Additional methods of examination

Clinical blood analyses. Laboratory tests often reveal anaemia, leucopenia, thrombocytopenia (a sign of hypersplenism), and increased erythrocyte sedimentation rate.

Biochemical blood analysis: they show hyperbilirubinaemia, hyperproteinaemia, hypergamma-globulinaemia, positive protein-sedimentation tests, increased activity of transaminase and alkaline phosphotase; decreased activity of cholinesterase; the prothrombin index is sharply decreased; excretion of bromsulphthalein is delayed.

Puncture biopsy of the liver and (for special indications) laparoscopy establish the special histological and macroscopic changes in the liver characteristic of these forms. Chronic cholestatic hepatitis is mainly characterized by the cholestatic increased activity of alkaline phosphatase in the blood, and high cholesterol of blood. Persistent subfebrile temperature and regular increase erythrocyte sedimentation rate are also not infrequent.

CIRRHOSIS OF THE LIVER

Cirrhosis of the liver is a chronic progressive disease characterized by diffuse affection of liver's parenchyma and stroma with quantity reduction of functioning cells, their nodular regeneration and excessive development of connective tissue that leads to cytoarchitectonic reorganization of the liver and development of hepatic insufficiency.

Etiology

Cirrhosis of the liver is a polyetiological disease. It may develop due to postviral hepatitis: hepatitis B, C and D; alcohol; drugs (isoniazid, methotrexate and other); toxic factor; biliary obstruction: primary and secondary biliary cirrhosis; genetically caused disorders of a metabolism: deficiency of alpha-1-antitripsini; Konovalov-Wilson's disease; cardiac failure; cryptogenic.

Clinical features

They are defined by a stage of process and presence of complications - from full absence of symptoms up to common clinical picture of hepatic coma. The sharp painful syndrome is not specific. More often, the patients have complaints on the feeling of weight and dull pains in right hypochondria and epigastria, that amplifying after taking food and physical activity. The patients also suffering from the dyspeptic symptoms that connected with disorders of digestion, general intoxication and accompanying pathologies of a gastro-intestinal tract: the swelling of a stomach, less often - a nausea, vomiting, a heartburn, bitterness in a mouth, infringements of a stool. Also can be present the general complaints - weakness, fatigue, decrease in working capacity, weight reduction, rise in temperature (asteno-vegetative syndrome); yellowness of the skin and visible mucosa, skin itch, hemorrhages, nasal and uteri bleedings (coagulopathy syndrome).

The liver cirrhosis allocates the following clinical syndromes:

- the syndrome of portal hypertension (includes edematous-ascitic syndrome);

- the syndrome of hepato-cellular insufficiency;

- hepatic encephalopathy;

- hepatolienal syndrome.

Objective examination: General patient's condition is from satisfactory to extremely grave. May observed deranged consciousness with hepatic coma develops at final stage of diseases.

In general inspection may detect jaundice, expansion of the veins on the forward abdomen wall, palmary erythema, red lustrous lips, scarlet (lacquered) tongue, spider nevi or telangiectasia, Dupuitrens' contracture, hynecomastia at men, traces of scratches on all body, xanthomatous plaques on the skin (observed in patients with biliary cirrhosis of the liver. Inspection of the abdominal skin can relation or the veins that can be seen through the thinned skin of the abdominal wall (caput medusae). Collateral venous system can be seen on the chest as well. There can be an expressed loss of weight of a body down to cachexia, enlargement of abdomen in sizes, edematous ascitic syndrome even anasarca.

In superficial tentative oriental palpation of the abdomen may be detect moderate pain in right and left hypochondrias, muscular resistance and positive fluctuation symptoms.

In percussion of the liver according M. G. Kurlov and palpation of the liver and spleen may be detecting enlargement of the liver and spleen sizes with increase of their density and rough surface. However, in patients with significant amount of the fluid in abdominal cavity the enlarged lower liver border and spleen are not accessible for palpation.

Complications: encephalopathy, hepatic insufficiency, portal hypertension, hepatorenal syndrome, bacterial peritonitis, bleeding from varicous expanded veins.