1. Early symptoms of cirrhosis include only weakness and a feeling of tiredness.

2. Cirrhosis results in a kind of scar tissue that interferes with the flow of blood through the liver.

3. 

   There are no complications after cirrhosis.

5. Specialized care over a long period includes a high-protein diet with extra vitamins.

6. Cirrhosis is a type of constant and progressive liver damage.

   2. Choose the sentences in the text to answer the following questions.

      1. What can lead to the formation of fibrous scars and nodules.

      2. What is cirrhosis?

      3. What are the causes of cirrhosis?

      4. What raises the blood pressure in the veins within the abdomen, especially at the lower end of the esophagus?

         6. What drugs may be prescribed in case of cirrhosis?

            3. Choose the correct definitions to the following terms:

1. coma 1. this gland is situated in the top right portion

of the abdominal cavity;

2. inflammation of the liver due to a virus infection ulcer or such disease as amebic dysentery and lupus;

3. a state of unconsciousness;

4. the accumulation of fluid in the peritoneal cavity, causing abdominal swelling;

5. A breach in the lining (mucosa) of the diges­tive tract produced by digestion of the mucosa by pepsin and acid.

IV. Say it in one word.

1. An inborn defect of copper metabolism in which there is a defi­ciency of caeruloplasmin (which normally forms a nontoxic com­plex with copper). The free copper may be deposited in the liver, causing jaundice and cirrhosis, or in the brain, causing mental retardation and symptoms resembling parkinsonism.

2. Frequent bowel evacuation or the passage of abnormally soft or liquid faeces. It may be caused by intestinal infections other forms of intestinal inflammation.

3. 2. peptic ulcer

   3. hepatitis

   4. liver

   5. ascites

   The inflammation of the bile ducts. It usually occurs when the ducts are obstructed, especially by stones, or after operations on the bile ducts. Symptoms include intermittent fever, and І лісі' mittent jaundice. Initial treatment is by antibiotics but removal ill' the obstruction is essential for permanent cure.

5. A condition in which bowel evacuations occur infrequently or in which the faeces are hard and small, or where passage of faeces causes difficulty or pain.

6. Invasion of the body by harmful organisms (pathogens)> such as bacteria, fungi, protozoa, rickettsia, or viruses.

Key: diarrhea: infection; cholangitis; Wilson's diseasse; constipation.

V. Make a diagnosis of your own. Choose the right variant below.

This is a disorder in which there are excessive amounts of iron absorbed by the body. It is more common in men than in women. The skin gradually darkens; diabetes mellitus usually develops because of pancre­atic damage; and there may be cirrhosis of the liver. This disease may be fatal if untreated.

Treatment is directed towards removing the deposited iron. This may be achieved by the weekly removal of a pint of blood, because hemoglobin contains large amount of iron. When the patient's iron level returns to normal, removal of blood may be continued to prevent reaccumulation of iron but at less frequent intervals.

Answers: jaundice; hepatitis; infectious hepatitis; haemochromatosis; cir­rhosis.

TEXTS FOR INDIVIDUAL READING

ACUTE HEPATITIS

Acute viral hepatitis is a systemic infection affecting predominantly the liver. Two types of viruses (types A and B) have been implicated as the etiologic agents in this systemic infection; others (among them type C) have been postulated. These viruses (A and B) can now be distin­guished by their antigenic properties but are known to produce clinically similar diseases in man.

The typical morphologic lesions of both hepatitis A and В are often similar and consist of panlobular infiltration with mononuclear cells, hepatic cell necrosis, hyperplasia of Kupffer cells, and variable degrees of cholestasis. Hepatic cell regeneration is present as evidenced by numer­ous mitotic figures, multinucleated cells, and "rosette" or "pseudoglan- dular" formation. The mononuclear infiltration consists primarily of small lymphocytes, although plasma cells and eosinophils are occasional­ly seen. Liver cell damage consists of hepatic cell degeneration and necro­sis, cell dropout, ballooning of cells, and acidophilic degeneration of hepa- tocytes (so-called Councilman-like bodies).

A more severe histologic lesion, subacute hepatic necrosis, is occa­sionally observed in some patients and тгтауЧшрІу^а—• _jEors©~pix>gnosis.

With this lesioit-one finds "bridging" between lobules because the necrosis leads to large areas of hepatic cell dropout, with collapse of the reticulin framework. Charactwi'ij Ікаїїу, the "bridge" consists of con­densed reticulum, inflammatory debris, and degenerating liver cells that span adjacent portal areas, portal to central veins, or central vein to cen­tral vein.

This lesion has prognostic significance since a substantial number of affected individuals may either have a subacute course terminating in death within several weeks to months or develop chronic active hepatitis and postnecrotic cirrhosis.

Traditionally, viral hepatitis had been classified into two epidemio- logically distinct types: infectious hepatitis (hepatitis A) and serum hepatitis (hepatitis B). These distinctions were based on earlier observa­tions that hepatitis A had a shorter incubation period, high contagious rate, and usually a fecal-oral route of transmission, while hepatitis В had a longer incubation period, was less contagious, and was thought to be transmitted only by the parenteral route.

Epidemiologic studies have demonstrated a progressive increase in the incidence of hepatitis В in the population and in hospitalized patients with acute hepatitis. The reasons for this change are not entirely clear; it may reflect in part increased drug abuse as well as more sensitive tech­niques for the measurement of HBsAg. Statistics are complicated by the fact that hepatitis В is usually clinically more severe, and patients with this illness are more likely to seek medical attention than those with hepatitis A. In many patients with acute hepatitis B, there is no history of known parenteral exposure, raising the possibility of obscure routes of transmission for hepatitis В infection. Indeed, inadvertent parenteral, transcutaneous, oral, and as yet other unidentified routes of transmission may be responsible for many cases. HBsAg has been identified in seminal fluid, saliva, breast milk, tears, synovial fluid, intestinal fluid, gastric juice, and rarely in urine and feces, but the infective nature of these body fluids is not yet clearly established.