06 November 2008

Liver in a hundred-gram way: 10 myths about cirrhosis

We don't want to scare you, but we're not going to joke either. We will really be offended if at least one of the readers of Men's Health accidentally passes away due to the fact that his liver has turned into a rotten sponge. So read all the material carefully and try not to upset us.

1. The real danger of cirrhosis of the liver is greatly exaggerated by doctors and the media. The usual horror story for weaning from the excesses of the bad.

Unfortunately, there is no exaggeration in the expression "drank the liver". The facts of her death from alcohol abuse were recorded by doctors of ancient India. And the term "cirrhosis of the liver" ("red liver") appeared in medicine at the beginning of the century before last, and at the same time the clinical picture of the disease was described. Little has changed since then. Chronic alcohol intoxication is the cause of half of all cases of cirrhosis. On average, every third alcoholic falls ill, usually 10-15 years after the onset of abuse. There are twice as many men among the patients as women (guess why). The essence of cirrhosis is the destruction of liver tissue due to necrosis and fibrosis of hepatocytes (that is, the death of liver cells and their replacement with collagen fibers). As a result, the liver ceases to be a blood purification factory and becomes a useless accumulation of connective tissue.

2. Cirrhosis threatens those who drink all kinds of filth, because it is not alcohol itself that is harmful, but poisonous fusel oils. Drink high–quality vodka - and your liver will only thank you.

Leave this statement on the conscience of alcohol producers. The liver destroys ethanol by itself, even the purest and highest quality. It has an unpleasant ability to activate fibrogenesis in liver tissues. In other words, it is under its influence that cells begin to produce collagen and the replacement of capable liver tissue with a completely useless connective tissue takes place.
The dangerous dose of alcohol has long been well known – 40-80 g of ethanol (200-400 g of vodka) per day – depending on the individual characteristics of the body. It is also known that the probability of cirrhosis after 15 years of drinking is 8 times higher than after 5 years.
Although there is some truth in the judgments of lovers of high–quality vodka: if any poisonous muck is added to ethanol, the risk increases.

3. Who does not drink – will not die from cirrhosis.

Alas.... A teetotaler is definitely not threatened by only one of the main factors in the development of cirrhosis, and there are about a dozen of them in total. The causes of the disease may be viral hepatitis, diseases of the biliary tract, the effect of toxins, drug overdose, some parasitic and infectious diseases (for example, echinococcosis, brucellosis, toxoplasmosis). Draw your own conclusions.

4. Cirrhosis is fate, and it is useless to fight it. You can't live long without a liver.But you can't give up ahead of time either.

The duration and quality of life depends on the origin of cirrhosis, the degree of destructive changes in the liver, the treatment and, of course, the stage of the disease – the earlier the diagnosis is made, the more favorable the prognosis. With alcoholic cirrhosis, lifelong abstinence from alcohol in the early stages and modern treatment lead to recovery, with viral cirrhosis, they suspend the development of the process and contribute to long–term remission.
Therefore, do not wait for clinical symptoms – bloating of the liver, jaundice and blood from the nose. These are signs not of the beginning, but of an expanded stage. Donate blood for biochemical analysis and undergo liver ultrasound for any diseases of the gastrointestinal tract or fever of unknown origin. Especially if there are risk factors in your life – transferred viral hepatitis or contact with such patients, blood transfusions, surgical interventions and, of course, addiction to alcohol.

5. For modern medicine, coping with cirrhosis is not a problem.Unfortunately, changes in liver tissue with advanced cirrhosis are irreversible – this unpleasant fact has to be reckoned with.

According to one of the classifications accepted in medicine, cirrhosis can end with: improvement, inpatient condition, deterioration, death. The word "recovery" in this list, alas, is missing. It is possible to get rid of cirrhosis only together with the liver, and only incorrigible optimists can hope for its successful transplantation.
But (see point 4) we repeat once again: at an early stage of alcoholic cirrhosis, timely measures taken can lead to the restoration of liver tissues. If it comes to irreversible destruction of liver tissue, even with the happiest combination of circumstances, the most favorable outcome is to reach the stage of inactive and non–progressive course of the disease.

6. But there is a miracle medicine, it is even shown in advertising - it restores the structure of the liver.Do you mean "Essentiale forte", "Essentiale-N" or "Essliver"?

That's right, these are hepatoprotectors. Their active ingredient – essential phospholipid lecithin – is part of the membranes of liver cells – hepatocytes. It is usually prescribed intravenously and orally to patients with alcoholic liver damage to restore destroyed cell membranes. However, at present, many researchers believe that the effectiveness of lecithin is slightly exaggerated (only half of the phospholipids injected are completely embedded in cell membranes and actually restore the liver). And most importantly, it cannot create a miracle and restore tissues in which irreversible changes have already occurred (see paragraph 5).

7. Any hepatitis will sooner or later lead to cirrhosis of the liver.Not everything is so sad.

First, acute viral hepatitis should turn into chronic with a high degree of activity, which, with proper and timely treatment, does not always happen. And even then, only half of the cases end in cirrhosis. According to medical statistics, cirrhosis develops on average within 5 years in about 1% of patients who have had a symptomatic or non-jaundiced form of hepatitis B or C. Unfortunately, hepatitis D and G viruses are more harmful and significantly increase the risk of cirrhosis, but do not turn it into a fatal inevitability.

8. Cirrhosis of the liver affects those unfortunate geese, which ruthless farmers forcibly fatten and then make foie gras from their liver for soulless gourmets.Not really.

Poor birds really have a hose inserted into their throats and super-calorie food is poured into their stomach through it. But this mockery only leads to an increase and obesity of the liver. By the way, gourmets would probably reject cirrhotic liver – it's too tough. Hence the conclusion (except for the rejection of foie gras for moral reasons): if you eat a lot, tasty and fatty, you still won't be able to die from cirrhosis of the liver. Most likely, the vessels or pancreas will not survive first. On the contrary, malnutrition with a deficiency of proteins and fats can lead to the so-called alimentary cirrhosis, but for this it is necessary to sit on a very meager diet of fruits and cereals for many years.

9. With cirrhosis, the liver atrophies, and the unfortunate quietly, culturally dies.Not really.

The final stage is usually: encephalopathy and hepatic coma, gastrointestinal bleeding or ascites followed by peritonitis. Does it sound unclear? For the curious – details.
Encephalopathy is a complex of neuromuscular disorders caused by severe liver failure. It all starts with a decrease in activity and apathy. Then the patient becomes aggressive and untidy, commits senseless acts. At the next stage, confusion develops, muscle cramps, and movement coordination disorders. The last stage is a hepatic coma, first with periods of clear consciousness and excitement, then without reflexes and sensitivity to pain. From that moment on, the extinction can really be considered quiet and cultured.
Gastrointestinal bleeding occurs as follows. In healthy people, about 1 liter of venous and 0.5 liters of arterial blood flows through the liver per minute. Both streams connect in the liver and intensively contact the villi of hepatocytes – this is the purification of blood by the liver. Fibrosis of the liver tissue (replacement of healthy cells with connective tissue) causes difficulty in normal blood flow, the blood begins to look for workarounds: to form connections where veins and arteries are located close to each other – in the mucous membrane of the esophagus and rectum, on the anterior abdominal wall. As a result, a vascular pattern "jellyfish head" characteristic of cirrhosis patients forms on the abdomen above the navel, and when the anastomoses rupture, life-threatening gastrointestinal bleeding begins (vomiting dark venous blood or tar-like stools).
Ascites is a violation of water–salt metabolism, as a result of which up to 3-6 liters of liquid accumulates in the stomach, and sometimes more (a bucket of water is practically). This fluid can spontaneously become infected with bacteria from the intestine, and then ascites turns into peritonitis, with mortality reaching 80-100%.

10. Let me die early, but I will remain a real man until the end.It's unlikely.

Patients with cirrhosis (especially of alcoholic origin) often have changes in the hormonal sphere, an excess of estrogens or a deficiency of testosterone is formed. As a result, gynecomastia (breast enlargement to female size) or impotence and testicular atrophy.

Men's Health, No. 11-2008 (with abbreviations)

Portal "Eternal youth" www.vechnayamolodost.ru06.11.2008

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