What examination to pass to detect cirrhosis of the liver. What tests are given for suspected cirrhosis of the liver. Viral hepatitis markers

Liver diseases complicate a person's life quite a lot, and at the same time, not only people suffering from alcohol addiction and other addictions, but also absolutely “respectable” citizens suffer from them.

Almost all diagnoses of this organ are characterized by a chronic course of the disease and are difficult to tolerate by the body.

Cirrhosis of the liver is a pathology characterized by an aggressive course, in which the cells of the organ mutate into a tissue that resembles scar tissue in structure. The disease is considered the final, most severe stage of chronic liver diagnoses.

The following degrees of the disease are distinguished:

1 - preclinical- symptoms are not expressed. It is diagnosed only by laboratory analysis of blood samples. The stage is harmless and can last for years;
2 - clinical- characterized by an increase in the size of the organ, pain in the hypochondrium, intestinal disorders and spontaneous nausea. The disease is in a state of latency;
3 - subcompensated- the size of the organ no longer changes, the total body weight of the patient decreases sharply. At this stage, a loss of up to 15% of the initial weight is typical. With a successful operation, the prognosis is very optimistic;
4 - terminal. The most difficult stage for both the patient and his relatives. The course is severe, the symptoms are frightening. The organ decreases in size several times. Often mutates into cancer. Characterized by the appearance of hepatic coma. The patient requires constant medical supervision and is in the hospital almost all the time.

Since the pathology is characterized by rapid progression, the time interval between each of the degrees described above can be minimal, and a person’s life depends on its timely diagnosis.

The sooner treatment begins, the higher the patient's chances of an optimistic prognosis.

Research

Comprehensive diagnosis of this pathology is a complex and lengthy procedure. The examination is carried out using various methods, while a competent doctor will prescribe exactly those studies that are most justified in each case.

Only after carrying out all the activities and passing a detailed analysis, based on their results, it is possible to state with a high degree of probability the presence or absence of cirrhosis.

In this video, the doctor talks about modern methods of diagnosing and treating the disease:

Blood analysis

Types of general blood tests prescribed if this disease is suspected:

clinical- They are also called ordinary. According to the state of the blood, anemia can be determined, provoked by dysfunction of the blood exchange system. This happens when the elements of iron and acids are contained in the human body in insufficient quantities, as well as in the presence of internal bleeding and other provoking factors;
biochemistry- fixes the degree of increase in the number of bilirubin, ACAT, the growth of phosphatose. In this case, the protein content will be reduced. To what extent the results obtained do not correspond to the norm, the comparative table will tell;
samples for enzymes- with cirrhosis of the organ, a pronounced increase in their concentration in the liver is observed. Enzymes are classified into specifically manifesting themselves and non-specific;
for antibodies to hepatitis- the method shows the average blood clotting. Immunological analysis reveals the presence of markers of viral origin, or the presence of hepatitis antibodies. If these antibodies are not found in the blood of a person, therefore, he is not infected;
alpha-fetoprotein– analysis determines hormonal changes. At the initial stage of the course of the disease, the presence of antibodies to mitochondria and fetoproteins is characteristic. This is accompanied by an increased concentration of insulin in the patient's blood.

ultrasound

The study by ultrasonic vibrations makes it possible with a high degree of probability to diagnose the degree of the course of the pathology, the boundaries of the organ, fluctuations in its size, structural content.

In addition, the specialist can understand whether there is intragastric ascites. Also, ultrasound diagnostics is a way to identify whether there are fragmentary foci of inflammation in the tissues of an organ, which can subsequently lead to the development of cancer. The specificity of hemodynamics is calculated using echography.

Laparoscopy

This diagnostic method involves surgical intervention with a minimally invasive method that allows you to thoroughly study the surface state of the organ, give a qualitative assessment of the physical condition of the liver, the degree of its functionality and the possible presence of cirrhosis.

If this is a large-nodular type of disease, nodular connections of a dark brown hue will inevitably be visible on the surface of the liver. Moreover, the size of such formations is more than 3-4 mm. They differ in fuzzy outlines and irregular shape.

In a situation with a micronodular type of pathology, the shape of the organ retains its natural parameters, and its tissues grow through reproduction in the internodular zone. The process is characterized by a significant thickening of the capsule and venous expansion, which, however, is characteristic of all types of cirrhosis.

FGDS

Research technology is considered one of the most progressive and informative methods. It is used in the diagnosis of diseases that are directly or indirectly related to the processes of internal bleeding of various vital systems within the human body.

Manipulation allows you to see to what extent the hepatic venous ducts are dilated, and to determine the cause of the development of this phenomenon.

CT

Computed tomography most accurately determines the presence of a cancer focus in any organ. As for the liver, in this case this diagnostic method is especially effective, since the organ is perfectly visible, and cirrhosis itself has pronounced external changes in its surface part.

Under the influence of ultrasonic vibrations, the areas affected by the disease are punctured, and the taken fragment of the material is subjected to deep study.

Based on the results obtained, the final diagnosis is made and the optimal treatment regimen is selected. In addition, CT detects all recurrent phenomena that occur with cirrhosis, so it is performed not only at the initial stage of detection, but also during therapy, as well as at the end of treatment.

MRI

An MRI study of an organ allows a qualitative assessment of its anatomy, namely: parameters relative to the norm, structural component, location, concentration of lesions.

At the same time, the procedure does not pose any threat to the patient, is completely safe and can be performed repeatedly if there are appropriate indications. An MRI clearly shows a significant decrease in the size of the organ with its partial right-sided atrophy, which is so characteristic of cirrhosis.

In addition, the study allows you to track pathological changes occurring in the portal vein, which passes through the liver and contains the main source of blood supply to the organ.

Biopsy

Without this analysis, not a single diagnosis of pathological processes of malignant degeneration of tissues in the body is complete. A fragment of tissues to be examined and taken from the affected area allows you to accurately diagnose the nature of the anomaly occurring in the organ, as well as the stage of the course of the disease.

As for cirrhosis, a biopsy objectively shows the degree of irreversibility that occurs with its tissues. Based on the analysis, a course of therapy is prescribed.

Differential Diagnosis

Distinguishes the nature of the pathology, types of cirrhosis of the liver. Almost 100% distinguishes between this disease and allows to exclude the presence of formations having a malignant nature of origin.

Diagnosis includes a set of procedures, such as ultrasound, biopsy, histology, laparoscopy.

In this case, the organ greatly increases in size, and its structural content becomes more compacted. The data obtained by the laboratory method constitute the main clinical base of the disease and serve as the basis for the appointment of one or another method of therapy.

At home

Naturally, at home it is impossible to determine an effective treatment option, as well as to refute, or, on the contrary, confirm the presence of this particular disease.

Such conclusions can only be made in a clinical setting. But there are signs by which an attentive person may well understand that not everything is in order with the liver and he needs medical help. These symptoms include:

spontaneous increase in body temperature for no apparent reason, continuing for a sufficiently long period of time;
weight loss (more than 10% of total weight);
loss of interest in food;
fatigue even with minimal physical exertion;
pain syndrome in the gastric region and between the ribs, characterized by prolonged sensations of a dull nature;
yellowness of the skin and whites of the eye;
sudden attacks of nausea, uncontrolled vomiting, indigestion, stool disorders;
bleeding.

However, some alarm bells should encourage the patient to contact the local therapist, who will take a general history and, if necessary, send to a specialist to identify the diagnosis and prescribe treatment.

The following should be of concern:

General long-term malaise;
Loss of appetite and weight;
Itching of the skin;
Pain in the joints;
Pubic hair loss (nails, skin and hair are given special attention during the examination, since they are indicators of the health or indisposition of the body).

With changes in the liver, the patient's skin may have an icteric hue. In addition, spider veins may be observed in the upper body. This indicates the expansion of blood vessels, which indicates a poor ability of the liver to inactivate female hormones in the body. In addition to the "stars", the skin on the palms of a patient with possible cirrhosis will also have a red tint.

The nails and hair of a patient with cirrhosis or changes in the liver will be weak and brittle. This is a clear indicator of impaired metabolism.

In addition to external symptoms, the doctor will necessarily interview the patient and determine the cause of possible cirrhosis (alcoholic or viral).

These main symptoms may indicate ongoing changes in the structure of the liver and the need for urgent treatment.

The specialist, when contacting the patient, will conduct, in addition to the survey, a palpation (palpation of the organ with fingers) research method. At the initial stage of the ongoing changes, the doctor can feel for an enlarged or, conversely, reduced liver. In addition, incipient cirrhosis may be characterized by heterogeneity of the organ walls during palpation examination and its increased density. The spleen may also be enlarged. It should be borne in mind that the patient will definitely feel pain when examining the liver with his fingers.

Laboratory diagnostics

In addition to the survey and examination, the attending physician will first prescribe laboratory tests. The main ones are the general analysis of blood and urine.

The results will indicate the following changes:

Reduced hemoglobin - a violation of the process of hematopoiesis or recurrent internal bleeding due to cirrhosis.
Elevated white blood cells - the likelihood of infection in the patient's body.
Decreased leukocytes are a clear signal of hypersplenism (enlarged spleen and its hyperfunction).

Methods for diagnosing liver cirrhosis: radiography

With radiography, the dimensions of the diseased organ and the adjacent spleen are established. This diagnostic method is considered the simplest and fastest.

To determine the external outlines of the diseased organ, its size, the diameter of the portal vein and the structure of a possibly diseased liver, ultrasound diagnostics (ultrasound) is used.

The same research method can also show the foci of possible malignant transformations of liver cells. Simply, to diagnose the likelihood of liver cancer. This will allow for faster treatment.

Liver biopsy and histological examination of the material

To confirm the results of ultrasound and radiography, the doctor will prescribe a laparoscopic diagnosis, which will allow a liver biopsy and a histological examination of the affected material to confirm or refute the diagnosis.

Laparoscopy is performed under general anesthesia using a special device - a laparoscope. The principle of the procedure is to form a small incision in the abdominal cavity in the umbilical region and then introduce the necessary surgical instruments into the cavity to take liver tissues for histological examination. After laparoscopy, one small, barely noticeable scar, 2 mm in size, remains.

The taken liver tissues are sent for histology (analysis for malignant tumors), the result of which will determine the presence of foci of benign or malignant tumors in the organ.

Scintigraphy (radionuclide diagnostics)

This research method is carried out by introducing the required amount of a radiopharmaceutical substance into the patient's body. After that, specialists clearly monitor the function of the liver regarding the fixation and retention of the radioactive element.

With cirrhosis of the liver, this ability of the organ is practically reduced to zero. And the radiopharmaceutical substance actively settles in the bones of the small pelvis and spine.

Differential Diagnosis

In case of doubt, the attending physician will also make a differential diagnosis. This will exclude all possible diagnoses that are closely intertwined in terms of symptoms, but at the same time are questionable. As a result of such a diagnosis, the only correct diagnosis will be identified and made.

It should be borne in mind that both chronic hepatitis and fatty hepatosis and cirrhosis lead to liver compaction and disruption of its structure. However, only with cirrhosis will portal hypertension (increased pressure in the portal vein) be clearly expressed.

In addition, there are a number of other pathological conditions of the liver, the symptoms of which are similar to cirrhosis. An experienced specialist will conduct a series of comparative studies that will lead to the only correct diagnosis and the appointment of a productive treatment.

Fibrogastroduodenoscopy

This type of diagnosis makes it possible to carefully examine the organs of the gastrointestinal tract (cardiac zone of the stomach, all veins of the esophagus) and determine the possibility of internal bleeding, which is the result of cirrhosis of the liver.

In addition, this diagnostic method allows you to immediately assess the condition of other organs of the gastrointestinal tract.

How to diagnose cirrhosis yourself

When certain symptoms appear, it is quite possible to suspect the onset of pathological changes with the liver (including cirrhosis).

So, if you have the following symptoms with persistence, then do not delay the visit to the doctor:

General weakness and drowsiness;
Fast fatiguability;
Intolerance to fatty foods and alcohol;
nausea, vomiting, diarrhea;
Pain in the epigastric region;
Redness of the palms and the appearance of spider veins;
Reduced blood clotting;
Frequent itching of the skin;
Hair loss in the armpits and on the pubis;
Irritability and nervousness;
Decreased libido;
Insomnia;
Uncontrollable tantrums.

However, do not try to make a diagnosis on your own and, even more so, start any kind of treatment. For professional help (diagnosis and treatment), contact your doctor. Timely prescribed tests to detect pathology and the right treatment can save a life.

Stay happy and healthy!

The early stages of cirrhosis are reversible if the underlying cause of the disease is eliminated, while the later stages of cirrhosis are usually irreversible and the only treatment is liver transplantation. Left untreated, cirrhosis will lead to liver failure and/or cancer. Knowing the symptoms of liver cirrhosis, you can recognize the disease at its early, reversible stage.

Steps

Part 1

Risk factors

Think about how much alcohol you drink. Alcohol causes liver damage by blocking the metabolism of carbohydrates, fats and proteins. When these substances accumulate in damaged areas of the liver, the body can respond to such damage with inflammation, leading to hepatitis, fibrosis, and cirrhosis of the liver. However, excessive alcohol consumption is not enough to develop alcoholic liver disease. Only one in five alcoholics develops alcoholic hepatitis, and one in four develops cirrhosis of the liver.

Get tested for hepatitis B and C. Chronic inflammation and viral damage to the liver can lead to cirrhosis of the liver after several decades.

Risk factors include unprotected sex, blood transfusion, and injecting drug use with contaminated needles. In developing countries, hepatitis B is less common due to vaccination.
Major risk factors for hepatitis C include injecting drug use, blood transfusions, piercings, and tattoos.
Cirrhosis due to hepatitis C is the most common reason for liver transplantation.

Be aware of the relationship between cirrhosis and diabetes . In 15-30% of people with cirrhosis, diabetes is a risk factor for developing non-alcoholic steatohepatitis (NASH). Diabetes is often present in chronic hepatitis C infection, which is a common cause of cirrhosis. This is probably due to insufficient secretion of the pancreas.
- Another cause of cirrhosis often associated with diabetes is hemochromatosis.
- This disease is characterized by the accumulation of iron in the skin, heart, joints and pancreas. The accumulation of iron in the pancreas leads to diabetes.
Consider your current weight. Obesity leads to a range of health problems, from type 2 diabetes and heart disease to arthritis and stroke. But excessive accumulation of fat in the liver causes it to become inflamed and damaged, leading to the development of non-alcoholic steatohepatitis.

Know the risks associated with autoimmune and cardiovascular disease. Be careful with autoimmune diseases such as inflammatory bowel disease, rheumatoid arthritis and. Although they do not directly cause cirrhosis, they increase the risk of complications in other disorders leading to cirrhosis. Heart disease is a risk factor for the development of non-alcoholic steatohepatitis leading to cirrhosis. In addition, heart disease associated with right ventricular heart failure can lead to liver congestion ("nutmeg liver") and cardiac cirrhosis.

Family history. Some types of liver disease that lead to cirrhosis are hereditary. Review your family's medical history for conditions that increase your risk of cirrhosis:

Part 2
Recognizing symptoms and signs
1. Know the symptoms of cirrhosis of the liver. If you have these symptoms, you should seek medical attention as soon as possible. He or she will be able to provide you with a professional diagnosis and prompt treatment. If you want to know if someone other than you has cirrhosis, be sure to include that person in your assessment, as there are symptoms that don't show up outwardly. Symptoms of cirrhosis of the liver include:
  - Fatigue or feeling tired
  - Easy bruising and bruising
  - Edema of the lower extremities
  - Yellowness of the skin and eyes (jaundice)
  - Fever
  - Loss of appetite or weight
  - Nausea
  - Diarrhea
  - severe itching
  - Abdominal enlargement
  - Confusion
  - Sleep disturbance
2. Watch for the appearance of cobwebs from the veins. A more accurate term for this condition is "angioma", spider web or spider veins. A cobweb of vessels is an abnormal accumulation of veins, consisting of a central arteriole with a lesion. Usually angiomas occur on the trunk, face and upper limbs.
  
  Examine your palm for redness. Erythema of the palm is similar to red spotting on the surface of the palm, and it is caused by a change in the metabolism of sex hormones. Palmar erythema mainly affects the outer side of the palm along the thumb and little finger, while not affecting the central part of the palm.
  
  Pay attention to the change in nails. Liver disease in general often affects the skin, but nails can also provide useful information. Muerke's nails are pale horizontal lines or streaks that extend along the nail bed. This is due to insufficient production of albumin (hypoalbuminemia), which is produced exclusively in the liver. If you press on your nails, the lines will fade and disappear, after which they will reappear.
  - With Terry's nails, two-thirds of the nail plate at the base of the nail is white. The rest, which is closer to the tip of the nail, will have a reddish color. It is also associated with hypoalbuminemia.
  - In clubbing, the nail bed and fingertip become rounded and/or enlarged. In a severe form of this pathology, the nails become similar to drumsticks, hence the name. This symptom is more often observed in biliary cirrhosis.
3. Examine the joints of the long bones for swelling. If you notice the presence of recurring swelling of the knee or ankles, this may be a sign of hypertrophic osteoarthropathy. Arthritis is also possible in the joints of the fingers and shoulders. This is the result of chronic inflammation in the connective tissues that surround the bone and is very painful.
  - Note that the most common cause of hypertrophic osteoarthropathy is lung cancer, which should be ruled out if cirrhosis is detected.
4. Twisted fingers. With "Dupuytren's contracture" there is a thickening and shortening of the palmar fascia - the tissue that connects the various parts of the palm. This leads to a restriction in the mobility of the fingers, due to which they twist. This condition mainly occurs in the ring finger and little finger and is often accompanied by pain and itching. With this disease, it will be difficult for a person to hold any object, as it affects the grip strength.
  
  Examine the man's chest for a hard mass. Gynecomastia is an overgrowth of the glandular tissue of the mammary glands in men, emanating from the nipples. This is due to an increase in estradiol levels and is present in 60% of cases. Gynecomastia can be similar to pseudogynecomastia, in which breast enlargement is due to fatty deposits rather than glandular proliferation.
  
  Watch for symptoms of hyponogadism in men. In men with chronic liver disease, such as cirrhosis, there is a decrease in testosterone production. Symptoms of hyponogadism include impotence, infertility, loss of sexual desire, and testicular atrophy. This may be caused by damage to the testicles or suppression of the function of the hypothalamus or pituitary gland.
  
  Pay attention to abdominal pain and bloating. These may be signs of ascites, accumulation of fluid in the peritoneal (abdominal) cavity. With a significant accumulation of fluid, you may also experience shortness of breath.
  
  Examine the abdomen for prominent veins. Medusa head is a condition in which the umbilical veins dilate, allowing blood to flow back into the venous system. This blood is then shunted into the umbilical veins and then into the superficial veins of the abdominal cavity. Because of this, the veins are clearly visible on the surface of the abdomen. These bulges are called the head of the Medusa because they resemble the head of the Gorgon Medusa from Greek mythology.
  
  Check your breath for musty smells. This points to "fetor hepaticus" (hepatic respiration), which is caused by the same severe case of hypertension that causes the jellyfish head and murmurs of Cruveilhe-Baumgarten syndrome. The smell comes from an increase in the amount of dimethyl sulfide in severe portal hypertension.
  - The noise will become quieter if the doctor realigns the blood vessels by applying pressure to the area of skin above the navel.
5. Notice the yellow eyes and skin. Jaundice is a condition that results in an icteric discoloration due to elevated levels of bilirubin when the liver is unable to process it effectively. The mucous membranes may also turn yellow and the urine darken.
  - Be aware that yellow skin can also be the result of excessive consumption of carotene (carrots). However, from eating carrots, the sclera of the eyes will not turn yellow, as with jaundice.
6. Examine your hands for asterixis. Ask the person with suspected cirrhosis to fully extend their arms in front of them, palms down. The patient's hands at the wrists will begin to move and flap like the wings of birds.
  - Asterixis is also seen in uremia and severe heart failure.
Part 3
Professional medical examination
1. Ask your doctor to check for changes in the size of your liver and spleen. On palpation, the liver with cirrhosis will be bumpy and compacted. Splenomegaly (enlargement of the spleen) is caused by portal hypertension, which leads to the accumulation of blood in the spleen. Both of these conditions are signs of cirrhosis of the liver.
  
  Have your doctor check you for blood flow noise. Most therapists do not perform this test. This is a murmur in the veins that can be heard through a stethoscope in the epigastric (upper central) region of the abdomen. Like the "head of a jellyfish", it is the result of a problem in connecting different venous networks to each other in portal hypertension.
  - The doctor will perform a Valsalva maneuver - a test in which intra-abdominal pressure increases. This will allow him or her to hear the noise more clearly, if any.
2. Let the doctor take a blood test. Your doctor will take your blood and do lab tests to check for cirrhosis. Such tests may include:
  
  Have the doctor perform imaging studies. Imaging tests will help recognize cirrhosis, but they are more useful for detecting complications of cirrhosis, such as ascites.
  
  Do a liver biopsy for a definitive diagnosis. Checking for symptoms and having a blood test are good ways to confirm the presence of cirrhosis. However, to know for sure, it is necessary to allow the doctor to perform a liver biopsy. After examining a sample of the liver under a microscope, the doctor will be able to tell for sure if the patient has cirrhosis of the liver.
Part 4
Treatment of cirrhosis of the liver
- Do not take any medications unless your doctor tells you to. Support your immunity by taking vitamins, juices and fruits.
- Early stages of liver cirrhosis can potentially be reversible by treating the underlying cause of the disease, such as controlling diabetes, abstinence from alcohol, treating hepatitis, and weight loss.
Warnings
- Late stages of cirrhosis are usually irreversible, and the disease and subsequent complications are ultimately fatal. A liver transplant is the only option to stay alive and save your life.
Sources
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4. Grant BF, Dufour MC, Harford TC: Epidemiology of alcoholic liver disease. Semin Liver Dis 1988;8(1):12-25.
5. http://www.cdc.gov/alcohol/faqs.htm#excessivealcohol
6. http://www.hopkinsmedicine.org/gastroenterology_hepatology/_pdfs/liver/alcoholic_liver_disease.pdf
7. Petrides AS, Vogt C, Schulze-Berge D, et al. Prognostic significance of diabetes in patients with cirrhosis. Hepatology 1994; 20:119.
8. http://www.webmd.com/diet/obesity/obesity-overview
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Cirrhosis of the liver is an almost irreversible pathological process. How to diagnose cirrhosis of the liver knows a gastroenterologist. For this, first of all, a thorough questioning and physical examination of the patient is carried out, after which a number of laboratory tests of blood and urine are prescribed. But instrumental techniques have the greatest diagnostic value. Liver cirrhosis is best displayed on ultrasound.

Preliminary diagnosis of cirrhosis at home

In order for a person to seek help from a specialist, he must have grounds, that is, complaints about the manifestation of certain unpleasant signs. At home, you can assume the presence of such a disease yourself, based on the manifestation of symptoms such as:

jaundice - acquires a yellow tint not only in the skin, but also in the mucous membranes of the mouth and eyes. This process is due to the fact that the liver begins to function improperly and produce a large amount of bilirubin;
change in the shade of urine and feces, which develops against the background of the previous symptom. Urine becomes dark brown, and feces discolor to gray;
an increase in the size of the anterior wall of the abdominal cavity - suggests that such a disorder has become a predisposing factor to the accumulation of fluid in the peritoneum. This process is caused by stagnation of bile in the liver ducts. In addition, there may be discomfort and soreness in the abdomen when performing heavy physical exertion, as well as swelling of the lower extremities;
loss of appetite resulting in weight loss. At the same time, a person eats normally, but a weakened liver is not able to process and absorb nutrients from food;
severe weakness - a large number of patients note a decrease in strength to such an extent that a person cannot perform even elementary actions;
a depressive state, which is accompanied by sleep disturbances and indifference to everything that happens;
lack of sexual attraction to the opposite sex - often indicates the presence of cirrhosis of the liver, because the inflammatory process can affect nearby organs of the peritoneum and small pelvis;
a feeling of heaviness in the stomach and rapid satiety from food - due to the fact that the enlarged liver compresses the stomach;
the acquisition by male representatives of some signs of the feminine, in particular an increase in the size of the mammary glands;
constipation followed by diarrhea. This reduces the time it takes to digest food. After eating, no more than an hour passes before the defecation process;
loss of skin moisture and elasticity. In addition to the yellowish tint, the skin can be covered with dark brown spots;
redness of the tongue and palms.

But the main symptom of liver cirrhosis, with which people go to a medical facility, is pain. In order to identify problems with the liver, it is necessary to slightly press on the area of its projection, i.e., in the area under the right ribs. With such a disease, a person will feel severe pain of a pulling nature, which persists for quite a long time. With a strong increase in the affected organ, you can independently feel the contours of the liver through a thin layer of skin.

Medical diagnostics

After the patient is admitted to the hospital, he is immediately sent for examination to a gastroenterologist. The first thing a specialist should do is to get acquainted with the medical history and anamnesis of a person’s life. This will make it possible to determine some of the causes of such a disorder, for example, long-term alcoholism or the presence of hepatitis.

Then the doctor must necessarily interview the patient. This will help to identify the presence, initial time of onset and intensity of expression of the clinical picture. After listening to complaints, the specialist conducts a thorough physical examination to detect external signs of the disease.

Such an examination must necessarily include palpation of the entire region of the anterior wall of the abdominal cavity. Such a measure will allow not only to detect the accumulation of fluid and an increase in the size of the liver, but also to differentiate cirrhosis of the liver with other ailments that may have similar symptoms. For example, acute inflammatory processes in the peritoneum, gallbladder or pancreas. These conditions require immediate surgery.

There are several ways to pre-certify cirrhosis. They can serve as certain zones on the abdomen, which, in response to palpation, give increased susceptibility, pain points in the right hypochondrium, as well as various methods of pressing and studying the patient's reaction. With such an ailment in the projection of the liver, the doctor will feel the edge of this organ - it is dense, sharp and causes pain to a person. With a significant increase, when the liver goes beyond the hypochondrium, the doctor will feel for hard bumpy formations.

Be sure to palpate the spleen in the area under the left ribs. For such a disease, a slight increase in its volume is characteristic. Palpation and tapping of the lower parts of the peritoneum is carried out to detect accumulated fluid in this area.

Puffiness of the lower extremities is determined by the remaining traces of the fingers after pressure.

Laboratory diagnostic methods

To find out the extent of liver damage and determine the future treatment tactics, the patient is shown laboratory diagnostic methods to determine the presence of characteristic changes in the blood, urine and feces.

General and biochemical blood tests are necessary to detect changes in its composition. With cirrhosis of the liver, an increase in the number of leukocytes is found, as well as a decrease in erythrocytes and hemoglobin. They check the ability of blood to coagulate and the presence of indicators that indicate liver damage.

The study of urine and feces, first of all, is aimed at identifying changes in their shade - the main indicator of a violation of the normal functioning of the affected organ. In addition, urinalysis is necessary to determine the presence of a concomitant disorder, since cirrhosis of the liver reduces immunity and a person is prone to frequent viral or colds.

After completion of laboratory diagnostics, patients need to undergo a hardware examination.

Instrumental methods for diagnosing cirrhosis

Instrumental diagnosis of liver cirrhosis includes the following:

EGDS is a procedure for examining the surface of the abdominal organs, as well as to consider an expanded venous network and the location of possible hidden bleeding that may accompany cirrhosis;
Ultrasound - will show a change in the volume of the affected organ, the presence of stagnation of blood and bile;
Laparoscopy is an endoscopic procedure for examining the liver, during which a biopsy is performed.

In addition, the radionuclide method is often used, in which isotopes deposited in the liver cells are injected into the blood. With cirrhosis, dark spots will be visible on the ultrasound screen.

However, the most informative and common diagnostic method is ultrasound in liver cirrhosis. During such an examination, the dimensions of the affected organ are studied, the correspondence of the parameters between the lobes of the liver is traced, the features of the blood supply are determined, as well as the structure of the bile ducts and gallbladder.

During such a procedure, it is very important to detect specific manifestations of the disease. Ultrasound signs of liver cirrhosis are:

an increase in the size of the affected organ and a pronounced unevenness of the contours;
surface change - it is uneven and bumpy, due to the formation of fibrous nodes;
the presence of a large number of areas with increased echogenicity, i.e. sensitivity to ultraviolet rays;
wrinkling of the right lobe of the liver - noted in the later stages of the course of the disease;
change in the vascular pattern, there is a reverse flow of blood in the vessels;
decrease in the parameters of the gallbladder;
detection of a large amount of fluid in the peritoneum;
splenomegaly.

It is by ultrasound examination that the diagnosis of "liver cirrhosis" is clarified and the most effective tactic for treating this disease is prescribed.

How does the hepatitis C virus work?

I was probably one of those "lucky ones" who had to go through almost all the symptoms of a diseased liver. According to me, it was possible to draw up a description of diseases in all details and with all the nuances!

The virus is quite common. For a short time it can exist in the external environment. It stays in the syringe needle for 4 days, during boiling it dies within 2 minutes, with UV irradiation - in 10 minutes. It can live on different surfaces for up to several days.

The hepatitis C virus was discovered in 1989. It is able to easily mutate, so the body does not have time to produce new antibodies to fight the rearranged virus. And the pharmaceutical industry is forced to create new forms of drugs.

With the blood stream, the virus passes into the liver cells. Here he begins his activity, multiplying on a huge scale. Liver cells are destroyed and cease to perform a barrier function, freeing the blood from poisons and toxins.

In the course of the development of the disease, not only the liver is affected, there are also concomitant diseases of internal organs, metabolic disorders, and changes in the immune system. Since the symptoms of hepatitis C do not manifest themselves in any way, the patient is not treated, the disease gradually becomes chronic. If no measures are taken, then the result of the disease is cirrhosis or liver cancer.

How to define a disease?

For the treatment and cleansing of the LIVER, our readers successfully use the method of Elena Malysheva. Having carefully studied this method, we decided to offer it to your attention.

The incubation period (from the moment of penetration into the body to infection of liver cells) lasts about 50 days. Hepatitis C symptoms may not appear at all. The existence of the disease becomes known when the disease ends with the complete destruction of the liver.

The disease is insidious precisely because it is difficult to identify it. It is usually discovered by chance, during an annual examination. Signs of hepatitis C are not clearly expressed.
The disease is quite difficult to diagnose, because. it may show signs of other diseases:

easy and fast fatigue, weakness,
no appetite,
sometimes there is an increase in the volume of the liver and spleen,
nausea associated with intoxication,
pain and aches in the joints,
possible development of jaundice.

Antibodies appear in the body of 70% of the sick almost immediately after the appearance of the virus, in 90% - after 3 months. Viral particles are found in the blood 1-2 weeks after infection.

According to WHO, in Russia the number of people infected with this virus is 5 million. people, in the world - 500 million. Their number is steadily growing despite the fact that they began to register this disease recently.

How is the virus transmitted?

Do not destroy the body with pills! The liver is treated without expensive drugs at the intersection of scientific and traditional medicine

There are only two ways of transmission: sexual and hematogenous (through the blood). Infection through the blood is the most common cause of infection:

The introduction of the virus during piercings and tattoos is most common, especially if these procedures are carried out at home. Sterilization of instruments is not always carried out, and sanitary conditions are usually substandard.
During trips to manicure rooms and during treatment at dentists.4. With intravenous drug use using shared syringes. Drug addicts are at risk.
Infection at birth is possible, but the risk is low.
Sexual contact is also dangerous, but the probability of getting infected is small and amounts to 5% with an unprotected act. It is advisable to use condoms to protect yourself.
Use of personal hygiene products for the patient: scissors, razors, toothbrushes.
Infection in medical institutions through injections during various medical procedures or operations.

The source of infection is difficult to determine and not always possible. As a rule, the patient cannot say exactly by what method he acquired the disease.

Pregnant women with the hepatitis virus normally carry a child. Pregnancy proceeds without consequences for the baby. Most often, a healthy baby is born, but the transmission of the virus cannot be completely excluded (probability - 6%).

Diagnosis of hepatitis C

Elena Nikolaeva, candidate of medical sciences, hepatologist, associate professor: “There are herbs that act quickly and act specifically on the liver, nullifying diseases. […] Personally, I know the only preparation that contains all the necessary extracts….”

Signs of hepatitis C will not make it possible to recognize the disease, so it is important to make a correct diagnosis and plan for subsequent treatment. There is a PCR diagnostic that can confirm the infectious nature of the disease and the presence of the virus in the blood.

For a correct diagnosis:

It is necessary to check the blood by a number of tests: biochemical, general blood test, blood clotting test.
View abdominal organs with ultrasound.
You may need a liver biopsy.

Having received the necessary data, the doctor will have a complete picture of the development of the disease, determine the degree of its development, consider how damaged the diseased organ is and select the optimal treatment, which is usually quite long.

The infection is not transmitted by household or airborne droplets, it is impossible to get infected through saliva, when using common dishes or clothing, during touching and kissing.

Hepatitis C treatment

Treatment of hepatitis C in acute and chronic forms has fundamental differences. In the acute form, the task of treatment is as follows:

relieve the main symptoms of the disease,
stop further damage to the liver,
support the basic functions of the body.

Conduct intravenous administration of physiological solutions that help remove toxins, use vitamins, choleretic drugs. They prescribe medications that restore the immune system. Intensive therapy is not prescribed, as it is dangerous for a damaged liver.

In chronic hepatitis, antiviral drugs are prescribed (for example, Remantadine, Ribavirin). It is important to use immunomodulators (regulate the functioning of the immune system): interferons or interferon stimulators, immunity correctors. According to the treatment regimen, they are changed. Treatment of hepatitis C is long and requires serious efforts.

There are specialized clinics in Moscow and other cities where they study and treat hepatitis C. Hepatologists are looking for ways to more effectively influence the virus, trying to improve the quality of life of their patients.

Diet food

Diet is important in the treatment of any form of hepatitis. For meals, table N5 is usually prescribed, which contains:

lightly toasted bread
soups of different composition: with vegetables, cereals, milk,
lean meats and fish,
dairy and dairy products,
drinks: tea, juice, compote, still mineral water,
fruit and dessert.

It is necessary to refuse smoked, fried, pickled, pickled, carbonated, canned; from foods that have a sour or spicy taste. Since the liver is under serious stress, it can no longer process “heavy” foods.

Vaccination is not carried out, because. no vaccine currently exists. It is necessary to develop a stable viral protein, on which the corresponding antibodies would be formed. Such studies are underway, but since the virus is able to mutate, the problem remains unresolved.

How not to get infected with a dangerous disease?

Prevention will avoid the disease if you take good care of your health. The disease will pass by if:

You do not use drugs, do not take other people's needles or any other devices.
Do not use another person's personal belongings, especially those that may have blood on them (razors, scissors).
If you are a healthcare worker, use sharps with care and vaccinate against other types of hepatitis.
During hospital treatment, make sure that disposable instruments are opened in your presence.
Think carefully before getting a tattoo or piercing, and use specialized salons where the chances of getting infected are not so great.

The virus is dangerous, it is not vaccinated, and its presence in the body leads to serious consequences. Therefore, the forecasts for the outcome of the disease are rather pessimistic.

With a late diagnosis of hepatitis C, life expectancy will be reduced to 10-30 years. In addition, the quality of life will be somewhat different, you will have to limit yourself in many ways.

Therefore, once a year, check the blood for the presence of the virus. This is a simple and inexpensive study, it is carried out without special indications. When the disease is detected in the early stages, then the methods of treatment of modern medicine give a chance for recovery. Do not forget about prevention, and take care of your health.

Liver examination - diagnostic methods and tests

Nowadays, liver diseases are much more common than, for example, 100 years ago. Many factors lead to the pathology of this organ - refined, high-fat foods, a sedentary lifestyle, taking many pharmaceuticals, sexual freedom, invasive cosmetic procedures and surgical manipulations.

Despite the availability of information, quite often there are neglected forms of diseases that are much more difficult to treat and lead to irreversible changes in the body.

What is the modern diagnosis of liver diseases based on? What steps should be taken to make an accurate diagnosis?

Symptoms of liver diseases

Any diagnosis begins with the identification of symptoms characteristic of a particular disease. The problem is that different liver lesions give the same clinical picture, sometimes very blurred, so it's enough just to skip the initial stage. What symptoms to look out for:

Discomfort or feeling of heaviness in the right hypochondrium. Since the liver does not have pain receptors, pain of varying intensity can occur only with a significant stretching of the organ capsule.
Yellowing of the skin and mucous membranes due to the accumulation of bilirubin in them.
Change in the frequency of defecation, discoloration of feces.
Itching of the skin.

Liver diseases can cause a variety of disorders from other internal organs. Hence, there are many non-specific symptoms. The nervous system reacts with insomnia or a change in sleep rhythm, decreased performance, emotional lability, memory impairment, etc. An unstable hormonal background can provoke bone pathology (deformities of flat bones, spontaneous fractures).

With the progression of hepatocyte deficiency, symptoms of intoxication may increase: loss of appetite, fever, muscle pain, nausea, vomiting, and others. If any of the symptoms described above appear, you should consult a specialist. Especially carefully you need to monitor your well-being during pregnancy.

Liver examination algorithm

In order to make the correct diagnosis and prescribe treatment, a certain algorithm is needed - a sequence of studies. The following procedure is usually recommended:

general analysis of blood, urine;
blood chemistry;
identification of markers of viral hepatitis;
Ultrasound of the liver and abdominal organs;
fibrotest;
computed tomography, magnetic resonance imaging;
liver biopsy.

General blood analysis

This quick and affordable analysis can show some of the changes that are taking place in the body. However, it is not specific for liver lesions. By changing the number of leukocytes, one can judge the severity of the inflammatory process. A decrease in the level of platelets indicates a violation of the liver cells, which is more typical for viral hepatitis. The ESR indicator is the erythrocyte sedimentation rate, a non-specific indicator of changes in the body. At a rate of 2–15 mm/h, it can increase significantly during pregnancy, with inflammatory diseases (hepatitis), and infectious lesions.

The normal values of the general blood test are individual. They depend on age, gender, pregnancy. These can be consulted in the table of results in each laboratory.

Blood chemistry

Such a study includes more than 40 main indicators of the internal state of the body. In the presence of symptoms of liver damage, it is important to pay attention to the following tests: ALT, AST, alkaline phosphatase, GGTP, bilirubin.

ALT and AST (alanine aminotransferase, aspartate aminotransferase) are intracellular enzymes, the maximum amount of which is found in the liver, cardiac muscles, and skeletal muscles. They enter the bloodstream when the cell membrane is damaged. At a rate of up to 41 U / l, ALT can significantly increase with viral, toxic hepatitis, liver cancer, myocardial infarction. AST shows maximum values in lesions of the cardiovascular system, toxic and chronic hepatitis. Not only the absolute figure of the indicator is important, but also the ratio of 2 enzymes.

The predominance of ALT over AST is a sign of destruction of hepatocytes.

Alkaline phosphatase is found in all human organs, but the highest concentration is in the liver, bile ducts, and kidneys. An increase in this enzyme is a characteristic sign of blockage of the bile duct. During pregnancy, the amount of alkaline phosphatase may exceed the physiological norm.

GGTP (gamma-glutamyltransferase) is an enzyme involved in the metabolism of amino acids, so its highest concentration is in the kidneys and liver. It can be considered the most sensitive marker of cholestasis - bile stasis, due to the rapid increase in the concentration of the enzyme in the blood during blockage of the bile ducts. The intervals of normal GGTP values vary depending on the analysis technique.

It is worth remembering that there are no specific enzymes that accurately indicate liver damage, they can exceed the norm in physiological conditions (pregnancy), alcohol abuse, diseases of other organs, intense physical exertion.

The reasons for the increase in total bilirubin include: liver damage (toxic, viral), cirrhosis, increased breakdown of red blood cells (hemolytic anemia), cholestasis (cholelithiasis). Direct and indirect bilirubin should be separated. The destruction of erythrocytes increases the indirect, hepatic causes affect the direct. The norms of values depend on the method of analysis and the test systems used. Usually they are given in the form of a table on the form for issuing the results of the analysis.

Viral hepatitis markers

Antibodies can be divided into 2 types: IgM and IgG. The former indicate an acute stage of the process, the latter indicate an infection and persist throughout life.

For hepatitis A, it is sufficient to determine IgM. The most accurate indicator for viral hepatitis B is HBeAg. This nuclear antigen shows the presence of active reproduction of the virus in hepatocytes, high blood infection. Hepatitis C is also detected.

It is important to monitor the increase in antibody titer over time. Since viruses can pass from mother to child, it is necessary to be examined for hepatitis before pregnancy.

This study requires preparation. 3 days before the ultrasound, you should exclude foods that cause flatulence from the diet, if necessary, make a cleansing enema.

Ultrasound examination shows the size of the liver and gallbladder. Diffuse or focal lesions can be identified.

The first ones include:

hepatosis;
acute and chronic hepatitis;
cirrhosis.

Hepatosis is associated with the accumulation of fat in the liver cells. Due to the different density of hepatocytes and fat droplets, the picture of the liver becomes "variegated". With the progression of the disease, functionally active tissue is replaced by connective tissue, so signs of fibrosis are clearly visible on ultrasound. The size of the organ increases due to both lobes, the edge is rounded.

Regardless of the type of hepatitis (viral, toxic), the ultrasound picture is nonspecific. The size of the lobes may increase, the shape of the edges may change, the density remains within the normal range. Over time, areas of hypoechogenicity may appear.

Signs of cirrhosis can be direct and indirect. To make a diagnosis, 3 direct symptoms or a combination of 2 direct and 2 indirect symptoms are sufficient. More details about them in the table.

Focal changes in the liver are seen more clearly than diffuse. You can immediately identify areas of increased density (hemangioma, adenoma, cancer metastases, calcifications), reduced echogenicity (sarcoma, lymphoma, abscess, hematoma).

The information content of ultrasound is quite high, however, the absence of specific signs makes it impossible to make a diagnosis using only one examination method.

Fibrotest

In modern laboratories, a new non-invasive method for diagnosing liver damage, the fibrotest, is being actively introduced. It is an alternative to a biopsy. The main task is to determine the stage of fibrosis and necroinflammatory activity. Indications for fibrotest may be chronic hepatitis. Since 2008, this study has been recognized in France as a reliable method for determining hepatitis C in an advanced stage. Fibrotest is safe, so it can be used during pregnancy.

MRI, CT of the liver

Non-invasive studies of the liver include computed tomography and magnetic resonance imaging. These techniques make it possible to obtain a picture of the organ in the form of sections with a step of 5–10 mm. Contrast enhancement is used to identify the most common focal pathology. Methods allow you to determine any deviations from the norm in size and structure. Among the shortcomings, one can single out the high cost of research, the presence of contraindications (pregnancy, the presence of a pacemaker).

Liver biopsy

This method is used in cases where other methods are not sufficiently informative. Since this procedure is quite traumatic and is a surgical intervention, it is resorted to only in extreme cases. There are several methods for performing a biopsy:

Standard - using a needle, a small area of \u200b\u200bthe liver is taken from the patient;
Laparoscopic - together with a needle, a camera is inserted into the abdominal cavity for better visualization of the process;
Transvenous - through a venous catheter through the vessels, the instrument moves to the liver, where material is taken for research.

Biopsy is the last method for the differential diagnosis of liver lesions.

Accurate laboratory diagnosis of liver diseases, modern methods of instrumental examination, timely access to a specialist are factors that contribute to the early detection of pathology.

The less time passes from the onset of the disease to the start of treatment, the greater the chance of a positive result!

What examination to pass to detect cirrhosis of the liver. What tests are given for suspected cirrhosis of the liver. Viral hepatitis markers

Research

Blood analysis

ultrasound

Laparoscopy

FGDS

CT

MRI

Biopsy

Differential Diagnosis

At home

Laboratory diagnostics

Methods for diagnosing liver cirrhosis: radiography

Liver biopsy and histological examination of the material

Scintigraphy (radionuclide diagnostics)

Differential Diagnosis

Fibrogastroduodenoscopy

How to diagnose cirrhosis yourself

Steps

Warnings

Sources

Preliminary diagnosis of cirrhosis at home

Medical diagnostics

Laboratory diagnostic methods

Instrumental methods for diagnosing cirrhosis

How does the hepatitis C virus work?

How to define a disease?

How is the virus transmitted?

Diagnosis of hepatitis C

Hepatitis C treatment

Diet food

How not to get infected with a dangerous disease?

Liver examination - diagnostic methods and tests

Symptoms of liver diseases

Liver examination algorithm

General blood analysis

Blood chemistry

Viral hepatitis markers

Fibrotest

MRI, CT of the liver

Liver biopsy