver is accompanied by a decrease in the number of spider veins or their disappearance. In addition, the asterisk may disappear with a decrease in blood pressure due to shock or bleeding. Profuse bleeding may occur from the asterisk.

The mechanism of occurrence of spider veins is associated with an increase in the amount of estrogen. This explains the possibility of spider veins during pregnancy. Estrogens promote enlargement and dilatation of the endometrial spiral arteries. Perhaps a similar mechanism underlies the appearance of skin asterisks in liver failure: the liver inactivates estrogens. There is a point of view that the mechanism of the formation of stars is due not so much to an increase in the concentration of estrogens as to a violation of the ratio of estrogens and androgens.

Feminization. O an increase in estrogen activity is also associated with feminization observed in some patients, mainly in patients with active cirrhosis of the liver. In women, these changes are less pronounced. Feminization is manifested by gynecomastia, formation of the female type of hair growth. Some patients may develop a decrease in libido and potency, hypogonadism, hair loss in places of secondary hair growth. In women, ovulation may be disrupted. In premenopause: signs of a female physique disappear, especially the deposition of fat in the mammary glands and in the pelvic area. Usually these women are infertile, menstruation is irregular, scanty or absent, but can sometimes be profuse.

"flapping" tremor. The most characteristic neurological sign of hepatic encephalopathy is a "flapping" tremor (asterexis). It is associated with a violation of the supply of afferent impulses from the joints and other parts of the musculoskeletal system to the reticular formation of the brain stem, which

: leads to inability to retain

Zu. The "flapping" tremor is especially well detected on outstretched arms with

: with placed fingers or at maximum extension of the patient's hand with: fixed forearm. At the same time, fast flexors are sometimes observed -

No-extensor movements in the metacarpophalangeal and radiocarpal joints, which

: accompanied by lateral movement of the fingers. Sometimes hyperkinesis captures the entire arm, neck, jaw, protruding tongue,

Tightly closed eyelids, this attack appears when walking. The tremor is usually bilateral but not synchronous. It may be more pronounced on one side of the body than on the other. During a coma, the tremor disappears.

Enlargement of the liver. The most common symptom of liver damage may be due to direct damage to hepatocytes, cholestasis, focal liver lesions in abscesses, cysts, tumors, as well as the development of regenerative nodes and fibrosis in liver cirrhosis, blood stasis in heart failure, hepatic vein endophlebitis. For the edge of the right lobe of the liver, neoplasms of the gallbladder, colon, and right kidney can be taken. Hepato-ptosis can also mimic hepatomegaly. Emphysema, exudative pleurisy, subdiaphragmatic abscess lead to the displacement of the liver from top to bottom. To distinguish the actual enlargement of the liver from these conditions allows palpation in various positions of the patient, as well as instrumental research methods.

In some cases, there may be a reduction in the size of the liver in the dynamics of the disease. This is a consequence of not only the favorable course of the disease, but also the development of massive necrosis and may indicate a poor prognosis.

Enlargement of the spleen in liver diseases, it is associated with portal hypertension and systemic hyperplasia of the mononuclear phagocytic tissue of the liver and spleen. Growth of the spleen is observed in portal hypertension; in some forms of cirrhosis, it is larger than the liver; under these conditions, hypersplenism usually occurs. On the contrary, with stagnation in the liver, the spleen usually enlarges slightly, and there is no hypersplenism.

In the development of hepatolienal syndrome, liver diseases play a leading role: in more than 90% of cases it is caused by the pathology of the liver.

An important external secretion gland of the human body is the liver. It performs dozens of functions. The body promptly responds to the influence of negative factors. Liver dysfunction is any violation in its work that can lead to serious complications. What needs to be done in order to recognize the pathology in time and start the right treatment?

Liver dysfunction is any abnormality in its work that can lead to serious complications.

What is liver dysfunction

The gallbladder, liver and bile ducts form the hepatobiliary system. Its main function is the formation and transportation of bile. This gland neutralizes poisons, removes harmful substances, accumulates glycogen, and participates in metabolism.

The work of the liver can be disrupted as a result of a failure in the metabolism of carbohydrates, fats, proteins, hormones and trace elements. Any functional disorders of the liver are dysfunction.

Incorrect carbohydrate metabolism can be inherited or be the result of any disease. Carbohydrates provide energy. Severe disturbances in the function of carbohydrate metabolism lead to a decrease in blood glucose levels.

Lipid metabolism in liver dysfunction is manifested by improper absorption, breakdown of fats in the intestine. The work of blood vessels and the heart is disrupted. Some fatty acids are produced only in the liver. They are needed for muscle function.

With the development of organ pathologies, protein metabolism changes. There are enzymatic disorders. The activity of biologically active substances decreases. At the same time, allergic reactions of the body are aggravated, toxic substances accumulate. There is a violation of the activity of thyroid hormones, which causes endocrine diseases.

The deterioration of microelement metabolism occurs due to changes in the storage functions of manganese, iron, etc. in the vital gland. It was revealed that this process affects hematopoiesis.

Normal liver function is impossible without trace elements. With their low activity, blood circulation worsens, the neutralization of toxic substances decreases. The occurrence of hepatic encephalopathy leads to nervous disorders, depression, and coordination disorders. This is the barrier function.

Liver dysfunction associated with the formation and secretion of bile leads to the development of a disease such as jaundice.

It is known that the processes of bile formation and its secretion are associated with the entire digestive system. Therefore, failures in the work of any digestive organ can be accompanied by biliary insufficiency.

Chronic biliary insufficiency is manifested in patients with liver dysfunction due to a decrease in the synthesis of fatty acids.

Often the disorder of one of the functions entails a change in the work of others, because the factors are inextricably linked. Typically, such dysfunction syndromes manifest themselves in a complex.

The reasons

Malnutrition or alcohol abuse can lead to liver dysfunction.

Violation of the liver occurs due to external or internal factors. External causes include unfavorable environmental conditions, malnutrition and alcohol abuse. The cause of liver dysfunction may be long-term medication.

Internal factors include diseases of other organs. This applies primarily to the pancreas and biliary tract. Biliary insufficiency is a complex of symptoms that accompanies diseases of the digestive system.

Another cause of the disease of this important organ is nervous breakdowns, infections, excessive exercise.

Symptoms depending on the stage

Certain signs are characteristic of liver dysfunction. These symptoms occur individually or in combination. At an early stage, there may be:

fatigue;
loss of appetite;
weakness, fatigue;
depressive state;
skin itching;
the appearance of spots and spider veins on the skin.

At the initial stage of liver dysfunction, the symptoms are mild. Later they will be more pronounced.

The gland has no nerve endings. It increases and presses on neighboring organs, in which pain can be felt.

By the late stage, negative signs of liver function include pain of a different nature in the right side, jaundice of the skin, fever, malfunctions of the digestive organs, aggravation of all early symptoms of the disease.

Incorrect outflow of bile indicates hepatitis. This is a severe liver dysfunction. Jaundice develops. Additional signs of hepatitis are itchy skin, dark urine, and discoloration of the stool. In the obtained blood tests of the patient, an increase in the norm of cholesterol and bilirubin is detected.

With poor blood supply to the organ, portal hypertension often develops. This intensifies the pain. There are symptoms of liver dysfunction such as bloating, swelling, problems with bowel movements. There is a deterioration in the functioning of the digestive tract, the spleen is enlarged.

With hepatocellular insufficiency, the skin of the legs and arms turns red, the patient loses weight.

So, violation of liver function threatens with serious disorders and complications.

Diagnostics

Liver dysfunction can lead to dangerous disorders in the body and even death. To prescribe treatment, you need the right diagnosis.

The patient takes a blood test for biochemical substances and liver tests

The patient takes a blood test for biochemical substances and liver tests. It is necessary to establish the number of blood cells and draw certain conclusions. If erythrocytes and leukocytes have decreased, then this indicates kidney dysfunction. The number of leukocytes increases with hepatitis. If there is a suspicion of viral hepatitis, then a blood test for antibodies is prescribed.

The doctor examines the patient, collects information about his lifestyle, asks about his well-being. Various examinations are scheduled. Biochemical tests are of great importance. The patient undergoes ultrasound, magnetic resonance therapy, electroencephalography, computed tomography.

With the alleged intoxication of the body, a toxicological study is necessary. If it is not possible to find out the cause of various dysfunctions, then a biopsy is performed. With its help, the state of liver cells is assessed, fibrous changes are detected, and cancer cells are detected.

Therapy Methods

Liver dysfunction is treated comprehensively. Drug therapy includes drugs made from plants. Extracts help restore cells, improve the body's resistance to harmful substances.

Additionally, choleretic agents and drugs are prescribed to increase immunity. Well restores individual functions of lipoic acid. The patient needs vitamin preparations.

If the gland is poisoned with toxins, then the stomach is washed first, then antidotes are used.

Patients with liver dysfunction require a therapeutic diet

Patients with liver dysfunction require a therapeutic diet. Indigestible food should be excluded from the patient's diet. This is all fried, fatty, as well as smoked meats, spices, alcohol.

The diet should include cereals, fresh vegetables and fruits. It is better to cook food for a couple or bake. Useful pasta, low-fat soups, fish, dairy products, jelly, herbal tea.

With the ineffectiveness of all methods resort to surgery. It is performed when a transplant or removal of a diseased organ is needed to treat a patient.

Prevention and prognosis

Liver dysfunction is a serious disease. To prevent it, it is necessary to engage in prevention. Everyone should try to lead a healthy lifestyle, avoid stressful situations, junk food and alcohol.

At the first symptoms of indigestion, you should switch to diet food.

The state of public nutrition is also of great importance for the prevention of the disease.

It is important to recognize the disease in time, otherwise it can become chronic.

Video

Live healthy! What hurts in the right hypochondrium.

Thus, liver dysfunction is a violation of the various processes that it normally performs.

Many diseases can be hidden under this term, so it is often used when the causes of the disease are not fully understood, and a more definite diagnosis cannot be made.

In this article, we will tell you what liver functions can be impaired, how it manifests itself, and what threatens liver dysfunction.

A normally functioning liver of a healthy person performs many vital functions:

neutralizes poisons, toxic metabolic products, etc., converting them into harmless or quickly excreted compounds from the body;
breaks down and ensures the excretion of spent biologically active substances (hormones, neurotransmitters, vitamins, etc.) from the body;
during gluconeogenesis, it converts fatty acids, amino acids, glycerol and other substances into glucose as an energy source;
accumulates glycogen (a substance that can quickly turn into glucose when it is strongly reduced in the blood);
participates in the formation and metabolism of vitamins;
participates in the regulation of fat metabolism;
produces enzymes, bile acids and bilirubin necessary for the digestion of food and the neutralization of toxic substances.
plays the role of a depot for blood volume (with large blood loss, this blood returns to the bloodstream, thereby preventing oxygen starvation of tissues).

Theoretically, any of these functions will be disturbed for one reason or another, and such a condition will be called liver dysfunction. Most often, the liver is disturbed as a result of poisoning, alcohol abuse, junk food, etc. The state of other organs and systems of the body also plays an important role.

Possible violations

Various disorders of liver function can be combined into several groups, depending on which function of this organ undergoes pathological changes:

Carbohydrate metabolism (metabolism of sugars). Carbohydrates play a vital role in energy production. A typical manifestation of a carbohydrate metabolism disorder is a decrease in blood glucose levels (hypoglycemia).
Fat metabolism. Violation of the processes of digestion and absorption of fats in the intestine leads to a violation of the metabolism of fat-soluble vitamins (A, E, K, D), as well as cholesterol and fatty acids. This disrupts the functioning of blood vessels and the heart.
Protein exchange. Impaired protein breakdown can lead to the accumulation of toxic products such as ammonia in the body. In addition, protein synthesis is disrupted, which is fraught with a wide variety of consequences, ranging from loss of muscle mass to disruption of many organs.
Metabolism of biologically active substances and hormones. With this type of dysfunction, disturbances in the synthesis of estrogen and thyroxine are possible, as well as an increase in the patient's sensitivity to allergens.
barrier function. Violation of the protective function of the liver is expressed in a decrease in the number or activity of enzymes that break down toxic substances into simpler, non-hazardous compounds.
Bile formation and excretion. Most often, bile acids and bilirubin enter the bloodstream, which leads to the development of jaundice, severe skin itching and a rash on the body. In parallel, there is a decrease in appetite and disruption of the intestines (frequent constipation).

Thus, violations of the liver are diverse in their causes and manifestations. Often, a violation of one of the functions of the liver pulls another, and so on. In this case, there is a complex of symptoms characteristic of liver dysfunction of various etiologies.

Symptoms

In general, signs of liver dysfunction are quite typical. In the early stages, the general symptoms of itching of the skin, the appearance of age spots, constant fatigue, etc. are of greater importance. Often the patient does not see the connection between these manifestations and the state of the liver, attributing them to stress, allergies, poor ecology, etc. Most patients go to the doctor in the later stages of the disease, when there is pain in the right hypochondrium, jaundice and other obvious symptoms.

Early stage

The liver tissue is devoid of pain receptors, so it does not hurt in the early stages of various diseases.

Pain appears later when the pathological process affects the liver capsule, or if the disease has led to an increase in the liver (the enlarged liver stretches the capsule, which leads to pain).

How can a patient determine that the liver is not coping with its functions? In the early stages of liver dysfunction, extrahepatic symptoms occur, such as:

constant causeless fatigue;
depressed mood, depression, poor sleep;
loss of appetite;
violation of the digestive system, the occurrence of heartburn, periodic nausea;
causeless itching of the skin of the body (usually at night);
the appearance of spots on the skin, sometimes a rash;
the appearance of angiomas of "spider veins" on the skin of the face, neck, hands, feet.

People do not always go to the doctor, noticing such symptoms, and very in vain. Liver disease progresses over time. Moreover, the violation of its work affects other organs. Thus, timely seeking medical help in case of suspected liver dysfunction can protect against serious health problems.

Late stages

In the later stages of liver dysfunction, more pronounced symptoms occur that people simply cannot help but pay attention to. So, for severe violations of the work of this body, the following manifestations are characteristic:

drawing, sharp or aching pain in the right side;
a specific sweet smell from the mouth (the so-called "liver smell");
yellowing of the skin is a sign of impaired bilirubin metabolism;
pallor of the skin occurs as a result of anemia (low levels of red blood cells in the blood);
with hemochromatosis, multiple age spots appear on the body;
the appearance of clearly visible veins on the abdomen, resembling varicose veins (the result of portal hypertension);
red spots on the palms (the so-called "liver palms");
in violation of the liver in women, the development of dysmenorrhea is possible (a pathological cyclic condition in which during menstruation a woman suffers from severe pain in the lower abdomen, weakness, nausea and headache);
in men, an increase in estrogen levels leads to an increase in the mammary glands, loss of body hair, and sexual dysfunction;
dyspeptic syndrome (a person's appetite worsens, often nausea, vomiting, heaviness in the area above the stomach, bloating, constipation) develops with cirrhosis, hepatitis.

If you experience these symptoms, you should seek medical advice.

Diagnostics

It is possible to talk about liver dysfunction only when suspicions of possible violations are confirmed by the results of laboratory and instrumental studies. For example, if a liver dysfunction is suspected, the patient should take a biochemical blood test, including liver tests (bilirubin, transaminase, alkaline phosphatase, bile acids in the blood serum, etc.).

It is also mandatory for the patient to be assigned a general clinical blood test. It allows you to evaluate the number of platelets and red blood cells, often the proportion of these cells decreases against the background of liver dysfunction. In addition, it provides information on the number of leukocytes (with inflammation, such as hepatitis, their proportion increases significantly).

If you suspect viral hepatitis, you must take a blood test for antibodies to a specific hepatitis virus (ELISA analysis). Also, PCR analysis is often used; it allows you to detect the genetic material of hepatitis pathogens (DNA or RNA) in the patient's blood.

For a more accurate diagnosis, an ultrasound examination (ultrasound) can be performed. This diagnostic method allows you to assess the size and structure of the internal organ, detect neoplasms in tissues, tumors, stones, etc. Much less often resort to magnetic resonance imaging, if the results Ultrasound is not enough to make a diagnosis.

If the above examination options could not shed light on the cause of the violation, the question arises of conducting a biopsy. This study involves the taking of living patients for subsequent cytological and histological examination. A biopsy allows you to assess the condition, detect cancer cells, fibrotic changes, etc.

Treatment

Treatment of liver dysfunction depends on the causes and characteristics of the course of the disease. For example, detoxification dysfunction is often caused by insufficient bile production. In this case, the patient needs drugs that stimulate bile formation (holosas, ursochol, and others).

If bile is formed in sufficient quantity, but its outflow is impaired as a result of spasm of the sphincter of the bile duct, antispasmodic drugs no-shpa, papaverine are needed.

If the cause of jaundice and pain in the side is hepatitis, long-term antiviral therapy (interferon, interferon stimulants, etc.) will be required, and then a course of hepatoprotectors that help restore the functioning of the organ. Many hepatoprotectors are made on a plant basis (such as heptral, carsil, essentiale).

The patient's diet also deserves more attention. It is necessary to limit the use of salt, smoked meats, coffee, fats. Alcohol and other toxic products must be completely abandoned. At the same time, it is necessary to ensure sufficient intake of protein and polyunsaturated acids. It is worth enriching the diet with sea fish, chicken fillet, and various cereals.

Since the liver ensures the neutralization of harmful substances that enter the body with food, during treatment it is necessary to give it a rest, make sure that the food consumed is as light and natural as possible.

What it is?

The liver protects the body from the penetration into the blood of toxins and other substances that have a negative effect on the body. Thus, this organ is more prone to diseases, disruption of functioning, because it is the first to react to the negative influence of certain factors. Such disorders manifest themselves in the form of different symptoms. Among the consequences of insufficiency are poor blood supply, changes in structure, blockade of some cells. The functioning of the liver can be impaired for various reasons. According to official statistics, there are 200 million people worldwide suffering from liver disease. As a rule, the following causes cause the disease: a viral infectious disease, poisoning with toxic compounds (alcohol, metals, synthetic substances, poisons).

Etiology and pathogenesis of disorders

With varying degrees of severity of the disease, characteristic violations of the following processes appear:

Violations in the liver are manifested in the failure of the metabolism of glucose, lipids, amino acids, hormones, trace elements.

Metabolism of carbohydrates. It manifests itself in the development of hepatogenic hypoglycemia and diseases that are inherited (for example, galactosemia).
Metabolism of fats (fat metabolism). With liver ailments, a violation of fat metabolism manifests itself in the form of changes that occur during the process of absorption, splitting of fats in the intestines. In addition, improper fat metabolism leads to the fact that the synthesis of cholesterol, triglycerides and other substances is disrupted. Violation of fat metabolism poses a danger to metabolic processes and the body as a whole.
Protein metabolism. In addition to fat metabolism, there are changes in protein metabolism. With the development of pathological processes in the liver, this disorder affects protein synthesis, causes the breakdown of proteins, the formation of ammonia and products of the final stages of protein metabolism.
Metabolism of biologically active substances and hormones. Liver diseases affect the synthesis of various hormones and their proteins, lead to a loss of activity of BAS (biologically active substances). Damage to the liver by a pathology that causes a violation of the activity of thyroxine, estrogens and other hormones, provokes a change in their amount in the blood, the development of diseases of the endocrine system. Reducing the process of removing amino groups from BAS molecules can lead to an aggravation of allergic reactions.
Metabolism of trace elements. This metabolic disorder is caused by a change in the storage function of manganese, iron and other elements in the liver.

barrier function. Failure is expressed in the low activity of endotheliocytes and other macrophage microelements, antitoxic function. Poor circulatory function. In turn, the violation of the antitoxic function of the liver is caused by the fact that metabolic processes do not occur correctly. We are talking about the synthesis of urea, hydrolysis, oxidation, acetylation, reduction, conjugation (the process of formation of compounds necessary for the binding of indole, skatole, etc.). If we talk about turning off the antitoxic function of the liver, then it provokes hepatocerebral syndrome and the most dangerous form of organ failure - hepatic coma. Hepatic encephalopathy, which is characterized by mental deviations of varying degrees, impaired coordination of movement (ataxia) can also lead to coma.
Formation and secretion of bile. This dysfunction of the liver leads to the development of jaundice of varying degrees of severity, improper functioning of the digestive system. Weakening, stopping the penetration of bile into the duodenum also negatively affects the patient's health and significantly reduces the content of certain substances in the composition of urine and feces.

Symptoms

The main characteristic symptoms of liver dysfunction include:

The early stages of hepatic dysfunction are characterized by a weak degree of manifestation of signs of the pathological process. This is due to the absence of nerve endings in the liver - they are only in the capsule. When it begins to swell, increase and stretch, a person experiences pain. Often, pain occurs in organs that are located nearby, as the liver puts pressure on them due to an increase in size. Treatment of liver dysfunction in the initial stages is faster and much more effective in comparison with the treatment of a disease that is in a neglected state.

Pigmentation of the skin of a bronze color with a grayish color on the palms is characteristic of hemochromatosis of the liver. The development of cholestatic syndrome is caused by a violation of the process of outflow of bile secretions. This syndrome is a common symptom of hepatitis. In addition, patients may be disturbed by jaundice, which appears due to a violation of bilirubin metabolism. It is important to pay attention to its symptoms in a timely manner. Jaundice is manifested by a change in the shade of the skin and mucous membranes. In addition, other signs are also characteristic of the syndrome (itching on the skin, discoloration of feces, darkening of urine). When conducting a biochemical laboratory study, experts detect an increase in bilirubin and cholesterol.

Violation of the process of blood supply to the liver often leads to the development of portal hypertension. This syndrome is manifested by increased pain, problems with stools, bloating in the abdominal cavity, swelling, disruption of the organs of the gastrointestinal tract, and an enlarged spleen. Hepatocellular insufficiency leads to the appearance of symptoms such as reddening of the skin on the limbs, weight loss. Clinical signs make it possible to distinguish astheno-vegetative syndrome from dyspeptic, hemorrhagic, pain. The above syndrome is referred to as biochemical. It is determined by evaluating the level of various liver enzymes.

Diagnosis and causes

Liver dysfunction can lead to serious consequences and death of the patient. In order to prescribe effective therapy and improve the patient's condition, it is necessary to establish the causes of the disease and make the correct diagnosis. Diagnosis should be based on history. When making a diagnosis, the doctor takes into account the peculiarities of the patient's lifestyle, his well-being, instrumental and laboratory examination data. The most important role is played by the results of biochemical tests. Improper functioning of the liver affects the concentration of enzymes - it increases.

In addition, assess the state of the acid-base balance, indicators of blood composition. Acute deficiency often provokes anemia, a reduced number of platelets. Ultrasound, electroencephalography, computed tomography, and magnetic resonance imaging are used as instrumental examination methods. If there is any suspicion of the presence of intoxication in the body, a toxicological medical study is carried out. Not the least important in making the correct diagnosis are the patient's complaints and examination of the mucous membranes and skin. To restore liver function, complex therapy of the underlying ailment will be needed.

Treatment of liver dysfunction

Medical therapy. In drug treatment, medications are used, with a plant, rather than a synthetic basis. Considering that unnatural harmful substances often lead to liver diseases, such medicines will help improve the condition of the organ, and will not have such an aggressive effect on it. Hepatoprotective medications are made from plant extracts that help restore and then protect liver cells. The main components of medicines help to improve the body's resistance to harmful substances. In addition, doctors prescribe choleretic, tonic and drugs that stimulate the immune system. On sale there are medicines that contain lipoic acid, which helps improve liver function. In general, drug therapy is prescribed to restore and maintain the body. When the liver is damaged by toxic substances, it is necessary to wash the stomach, apply various antidotes.

Hepatic dysfunction is eliminated by pill therapy, supported by diet and treatment with medicinal herbs.

Therapeutic diet. Another important direction in therapy is the dietary table, which has a therapeutic effect on the body. Since nutrition often leads to disruption of the basic functions of the liver, it is necessary to strictly follow the recommendations of the attending physician regarding the selected daily menu. Therapy with dietary nutrition in acute pathology has a positive effect. To increase the chances of recovery, fried, fatty foods, smoked meats, spicy seasonings and spices should be excluded from the patient's diet. People suffering from liver dysfunction should eat more cereals, salads with fresh vegetables, fruits. Nutrition should be varied and rich in vitamins and useful trace elements - this will help to quickly restore the functions of a diseased organ. You also need to take into account that alcoholic beverages and junk food negatively affect the condition of the liver, so you should forget about them. Even the minimum amount of alcohol can lead to an exacerbation, which will result in complications and severe intoxication of the patient's body.
Treatment at home with the help of herbal medicine. Despite the fact that disputes about the benefits and harms of non-traditional therapeutic methods are frequent, hepatologists, therapists and other doctors prescribe herbal medicines to patients with liver dysfunction. Natural medicines are selected according to the properties that they can have on the cells of the body. Fees can be purchased at any pharmacy without a prescription. But at the same time, you should know exactly how to take them and in what dosage. Any collection, as well as a medication, has a number of contraindications. Therefore, before starting the reception, you need to consult a specialist.

Prevention

First of all, it is important to eat right, avoid stress and take care of your health. You should abandon the frequent use of fried foods, fatty and spicy foods, pickles and smoked foods - this will help protect the digestive organs from toxins and other harmful substances that lead to the development of diseases. If the digestive system becomes weakened, violations appear, you need to switch to a strict dietary diet: cook meals in a double boiler, eat boiled, baked foods, salads and fresh fruits. You can bake food in foil.

At the same time, the prevention of liver diseases does not always depend only on the habits of a person, since even if desired, it is difficult to protect oneself from them. To some extent, liver pathologies are also a public issue. Among the root causes of the development of ailments, there are those that cannot be influenced by the observance of conventional preventive measures. However, everyone should strive to improve conditions: government agencies, public catering facilities, medical institutions, and people who carefully monitor their health.

Like many other organs of the human body (and even more so because of its importance), the liver has a high margin of safety. Nevertheless, her condition is affected by eating disorders, taking medications, bad habits, frequent stress and unfavorable environmental conditions. Liver dysfunction can be manifested by external changes, which we will talk about today.

Improper functioning of the liver affects the entire body. Wrinkles are not only a sign of facial skin aging: in certain cases, they are a marker of liver problems. If the liver is overloaded, vertical wrinkles appear on the forehead and just below (between the eyebrows). The deeper they are, the higher the likelihood of hepatic dysfunction.

Many biochemical processes take place in the liver. If they are violated, this affects the exchange of melanin pigment, which plays a major role in the formation of skin color. Liver diseases are often manifested by abnormal pigmentation of the skin of the face. Spots of greenish or brown color appear on the forehead or temples. It is usually not possible to get rid of them with the help of brightening agents. In very old people, the skin of the face, hands, and then the whole body is covered with randomly located areas of brownish pigmentation (lentigo). Experts also associate this phenomenon with age-related changes in the liver.

The liver is the body's main filter. It is she who neutralizes and helps to remove toxic and simply unnecessary substances from the human body. If the liver cannot cope with excess fat, they accumulate in the ducts of the sebaceous glands.

Malfunctions in the liver are manifested in an increase in the fat content of the skin of the face. Most often, a cosmetic defect occurs on the forehead and wings of the nose. Sometimes fat content is combined with increased sweating of the same zones. Blockage of the sebaceous glands often leads to their colonization by pathogenic microorganisms; in such cases, acne, pimples and pustules appear.

Liver dysfunction interferes with the proper absorption of nutrients that promote hair growth. In particular, a decrease in liver function is considered one of the causes of early gray hair, especially when the loss of natural hair color begins from the parietal part of the head. Rapid baldness can also indicate problems with the liver - both in men and in women.

The liver is responsible for removing hemoglobin breakdown products from the body. If it does not work well, one of these substances - bilirubin - accumulates in the upper layers of the skin and mucous membranes, changing their color to yellow.

Many liver diseases are manifested by yellowing of the sclera. In advanced cases, other parts of the eyes also change: the pupils become whitish, and the irises become dull. The eyes lose their healthy appearance, the skin under them also turns yellow.

Incorrect liver function greatly affects the condition of the oral mucosa. Dryness and/or discoloration of the tongue and palate, swelling and bleeding of the gums may occur. Often, inflammation of the mouth and throat develops.

The liver plays a major role in the digestion and utilization of nutrients. If they do not proceed correctly, this is reflected in the appearance and other qualities of the feces. The following features should be cause for concern:

sticky texture;
strong smell of bitterness;
liquid consistency;
hard, dry ball-shaped stools;
floating chair;
light color (feces look like white clay).

Many liver diseases in the early stages are almost asymptomatic. Partly, the fact is that the tissue of this organ is devoid of nerve endings, and the violation of its functions does not bring pain to the patient. That is why it is so important to listen to the signals that the body gives. Noticing the external signs of a violation of the liver, it is necessary to consult a doctor without delay.

Video from YouTube on the topic of the article:

Education: First Moscow State Medical University named after I.M. Sechenov, specialty "Medicine".

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