In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single normative document for recording morbidity, reasons for the population's visits to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

ICD 10

ICD is a system of classification of various diseases and pathologies.

Since its adoption by the world community at the beginning of the 20th century, it has gone through 10 revisions, so the current edition is called ICD 10. For the convenience of automating the processing of diseases, they are encrypted with codes, knowing the principle of their formation, it is easy to find any disease. Thus, all diseases of the digestive system begin with the letter “K”. The next two digits identify a specific organ or group of organs. For example, liver diseases begin with combinations of K70–K77. Further, depending on the cause, cirrhosis may have a code starting with K70 (alcoholic liver disease) and K74 (fibrosis and cirrhosis of the liver).

With the introduction of ICD 10 into the system of medical institutions, the registration of sick leave began to be carried out according to new rules, when instead of the name of the disease, the corresponding code is written. This simplifies statistical accounting and allows the use of computer technology to process data sets both in general and for various types of diseases. Such statistics are necessary for analyzing morbidity on a regional and national scale, when developing new drugs, determining their production volumes, etc. To understand what a person is sick with, it is enough to compare the entry on the sick leave certificate with the latest edition of the classifier.

Classification of cirrhosis

Cirrhosis is a chronic liver disease characterized by liver failure due to tissue degeneration. This disease tends to progress and differs from other liver diseases in its irreversibility. The most common causes of cirrhosis are alcohol (35–41%) and hepatitis C (19–25%). According to ICD 10, cirrhosis is divided into:

• K70.3 – alcoholic;
• K74.3 – primary biliary;
• K74.4 – secondary biliary;
• K74.5 – biliary, unspecified;
• K74.6 – different and unspecified.

Alcoholic cirrhosis

Liver cirrhosis caused by alcohol is coded K70.3 in ICD 10. It was specially identified as a group of individual diseases, the main cause of which is ethanol, the damaging effect of which does not depend on the type of drinks and is determined only by its quantity in them. Therefore, a large amount of beer will cause the same harm as a smaller amount of vodka. The disease is characterized by the death of liver tissue, which transforms into scar tissue in the form of small nodes, while its correct structure is disrupted and the lobules are destroyed. The disease leads to the fact that the organ ceases to function normally and the body is poisoned by decay products.

Primary biliary cirrhosis

Primary biliary cirrhosis is an immune-related liver disease. According to ICD 10 it has code K74.3. The causes of the autoimmune disease have not been established. When it occurs, the immune system begins to fight the liver’s own bile duct cells, damaging them. Bile begins to stagnate, which leads to further destruction of organ tissue. Most often, this disease affects women, mainly 40–60 years old. The disease is manifested by skin itching, which at times intensifies, leading to bleeding scratching. This cirrhosis, like most other types of disease, reduces performance and causes depressed mood and lack of appetite.

Our regular reader recommended an effective method! New discovery! Novosibirsk scientists have identified the best remedy for CIRRHOSIS. 5 years of research. Self-treatment at home! After carefully reviewing it, we decided to offer it to your attention.

Secondary biliary cirrhosis

Secondary biliary cirrhosis occurs due to exposure to bile, which, having accumulated in the organ, cannot leave it. According to ICD 10 it has code K74.4. The cause of obstruction of the bile ducts may be stones or the consequences of surgery. This disease requires surgical intervention to eliminate the causes of obstruction. Delay will lead to continued destructive effects of bile enzymes on liver tissue and the development of the disease. Men suffer from this type of disease twice as often, usually in older age, although it also occurs in children. The development of the disease most often takes from 3 months to 5 years, depending on the degree of obstruction.

Biliary cirrhosis, unspecified

The word "biliary" comes from the Latin "bilis", which means bile. Therefore, cirrhosis associated with inflammatory processes in the bile ducts, stagnation of bile in them and its effect on liver tissue is called biliary. If it does not have the distinctive features of primary or secondary, then it is classified according to ICD 10 as biliary unspecified cirrhosis. The cause of these types of disease can be various infections and microorganisms that cause inflammation of the intrahepatic bile ducts. In the 10th edition of the classifier, this disease has code K74.5.

Other and unspecified cirrhosis

Diseases that, in terms of etiology and clinical characteristics, do not coincide with those previously listed are assigned a general code K74.6 according to ICD 10. Adding new numbers to it allows for their further classification. So, in the 10th edition of the classifier, unspecified cirrhosis was assigned the code K74.60, and the other - K74.69. The latter, in turn, can be:

• cryptogenic;
• micronodular;
• macronodular;
• mixed type;
• postnecrotic;
• portal.

Who said that it is impossible to cure liver CIRRHOSIS?

• Many methods have been tried, but nothing helps.
• And now you are ready to take advantage of any opportunity that will give you the long-awaited well-being!

An effective treatment for the liver does exist. Follow the link and find out what doctors recommend!

Read also:

Education: Rostov State Medical University (RostSMU), Department of Gastroenterology and Endoscopy.

Doctor of Medical Sciences

Good afternoon, during the autopsy my father-in-law’s cause of death was listed as another and unspecified cirrhosis of the liver, what does this mean? Could he have infected his family?

Liver cirrhosis: ICD 10 code and groups

The abbreviation ICD is the system by which all diseases and pathologies known to science are classified. Today, the ICD 10 system is in force. The name change is associated with a dozen revisions and additions since its adoption by the world community at the dawn of the 20th century.

Each ICD 10 code carries an encrypted name for a specific disease or pathology. Knowing how the system works, you can easily find any disease. In this article we will look at examples of encryption, and we will dwell in more detail on the cirrhosis of their classification and description.

Why is an encryption system needed?

The introduction of the ICD 10 system made it possible to automate the treatment of diseases. If you understand the principle of assigning letters and numbers, you can find the desired disease in a matter of minutes.

Today we’ll talk about the problems of the digestive organs, which in the above-described system are encrypted under the letter “K”. Next, the code displays the numbers that are responsible for a specific organ or their combination and the pathologies that are associated with them. Diseases that affect liver function are indicated by a combination of letters and numbers in the range K70-K77.

After doctors began to use such a system, the process of maintaining sick leave became much easier, because instead of the name of the disease, a code according to ICD 10 was simply written down. This solution will simplify as much as possible the recording of a large mass of data on a variety of diseases in electronic form, which is simply an ideal method analyzing the volume of cases of individual diseases on a large scale of cities, countries, etc.

Classification of liver cirrhosis according to ICD 10

Cirrhosis is a chronic liver disease in which the cells of the organ degenerate and can no longer fulfill their intended purpose. If this disease is not diagnosed at the initial stage and treated, it progresses rapidly and is irreversible. Most often, the catalysts for the development of cirrhosis are excessive alcohol consumption and the presence of the hepatitis virus in the body.

According to the ICD 10 system, cirrhosis is divided into several separate groups:

• alcoholic cirrhosis (K70.3). Liver problems caused by excessive alcohol consumption are specifically classified as separate diseases. Cirrhosis develops under the destructive influence of ethanol and it does not matter in what drinks it enters the body. Liver cells die and are replaced by scar tissue, forming small nodules. As the disease develops, the structure of the liver changes completely and reaches the point where it simply stops functioning;
• primary biliary cirrhosis (K74.3). It occurs as a consequence of the development of an autoimmune disease, when the immune system begins to fight against its own cells and destroys the bile ducts in the liver. As a result, the process of bile stagnation is activated, which ultimately poisons the liver cells. Basically, this type of cirrhosis is diagnosed in the female half of the population after 50 years;
• secondary biliary cirrhosis (K74.4). It occurs during the aggressive action of bile, which cannot be released due to clogged ducts. The bile ducts can become obstructed after surgery or as a result of the formation of stones that block the ducts. The causes of obstruction are removed only during the operation, otherwise the destructive process will lead to irreparable consequences;
• biliary cirrhosis, unspecified (K74.5). This group includes cirrhosis of viral etiology or infectious in the case when the disease differs in characteristics from the primary or secondary biliary form;
• unspecified cirrhosis (K74.6). If the etiology of the disease and its symptoms do not fit into any of the above groups, then it is classified as unspecified cirrhosis. Additional digits after the period allow further classification of each case.

The etiology of cirrhosis can be of definite, uncertain or mixed origin. Doctors often register several causes that influence the development of cirrhosis, for example, viral hepatitis with alcohol dependence. By the way, let’s say that alcohol abuse is the most common reason why patients are diagnosed with the development of cirrhosis.

It was the ICD system that became the international standard for classifying not only diseases, but also epidemiological purposes. With its help, the World Health Organization can analyze and monitor the health status of each population group with its help. The ICD 10 accounting system makes it possible to record the frequency of certain diseases or pathologies and their relationship with various factors.

Viral cirrhosis of the liver code according to ICD 10

Cirrhosis of the liver

Cirrhosis is a consequence of chronic liver disease and leads to loss of organ function. The liver affected by the disease is dense, reduced or enlarged in size, rough and lumpy.

Ascites (abdominal fluid retention) is the most common complication caused by cirrhosis and is associated with poor quality of life and an increased risk of infection. Other potentially life-threatening complications include confusion, hepatic coma, and bleeding caused by esophageal varices.

Liver cirrhosis is an irreversible process; its treatment is usually aimed at preventing the complications it causes. Later stages of cirrhosis require a liver transplant.

Liver cirrhosis is one of six diseases in the world due to which patients die in old age.

Symptoms of liver cirrhosis

The initial stages of the disease (class A) are not accompanied by symptoms, since complications have not yet arisen. This time is ideal for eliminating the cause of the disease, since the liver is an organ capable of regenerating its cells - this allows you to maintain healthy liver tissue and lead a normal and healthy lifestyle.

The main signs and symptoms of liver cirrhosis are:

• Enlarged abdomen;
• Changes in consciousness and behavior;
• Bleeding gums;
• Nosebleeds.

Also symptoms of liver cirrhosis are:

• Increased fatigue;
• Weight loss;
• Decreased appetite;
• Jaundice;
• Light-colored or discolored stool;
• Darkening of urine;
• The tongue is crimson;
• Dyspepsia;
• Stomach ache;
• Swelling of the legs;
• Vascular telangiectasia;
• Skin itching;
• Bleeding;
• Frequent bacterial infections;
• Erythema of the palms;
• Decreased libido;
• Dull or aching pain in the liver area;
• Gynecomastia in men.

Stages of liver cirrhosis

The development of the disease occurs very slowly, so during its course it is possible to distinguish the following stages of liver cirrhosis:

• Compensation stage – absence of symptoms due to increased liver function;
• Subcompensation stage - the first signs of the disease appear, which are expressed in weight loss, loss of appetite, weakness and a feeling of discomfort in the right hypochondrium, since the liver is no longer able to function at full capacity;
• Stage of decompensation - jaundice, portal hypertension syndrome and hepatic coma appear, which pose a threat to human life.

Diagnosis and treatment of liver cirrhosis

Diagnosis of liver cirrhosis is carried out by a hepatologist or gastroenterologist, who, after a thorough examination of the patient, conduct a biochemical blood test, ultrasound examination of the liver and abdominal organs, and a blood test for markers of viral hepatitis. gastroscopy, computed tomography, radioisotope study, and, if necessary, liver biopsy.

After diagnosis and confirmation of the diagnosis of liver cirrhosis, the treatment phase begins. This disease cannot be completely cured; it can only be slowed down and the development of complications slowed down. Treatment of liver cirrhosis consists of such therapeutic measures as:

• Taking diuretics;
• Purpose of the diet (no fried and fatty foods, salt and alcoholic beverages);
• Taking glucocorticoid hormones (for autoimmune disorders);
• Carrying out antiviral therapy (for viral hepatitis);
• Taking hepatoprotectors.

If, during the treatment of liver cirrhosis, the course of the disease worsens and complications appear, urgent hospitalization is necessary. Also, in the treatment of liver cirrhosis, surgical treatment may be necessary such as:

• Bypass surgery to create new pathways for blood;
• Paracentesis – puncture of the abdominal wall;
• Liver transplantation.

The International Statistical Classification of Diseases and Related Health Problems is a document used as a leading framework in health care. The ICD is a normative document that ensures the unity of methodological approaches and the international comparability of materials.

Currently, the International Classification of Diseases, Tenth Revision (ICD-10, ICD-10) is in force.

In Russia, health authorities and institutions transitioned statistical accounting to ICD-10 in 1999.

ICD 10 - International Classification of Diseases, 10th Revision

Liver cirrhosis of viral etiology

Liver cirrhosis of viral etiology is the outcome of 40-60% of cases of chronic hepatitis of viral etiology with a high degree of activity, accounting for 50-55% of all patients with CAH or, much less frequently, the outcome of chronic hepatitis with a low degree of activity and develops on average within 5 years in 0 ,8-1% of patients who have had a symptomatic or anicteric form of acute viral hepatitis type B or C (chronic hepatitis with a high degree of activity type C accounts for 21% of all patients with chronic hepatitis). The addition of a D-virus infection to chronic hepatitis B of viral etiology or B-virus carriage in 20% of cases causes fulminant viral hepatitis with transition to fast-flowing cirrhosis with an unfavorable outcome.

Currently, the hepatitis G virus has been isolated, which, like the C virus, causes chronicity of the process in the liver, and the outcome of chronic viral hepatitis G can be cirrhosis of the liver. In rare cases, posthepatitis cirrhosis develops directly after acute viral hepatitis, bypassing the stage of chronic hepatitis. Liver cirrhosis is diagnosed in the interval from 3 to 28 years after acute viral hepatitis, often within a year. If the histomorphological signs of active chronic hepatitis persist against the background of cirrhotic restructuring of the liver tissue, a diagnosis of active liver cirrhosis is established. Macronodular cirrhosis develops in 2/3 of patients. The viral etiology of liver cirrhosis is characterized by a long, latent course over a number of years. The pathological process persists without pronounced activity, often exacerbations stop on their own. Splenomegaly and dysproteinemia (hypergammaglobulinemia) are more pronounced, and hyperaminotransferasemia is moderate compared to active chronic hepatitis. Exceptions are cases of fulminant exacerbation of liver cirrhosis in the initial stages, when the disease manifests itself with severe hepatocellular jaundice, often with cholestasis, a pronounced increase in aminotransferase activity and often resistant to glucocorticoids.

Viral cirrhosis of the liver with a pronounced cholestatic component (in the past, the “cholangiolytic” variant of cirrhosis) has an extremely unfavorable course. Hyperaminotransferasemia and hyperglobulinemia, intrahepatic cholestasis are a manifestation of high activity of the pathological process, the latter does not show a tendency to reverse development and does not respond well to drug therapy.

An unfavorable, but relatively rare variant of the course is liver cirrhosis with high mesenchymal-inflammatory activity in the terminal period at the stage of parenchymal and/or vascular decompensation.

In most patients, the onset of the disease is gradual, with nonspecific complaints of general weakness, decreased performance, pain in the right hypochondrium, nausea, flatulence, and loss of body weight. These disorders increase during periods of exacerbation simultaneously with an increase in the activity of blood aminotransferases and the development of moderate jaundice. With exacerbation, an increase in hemorrhagic syndrome in the form of bleeding, arthralgia, and an increase in the number of skin telangiectasia is possible. An unfavorable course of the disease is indicated by resistant jaundice, significant dysproteinemia with hypoalbuminemia and hypergammaglobulinemia, and severe aminotransferasemia. Over time, most patients experience a gradual decrease in biochemical parameters reflecting inflammatory activity with a tendency toward normalization of aminotransferasemia. In this case, signs of hepatocellular insufficiency appear and decompensation of portal hypertension develops. Varicose veins of the esophagus and cardia develop in patients with viral cirrhosis more often and earlier, and ascites later and less often than in patients with alcoholic cirrhosis. The average life expectancy from the moment of diagnosis is about a year, but patients often live much longer.

The viral B etiology of liver cirrhosis is evidenced by a positive blood reaction to HBsAg, HBeAg (in 20% of patients) and anti-HBc IgM, anti-HBe and anti-HBc, and the detection in biopsied liver tissue by immunofluorescence of focal accumulations of hepatocytes containing HBcAg in the nuclei and HBsAg in the cytoplasm, the presence of stepwise and bridge-like necrosis with inflammatory infiltration in the peripheral parts of the pseudolobules and the absence of pronounced fatty degeneration of hepatocytes, characteristic of alcoholic cirrhosis. The absence of serological and tissue markers of virus B does not exclude the viral nature of liver cirrhosis. Liver cirrhosis due to acute viral hepatitis C (seronegative), by analogy with acute viral hepatitis C and active chronic hepatitis C, can be suspected when other etiological factors are excluded, especially in patients with slow evolution and moderate activity of the pathological process, which passes over several years into an inactive stage . Unlike type B cirrhosis, this form does not have a predominance of men; the number of males and females is approximately equal. At the same time, specific HCV RNA and antibodies to it are serologically determined in the blood.

In viral cirrhosis, increased ALT activity, hypergammaglobulinemia and an increase in the thymol test are more pronounced, and GGTP activity is increased much less frequently and less than in alcoholic cirrhosis, sediment tests are positive in 80% of patients, the concentration of IgG in the blood serum is moderately increased, and in alcoholic cirrhosis In cirrhosis, IgA increases predominantly.

Traditional modern principles of treatment of liver cirrhosis of viral etiology include:

interferonization (alpha 2-interferon, preferably intron or laferon in combination with lamivudine (Zeffix) for B and ribavirin (Rebetol) for C-virus infection, and immunomodulation (thymalin, T-activin, thymogen, vilosene, sodium nucleinate according to the scheme: 1 once a day for 3 days in a row, then once a week, 2 times, a total of 5 injections per course);

lactulose (Duphalac) at the rate of 1-1.5 g per 1 kg of the patient’s body weight throughout the day with the transition to maintenance doses reduced by 2-3 times;

in the absence of cholestasis, the drugs of choice may be Essentiale IV and orally for 1-2 months;

vitamins, microelements - antioxidants (tocopherol, alvitil, multitabs, unicap, triovit, namacite);

diuretics: aldosterone antagonists - spironolactones in combination with thiazide derivatives (according to an individual regimen);

drugs that affect the supra-detoxic function of the liver: citrarginine, ornitsetil (the dose is individual and depends on the severity of the disease).

There is an opinion that in liver cirrhosis, viral replication rarely occurs, therefore small doses of α2-interferon (1 million ME days) are prescribed not to suppress replication, but to restore the patient’s immune status

ICD-10: K70-K77 - Liver diseases

Chain in classification:

Diagnosis with code K70-K77 includes 8 clarifying diagnoses (ICD-10 headings):

1. K70 - Alcoholic liver disease

Contains 6 blocks of diagnoses.

Contains 3 blocks of diagnoses.

Included: hepatic. coma NOS. encephalopathy NOS hepatitis. acute not elsewhere classified. fulminant rubrics, with hepatic. malignant failure necrosis of the liver (cells) with liver failure yellow atrophy or liver dystrophy.

Excludes: alcoholic liver failure (K70.4) liver failure, complicating. abortion, ectopic or molar pregnancy (O00-O07, O08.8). pregnancy, childbirth and the postpartum period (O26.6) jaundice of the fetus and newborn (P55-P59) viral hepatitis (B15-B19) in combination with toxic liver damage (K71.1).

Liver cirrhosis ICD 10 is a deadly disease based on the replacement of healthy liver tissue (parenchyma) with abnormal, fibrous tissue. According to statistics, most males over the age of 45 suffer from this pathology. But unfortunately, modern cirrhosis is rapidly getting younger.

Doctors diagnose this pathology even in teenagers. The disease does not affect women either, although this disease is diagnosed in them 2 times less often. This is due to the fact that it is the male part of the population that is susceptible to alcohol abuse, which becomes the main cause of the fatal disease.

Liver cirrhosis has several varieties, and the classification of the pathology depends on this

The human liver is the body's main filter. It passes through itself all compounds and substances that enter the body. Poisonous toxins and breakdown products of ethyl alcohol gradually destroy hepatocides (organ cells). Fortunately, the liver is capable of natural resuscitation and repairs itself.

With prolonged and regular consumption of alcohol, the liver’s ability to self-reanimate disappears. Which leads to sad consequences.

According to medical data, cirrhosis develops after 10-15 years of regular abuse of alcohol-containing drinks. Moreover, in women this disease develops much faster. But not only alcohol is to blame for the formation of a dangerous disease. A number of other factors also lead to cirrhosis:

1. Chronic hepatitis. In about 60-70% of cases, people suffering from cirrhosis suffered hepatitis C before the disease.
2. Long-term exposure to certain medications. In this case, toxic cirrhosis forms.
3. Excess weight. The presence of obesity in a person leads to unstable functioning of all internal organs. Fatty deposits in this case are also characteristic of the liver. The result is the development of a chronic disease called “fatty liver.” This pathology is also known under other names: hepatosis, adiposis, fatty degeneration. This pathology becomes the impetus for the appearance of cirrhosis.
4. Infectious diseases. Especially the viral course. Pathogenic microflora has a detrimental effect on all processes occurring in the body. The liver can suffer from long-term and severe viral infections.

These are just the main reasons for the development of liver cirrhosis. Only a doctor can determine the exact culprit of the problem after tests and examinations.

What is alcoholic cirrhosis of the liver

Liver cirrhosis is an insidious disease. For a long time, a person does not even expect to develop a dangerous condition. In the first stages, the pathology is asymptomatic.

How to recognize the disease

For a long time, a fatal illness does not remind of itself. The person continues to live in a normal rhythm, and attributes slight lethargy to increased stress. The liver begins to clearly hurt only at the stages of the disease, which has been quietly destroying the organ for a long time.

How does cirrhosis develop?

In order to promptly identify the disease and record the onset of the pathology (when a person can still be helped), you should know the symptoms that are observed with cirrhosis. It is as follows:

• yellowing of the skin;
• sudden weight loss;
• constant fatigue, drowsiness;
• skin problems (peeling, redness, itching);
• the appearance of spider veins on the skin (usually in the back and palms).

These signs are observed at the initial stage of the disease. As soon as these symptoms manifest themselves, you must urgently go to a doctor. If you miss time, cirrhosis will enter an irreversible stage. Quite a lot of time has been allocated to correct the situation. A sharp deterioration in health occurs 10-15 years after the first signs appear.

Stages of cirrhosis

The disease has three stages. Each of them has its own differences and features:

1. Initial. Passes without external manifestations. At this stage, even blood biochemistry does not show deviations.
2. Subcompensation. The symptoms are becoming more pronounced. At this stage, the disease can already be diagnosed using ultrasound and various tests.
3. Decompensation. This phase is marked by the development of deep liver failure, occurring simultaneously with portal hypertension (increased portal vein pressure due to impaired blood flow). The patient is in an extremely serious condition requiring immediate hospitalization.

As cirrhosis develops and the disease transitions from one phase to another, the patient's condition noticeably declines. Therapy is also becoming increasingly complex to perform. The life of a patient with liver cirrhosis depends on timely seeking medical help.

How alcohol affects the liver

At some stages of cirrhosis, the only solution is to transplant the destroyed organ. But if there is an alcohol addiction, there is no point in a complex operation - a healthy organ does not take root in an alcohol-dependent body.

Therefore, the main condition for hope of recovery from liver cirrhosis is a complete abstinence from drinking alcohol. The sooner a person receives qualified medical help, the greater the guarantee of recovery..

Classification of pathology

Liver cirrhosis according to the ICD (International Classification of Diseases) has a code of 70-74. The code depends on the type of disease. Cirrhosis itself is a process complicated by irreversibility.

ICD is an international diagnostic standard used in the grading of diseases. The ICD 10th revision is currently in force. Russia joined the existing statistical accounting (ICD 10) in 1999.

Alcoholic cirrhosis of the liver code 10 according to the ICD has additional digital indicators. They depend on the type of pathology. At the moment, in modern medicine there is a gradation of cirrhosis into five levels.

Alcoholic

About 45% of diagnosed cases are of alcoholic type cirrhosis. The culprit of this disease is the abuse of alcohol-containing drinks over a long period of time. Alcoholic cirrhosis has a code of 70.3 and it develops regardless of the type of alcoholic beverages consumed by a person.

Alcoholic cirrhosis of the liver is one of the leading causes of human death

Ethyl alcohol has a detrimental effect on the normal functioning of the organ, allowing it to poison all body systems with toxic toxins. Liver tissue turns into scar tissue (fibrous), hepatocides completely stop their work of cleansing the body of poisons and toxins.

Primary biliary

The main culprits in the development of biliary cirrhosis are global disruptions in the functioning of the immune system. Liver cells are attacked by their own immune cells. This leads to prolonged stagnation of bile and complete destruction of the organ.

Primary biliary cirrhosis

Biliary cirrhosis is more often observed in women over 40 years of age.

The main initial symptoms of the disease include severely decreased performance, increased drowsiness and complete loss of appetite. Primary biliary cirrhosis has a code of 74.30.

Secondary biliary

This type of cirrhosis occurs due to the development of obstruction of the bile ducts. The pathology develops due to an abundant accumulation of stones in the gallbladder or as a result of complications after a major surgical operation. When bile stagnates, it, having no outlet, begins to attack hepatocytes, causing irreparable damage to the organ.

Secondary biliary cirrhosis

This type of cirrhosis has a code of 74.40. Secondary biliary cirrhosis requires immediate hospitalization and emergency surgery. More often, doctors diagnose this subtype of cirrhosis in young men. Pathology develops (unlike the alcoholic type of disease) very quickly - sometimes only 2-3 months are enough. In rare cases, the pathological process drags on for 4-5 years.

Unspecified biliary

If the development of pathology occurred due to stagnation of bile, but the disease does not have distinctive signs of primary or secondary, the pathology is classified (according to ICD 10) as unspecified. This type of pathology is code 74.50. The main reasons for this phenomenon (stagnation of bile) in this case is the influence of various pathogenic microorganisms that provoke severe inflammation of the bile ducts.

Other unspecified

Other types of cirrhosis, the etiological causes and clinical picture of which cannot be attributed to the previously listed pathologies, are classified according to code 74.60. In other editions of ICD 10, this type of pathology is assigned code 74.69. Unspecified cirrhosis may also be subdivided into:

• portal;
• cryptogenic;
• mixed type;
• micronodular;
• macronodular;
• post-necrotic.

The physician develops a course of therapy taking into account the type of pathology and the patient’s condition. The causes of cirrhosis are also taken into account. In each case of illness there is an individual approach. There is no single therapy for the treatment of cirrhosis.

What are the forecasts

For several more years, “cirrhosis” sounded like a death sentence for a person. But modern pharmaceuticals and medicine do not stand still. At the moment, many people suffering from cirrhosis have the opportunity to live a full life without suffering from pain. Before developing a treatment plan, the physician prescribes a complete examination to the patient, including:

• endoscopy;
• Ultrasound of the liver;
• puncture biopsy;
• general urine and blood tests;
• biochemical blood tests.

Based on the results obtained and after studying them, the specialist can continue to examine the person. Additional prescribed diagnostics make it possible to identify existing complications of cirrhosis. This:

1. Internal bleeding. This situation threatens the patient with death.
2. Ascites. This complication most often manifests itself at stages 2 and 3 of the development of cirrhosis.
3. Hepatic coma. When an organ stops functioning, massive poisoning of the entire body occurs. The brain also suffers. As a result of its intoxication, a person experiences loss of consciousness and transition to a coma.
4. Complications of an infectious nature. A weakened body practically ceases to resist pathogenic microorganisms. The result is frequent and severe infectious diseases.
5. Portal vein thrombosis. Closure of the lumen of the portal vein by the formed thrombus. This condition can lead to peritonitis, massive internal bleeding and death.
6. Oncological processes. In this case, only an organ transplant can save a person suffering from the disease. But the main condition for surgery is the absence of metastases.

What is the prognosis for cirrhosis? Treatment of pathology at the stage of decompensation is aimed only at maintaining life. According to statistics, 2/3 of patients die within 3 years after the disease reaches its final stage. In the case of early stages of the disease, the prognosis is more favorable.

It largely depends on the attitude of the patient himself to the prescribed treatment. You should strictly follow all the doctor’s recommendations and not refuse treatment. The main condition for life and recovery is compliance with the following medical recommendations:

• strictly adhere to the prescribed course of medication, without skipping time or changing the dose of the drug;
• follow a diet that completely excludes fatty and fried foods; dairy products are also subject to restrictions;
• completely and forever eliminate the consumption of even small doses of low-alcohol drinks, not to mention strong alcoholic beverages;
• in case of viral cirrhosis, smoking is also prohibited;
• maintaining optimal temperature conditions - do not expose the body to hypothermia or overheating;
• Restrictions include physical activity and active sports.

Treatment of pathology is carried out only by an experienced qualified medical specialist. In this situation, relying on numerous folk recipes and techniques is extremely dangerous. In any case, medical intervention will be required. You should also definitely agree with your doctor about any additional therapies you want to carry out.

In contact with

Liver cirrhosis is a very serious disease that often results in death. Complications of the pathology cause damage to many organs, and, despite the rapid development of modern medicine, the number of tragic consequences continues to grow. Most researchers associate this fact with alcohol abuse and deterioration in food quality. The priority influence of alcohol is confirmed by the fact that the disease affects men much more often than women.

Show all

The essence of pathology

The liver in the human body plays the role of a natural filter that cleanses the blood of all kinds of toxins.

At the same time, being the largest gland, this organ performs a number of important functions, including:

• production of bile necessary for digestion;
• participation in the synthesis of essential proteins, fats and carbohydrates;
• regulation of blood clotting;
• antibody formation;
• accumulation and redistribution of vitamins.

The liver has the unique property of self-regeneration when damaged. However, even this specific self-healing mechanism inherent in nature cannot cope with the huge flow of toxic substances. Under certain aggressive influences of endogenous and exogenous factors, irreversible destruction of liver cells (hepatocytes) can begin, which leads to severe organ dysfunction.

Liver cirrhosis is a progressive, chronic disease in which diffuse proliferation of fibrous connective tissue occurs to replace the fibers of the hepatic parenchyma. The pathology is accompanied by:

• necrosis of hepatocytes;
• irreversible restructuring of the architectonics of the liver structure and its vascular system;
• increase in functional failure and portal hypertension.



The organ changes significantly in size, and its base becomes dense with a rough and bumpy surface.

The concept of liver cirrhosis appeared in the 19th century. and after that is under constant control of doctors around the world. In the international classification ICD 10, pathology has category code K74, the alcoholic variety of the disease is K70. Most often, cirrhosis occurs in men over 45 years of age. The average incidence rate worldwide reaches 2.5-3.5%, and in some regions of the planet it exceeds 10%.

Liver cirrhosis develops depending on the etiological characteristics, but the end result is the same for all varieties. In the mechanism of pathogenesis, the role of repeated necrosis of hepatocytes, scar formation and circulatory disorders in the parenchyma is particularly highlighted. At a certain stage, a large regenerated node appears in the liver, exerting a compressive effect on the vessels (especially the hepatic veins) and surrounding tissues.

As a result of impaired blood outflow, portal hypertension develops and anastomoses are formed between the hepatic and portal veins. The fluid begins to circulate along a new path, bypassing the parenchyma, worsening its blood supply. Simultaneously with the hematogenous factor, connective tissue actively grows. All this creates a pathological process leading to liver failure.



Etiological mechanism

Liver cirrhosis can be safely attributed to a polyetiological pathology, taking into account the numerous factors that can cause necrosis of hepatocytes. We can name only the most important reasons that trigger the etiological mechanism of the disease:



In addition to primary cirrhosis of the liver, damage can become a secondary process - a manifestation of the following diseases: tuberculosis, brucellosis, syphilis, collagenosis, endocrine metabolic pathologies.



Classification of the disease

To facilitate the diagnosis of the disease and subsequent treatment, it is customary to classify cirrhosis of the liver according to a number of indicators. Based on clinical and morphological characteristics, the main types of pathology are distinguished: portal, biliary, postnecrotic, congestive (cardiac) and mixed cirrhosis. Moreover, all types, in turn, are divided into active (progressive) and inactive (stationary) forms.



The general classification takes into account the etiological principle, morphological, clinical and functional criteria. According to this mechanism, cirrhosis caused by the following factors is distinguished: viral, alcoholic, iatrogenic, nutritional, cholestatic, toxic and toxic-allergic, cardiovascular, hemochromatosis.

Based on the morphology of the process and the type of lesion, it is customary to distinguish the following types of lesion:

• small-nodular, or micromodular (portal), cirrhosis with lesions in the form of nodes up to 10 mm in size located on one lobe;
• large-nodular, or macromodular (post-necrotic), cirrhosis with regenerated nodes up to 5.5-6 cm in size and localized in several lobules;
• mixed type - a conglomerate of small and large nodes.

Based on how the lesion affects liver functions, compensated and decompensated cirrhosis are distinguished. During the course of the disease, 3 characteristic phases can be recorded: the initial stage, formed cirrhosis and the dystrophic stage.





Symptomatic manifestation of the disease

Liver cirrhosis is a chronic progressive disease and goes through several stages during its development. The following ones stand out:

1. 1. Initial stage (stage 1). In this early period, the disease often develops without obvious manifestations. Only in half of the patients can one notice the appearance of the following first signs of liver cirrhosis: rare periods of pain in the area of ​​the right hypochondrium with intensification during physical activity and after consuming fatty or fried foods, as well as alcohol; bitterness and dry mouth after getting up in the morning; slight loss of body weight; fast fatiguability; irritability; stool instability and flatulence. There may be a slight manifestation of jaundice on the skin.
2. 2. Subcompensated stage (second). At this stage, the number of dead hepatocytes increases, which affects the functional abilities of the organ, but the process is reversible, and the tissues are still capable of self-healing. Painful symptoms begin to become more pronounced: general weakness, decreased ability to work, nausea, noticeable weight loss. Men show signs of gynecomastia. The tests determine a drop in the level of bilirubin and albumin. The prothrombic index may drop to 36-38. At this stage, therapy easily transforms the disease into a compensated form.
3. 3. Decompensated (terminal) stage (third). The progressive disease leads to liver failure, functional impairment becomes irreversible. The first signs of liver cirrhosis are clearly expressed: yellowness of the skin, significant pain in the organ area, and the development of ascites. The drop in the prothrombic index and albumin content reaches critical values. Already at this stage, hepatic coma and internal bleeding are possible. A sick person should be under constant medical supervision, but therapy is not always effective.
4. 4. Final, or 4, stage. At this stage, treatment no longer gives a positive result, and all measures are aimed only at prolonging life as much as possible. The pain becomes very severe, which requires the use of narcotic painkillers.



In general, the development of the disease is accompanied by the following characteristic symptoms:

• pain in the right side in the form of colic or aching type with an increase as the pathology progresses;
• nausea and vomiting, possibly with blood;
• skin itching;
• progressive weight loss until complete exhaustion in the final stages;
• decreased muscle tone with gradual atrophy;
• signs of jaundice on the skin, eyes, mouth, palms and soles;
• the appearance of lipid spots near the upper eyelids (xanthelasma);
• deformation of fingers (clubs) and nail plates;
• pain and swelling of the joints;
• swelling of veins in the abdominal area;
• the appearance of spider veins on the upper body;
• angiomas on the nose and eyes;
• redness of palms;
• swelling and pigmentation of the tongue;
• ascites; unhealthy complexion;
• weight loss of a limb with prolapse of the abdomen in the anterior direction;
• frequent nosebleeds;
• increase in the size of the spleen;
• neurological signs.

The temperature increases with liver cirrhosis.

How to assess the severity of the disease?

In order to determine the severity of liver cirrhosis, the Child-Turcott-Pugh classification is often used. The assessment is carried out using a point system, taking into account such parameters as the presence of ascites and encephalopathy, bilirubin level, the value of the thrombosed index and time. Points are awarded according to the following system:

1. 1. Ascites: absent (1 point); present, but treatable (2 points); not curable (3 points).
2. 2. Bilirubin: less than 33 µmol/l (1 point); up to 50 µmol/l (2 points); over 51 µmol/l (3 points).
3. 3. Hepatic encephalopathy: absence (1 point); mild degree (2 points); pathology 3-4 degrees (3 points).
4. 4. Albumin: not less than 2.8 (2 points); less than 2.8 (3 points).
5. 5. Prothrombotic index (PTI) and time (PT): PTI over 61 with PTI - 1-4 (1 point); PTI - more than 41 with PTV - 4-6 (2 points); PTI - less than 40 with PTI above 6 (3 points).

The severity of cirrhosis is assessed according to the following scale: the sum of points up to 6 - 1 degree (full guarantee of one-year survival and the probability of life for more than 1 year - 86%); 2nd degree with 7-9 points (probability of life within a year is 82%, more than a year - 58%); 3rd degree - 10-16 points (annual life expectancy with a probability of less than 50%, and more than a year - no more than 36%).



Portal cirrhosis

Portal cirrhosis of the liver is expressed in necrotic and degenerative changes in the parenchyma. With this type of disease, the organ decreases in size or remains the same size. This cirrhosis is most common in men aged 42-65 years. The viral component does not play a significant role in the etiological mechanism. The leading positions are occupied by alcohol, toxic-allergic hepatitis, and fatty liver of various origins.

For a long period of time, portal cirrhosis does not show pronounced symptoms. Quite often, a sick person discovers the existence of pathology only at stages 3-4, when severe ascites and internal bleeding appear. There are no signs of jaundice on the skin. You should pay attention to pain. They arise in the liver area, are dull, aching in nature, intensifying after eating or physical activity.



During portal cirrhosis, 3 specific periods are distinguished: preascitic (characterized by dyspeptic symptoms, general weakness, nosebleeds); ascitic and cachectic. After the onset of ascites, the disease continues for up to two years. The most likely complications: profuse bleeding due to varicose veins of the esophagus and stomach, hemorrhoidal bleeding. The development of primary hepatic oncology is possible.

Postnecrotic cirrhosis

Liver cirrhosis of the postnecrotic type is characterized by massive necrosis of the parenchyma. The most common cause is a viral infection, but the culprits may be: chemical poisoning, poor diet with protein deficiency. One of the main signs of this type of pathology is jaundice. Recurrent exacerbations are typical for the disease. The liver is significantly compacted and increased in size. In the active form of postnecrotic cirrhosis, autoimmune disorders are clearly visible.



The prognosis of such a disease depends on the degree of activity. With rapid progression, life expectancy is estimated at three to four years. Hepatic coma, internal gastrointestinal bleeding, and portal vein thrombosis lead to tragic consequences. There is a high probability of developing a malignant tumor.

Biliary cirrhosis

Biliary type cirrhosis differs in its course from the types of pathology discussed above, although the symptoms largely coincide. Biliary cirrhosis can develop by a primary or secondary mechanism.



The primary disease, or pericholangiolytic cirrhosis, is caused by epidemic hepatitis or its toxic-allergic variety. The disease occurs due to blockage of the small bile ducts inside the liver, which leads to stagnation of the substance. At the same time, the bile channels outside the liver retain their patency. The secondary form is provoked by prolonged blocking of the extrahepatic ducts (stones, tumor formations, etc.), which leads to the development of cholangitis and pericholangitis, and then cirrhosis of the liver.

One of the first symptoms of biliary cirrhosis is severe skin itching, leading to neurotic-type symptoms. Also, already at an early stage, pronounced jaundice is noted, with the urine turning dark. An increase in temperature with this type of liver cirrhosis, as well as severe pain, is not observed.

The prognosis for biliary cirrhosis is more optimistic compared to other types of the disease. The average life expectancy after the first signs exceeds 11-12 years. The intensity of the icteric manifestation worsens the prognosis, as it indicates an increase in the intensity of the destructive process. The following complications lead to death: liver failure, internal bleeding, intercurrent infection.



Possible complications

The progression of liver cirrhosis inevitably leads to irreversible changes, which, following liver dysfunction, cause other serious complications. The following possible consequences of the development of cirrhosis can be noted:

• progression of ascites associated with the accumulation of fluid in the peritoneal cavity;
• peritonitis or inflammation of the peritoneum;
• varicose veins of the stomach and esophagus, which leads to internal bleeding, arterial hypotension, cardiac arrhythmia;
• hepatic encephalopathy;
• systematic loss of consciousness or clouding of consciousness;
• provoking carcinoma - a malignant neoplasm in the liver;
• renal failure as a result of the development of hepatorenal syndrome;
• decrease in transportable oxygen in the blood flow with the development of hepatopulmonary syndrome, including the development of pneumonia;
• impaired gastric function as a result of hepatic gastropathy;
• intestinal pathologies with hepatic colopathy;
• female or male infertility;
• thrombosis in the lumen of the portal vein;
• hepatic coma.



Treatment methods

The disease is one of those types of pathologies whose development can be completely stopped only in the earliest stages, so the first signs of liver cirrhosis should not be ignored.

When an irreversible process begins, modern medicine cannot completely eliminate the disease, but only helps to slow down the development and eliminate complications.

The only real way to get rid of cirrhosis is an organ transplant.



Treatment of the disease depends on the following factors:

• etiological mechanism;
• stage of development and degree of severity (compensation);
• degree of activity of the inflammatory-necrotic process;
• the presence of complications and concomitant diseases.

The following principles of organizing medical care help treat pathology:

• active prevention of complications;
• stopping further damage to the liver parenchyma;
• control of salt and fluid retention in the body;
• promoting the activation of the mechanisms of own regeneration of liver tissue.

Psychotherapeutic influence can play an important role in helping a person adapt to life in conditions of an incurable disease.



The basis of the treatment of pathology is the creation of the necessary conditions that exclude provoking influences - this is an optimal regimen, proper nutrition. The patient's first treatment should be gentle, with limited physical activity and proper rest. If the disease is active, bed rest is required.

A balanced diet is an important component of comprehensive treatment. The diet should have full energy value, but be easily digestible, frequent (up to 6 times a day) in small portions. It should contain sufficient amounts of potassium, protein, carbohydrates and vitamins. Fats are consumed only in the form of small amounts of butter and vegetable oils. Increased consumption of dairy products, especially cottage cheese, is encouraged.

Organization of drug therapy

The basis of drug therapy for liver cirrhosis is drugs that normalize hepatocyte metabolism and hormonal glucocorticosteroids. Therapy is divided into preventive, symptomatic and pathogenetic areas. Preventative - ensured by eliminating complicating factors. In this case, it is important to stabilize digestion, eliminate chronic constipation, etc.

Symptomatic therapy includes the following groups of drugs:

• vitamin complexes (vitamins B6, B12, Rutin, Riboflavin, Cocarboxylase, ascorbic, lipoic and folic acids);
• fat-soluble vitamins (A and D);
• calcium preparations;
• hepatoprotectors (Essentiale, LIV-52, Karsil, Legalon);
• infusion therapy drugs (solutions of glucose, potassium chloride and calcium gluconate, Panangin).



If malabsorption is detected, enzyme and replacement therapy is provided.

Positive results in some cases are achieved by introducing Hemodez. When ascites develops, measures are taken to remove fluid from the abdominal cavity. For this purpose, the abdominal wall is punctured with a trocar, and to compensate for the loss of the sodium component, a solution of sodium chloride is injected. Reducing the accumulation of fluid in the peritoneum is also achieved by using diuretics (Hypothiazide, Furosemide, Lasix, Uregit, Veroshpiron). To eliminate internal bleeding, hemostatic agents are indicated: Vikasol, vitamin K, thrombin preparations, gelatin.

Pathogenetic therapy is based on the use of etiotropic drugs. There is often a need for antiviral chemotherapy with the appointment of Interferon, Adenine, Arabinoside, and blocking hepatic fibrogenesis with Colchicine. Anti-inflammatory and immunosuppressive drugs in the form of azathioprine and glucocorticosteroids are actively used.



When acute liver failure occurs, it is very important to take immediate action. An effective method is taking laxatives and performing enemas. To neutralize ammonia in the blood, it is necessary to introduce a significant volume of liquid, glutamic acid, glucose, vitamins B6 and B12, Panangin. It is useful to carry out oxygen therapy. A positive result in the fight against liver failure is achieved by performing peritoneal hemodialysis and plasmaphoresis.

Liver cirrhosis is a severe pathology that is almost impossible to completely cure, so this disease should not be allowed to occur, except for the appearance of provoking factors. When the disease develops, it is necessary to provide effective treatment at the earliest stages. In an advanced state, therapy is based only on inhibiting the development of the process, but can no longer completely overcome it.

Cirrhosis of the liver is a diffuse process characterized by fibrosis and transformation of the normal structure of the liver with the formation of nodes. It serves as the end stage of a number of chronic liver diseases. Heaviness and cirrhosis prognosis depend on the volume of the remaining functioning mass of the liver parenchyma, the severity of portal hypertension and the activity of the underlying disease that led to impaired liver function.

ICD-10 K74 Fibrosis and cirrhosis of the liver K70.3 Alcoholic cirrhosis of the liver K71.7 With toxic liver damage K74.3 Primary biliary cirrhosis K74.4 Secondary biliary cirrhosis K74.5 Biliary cirrhosis, unspecified K74.6 Other and unspecified cirrhosis of the liver K72 Chronic liver failure K76. 6 Portal hypertension.

An example of a diagnosis formulation

Epidemiology

Liver cirrhosis ranks first among the causes of death from diseases of the digestive system (excluding tumors). The prevalence is 2–3% (based on autopsy data). Cirrhosis of the liver observed 2 times more often in men over 40 years of age compared to the general population.

Etiology

The most common causes of liver cirrhosis are the following diseases and conditions. ■ Viral hepatitis - (B, C, D). ■ Almost always, the development of alcoholic cirrhosis is preceded by constant alcohol consumption for more than 10 years. The risk of liver damage significantly increases with consumption of more than 40–80 g of pure ethanol per day for at least 5 years. ■ Immune liver diseases: autoimmune hepatitis, graft-versus-host disease. ■ Diseases of the biliary tract: extra- and intrahepatic obstruction of the biliary tract caused by various causes, cholangiopathies in children. ■ Metabolic diseases: hemochromatosis, α1-antitrypsin deficiency, Wilson–Konovalov disease, cystic fibrosis (cystic fibrosis), galactosemia, glycogenosis, hereditary tyrosinemia, hereditary fructose intolerance, abetalipoproteinemia, porphyria. ■ Impaired venous outflow from the liver: Budd–Chiari syndrome, veno-occlusive disease, severe right ventricular heart failure. ■ Use of hepatotoxic drugs (methotrexate B, amiodarone C), toxins, chemicals. ■ Other infections: schistosomiasis, brucellosis, syphilis, sarcoidosis. ■ Other causes: non-alcoholic steatohepatitis, hypervitaminosis A. The time required for the development of liver fibrosis largely depends on the etiological factor. The most commonly observed forms of fibrosis and cirrhosis develop slowly: alcoholic cirrhosis of the liver develops over 10–12 years of alcohol abuse, viral cirrhosis of the liver develops 20–25 years after infection. The fastest rates of development of liver cirrhosis (several months) were observed in patients with biliary obstruction of tumor etiology and in newborns with bile duct atresia.

Prevention

Prevention of liver cirrhosis includes timely identification of conditions that can lead to its development and adequate correction of detected disorders. ■ Hemochromatosis. Several studies have demonstrated the cost-effectiveness of population-based screening for hereditary hemochromatosis. During screening, iron in the blood serum, total and free iron-binding capacity of the serum are determined. If these indicators are elevated, they are determined again and if there is a significant increase, the patient is examined for hemochromatosis. ■ Screening for alcohol abuse: limiting alcohol consumption significantly reduces the likelihood of developing liver cirrhosisB. It is possible to use the CAGE test (Cut - cut, Angry - angry, Guilty - guilt, Empty - empty), which includes four questions. 1. Have you ever felt that you should cut down on your drinking? 2. Have you ever felt irritated if someone around you (friends, relatives) told you about the need to reduce your drinking? 3. Have you ever felt guilty about drinking alcohol? 4. Have you ever had the urge to drink alcohol the morning after an episode of drinking? Sensitivity and specificity are approximately 70%, the main advantage is the ability to test while collecting anamnesis. A positive answer to more than two questions allows one to suspect alcohol dependence, accompanied by changes in behavior and personality. Among the laboratory signs, markers of alcohol abuse can be a predominant increase in AST activity compared to ALT, an increase in GGTP, Ig A, and an increase in the average volume of erythrocytes. All of these signs have high specificity with relatively low sensitivity, with the exception of GGTP activity, the increase of which is considered a highly specific sign of both alcohol abuse and alcohol dependence A. ■ Screening for hepatitis B and C viruses: for more details, see the article “Acute and chronic viral hepatitis.” In individuals with risk factors for chronic hepatitis, it is necessary to conduct testing for hepatitis B and C viruses. The survival rate of patients with chronic hepatitis, both with and without cirrhosis, is significantly higher with timely interferon therapy. ■ Screening for the use of hepatotoxic drugs, primarily methotrexate B and amiodarone C, by determining the activity of ALT and AST every 1–3 months. These drugs, when used for a long time, can lead to cirrhosis of the liver. ■ Screening among relatives of patients with chronic liver damage. First-degree relatives are examined: the degree of transferrin saturation and serum ferritin concentration (detection of congenital hemochromatosis B), serum concentration of ceruloplasmin (diagnosis of Wilson-Konovalov disease B), and detection of α1-antitrypsin deficiency are determined. ■ Screening for non-alcoholic fatty liver disease. Risk factors - type 2 diabetes mellitus, obesity, hyperlipidemia, AST/ALT activity ratio above 1.0; The risk increases especially significantly in patients over 45 years of age. All patients at risk should undergo liver ultrasound to detect steatosis. Patients should be informed about the possibility of developing liver cirrhosis.

Screening

Screening to directly detect liver cirrhosis is not carried out. Screening activities are carried out in order to identify diseases and conditions that can lead to liver cirrhosis (see the “Prevention” section above).

Classification

Liver cirrhosis is divided according to etiology (see the “Etiology” section above) and severity, for which the Child–Pugh A classification is used (Table 4-10). Table 4-10. Determination of the severity of liver cirrhosis according to Child-Pugh

Each of the indicators is assessed in points (1, 2 or 3 points, respectively). Interpretation is carried out according to the following criteria. ■ Class A (compensated) - 5–6 points. ■ Class B (subcompensated) - 7–9 points. ■ Class C (decompensated) - 10–15 points.

Diagnostics

Survey plan

The diagnosis of liver cirrhosis can be assumed by clinical and anamnestic data (symptoms are very diverse, see section “Anamnesis and physical examination”), confirmed by the results of laboratory and instrumental examination. It is necessary to establish the etiology of the disease, since in some cases etiotropic therapy can slow down the progression of the disease and reduce mortality. The most common causes are viral hepatitis and alcohol abuse; less common causes are listed in the Etiology section. In some cases, the cause of cirrhosis cannot be detected, in which case a diagnosis of cryptogenic cirrhosis is made. When making a diagnosis, it is necessary to additionally evaluate the following parameters. ■ State of the main functions of the liver: the presence of cytolysis syndromes, cholestasis, the state of the blood coagulation system (cirrhosis is characterized by hemorrhagic syndrome), protein-synthetic function of the liver. ■ Detection of hypersplenism syndrome (primarily by platelet count). ■ Identification and assessment of the degree of portal hypertension (dangerous primarily due to bleeding from varicose veins of the esophagus and stomach - FEGDS). ■ Detection of possible ascites. ■ Assessment of mental status for timely diagnosis of hepatic encephalopathy. The severity of liver cirrhosis is determined by the Child–Pugh classification of hepatic cellular function in liver cirrhosis (see section “Classification”).

History and physical examination The following symptoms and syndromes are characteristic. ■ General symptoms: drowsiness, weakness, increased fatigue and itchy skin. With severe drowsiness, as well as with irritability and aggressive behavior, it is necessary to exclude hepatic encephalopathy. ■ Changes in the liver and spleen: the liver is compacted and enlarged, but can sometimes be small in size. In most patients, a moderately enlarged spleen is palpable (manifestations of portal hypertension). ■ Jaundice: the initial signs of jaundice are invisible to the patient and are characterized by icterus of the sclera and mucous membranes, frenulum of the tongue, and slight darkening of the urine, which patients usually do not attach due importance to. ■ Breathing difficulties (shallow, rapid breathing) can be caused by: ascites with increased intra-abdominal pressure and limited mobility of the diaphragm, chronic heart failure, hydrothorax against the background of edematous-ascitic syndrome. ■ Hemorrhagic syndrome (due to impaired synthesis of blood clotting factors in the liver): bleeding gums and nosebleeds are characteristic. Patients notice that bruises and bruises form even with minor mechanical stress. ■ Portal hypertension: ascites, varicose veins of the esophagus and stomach, dilatation of the veins of the anterior abdominal wall in the form of the “head of Medusa”, splenomegaly, hepatic encephalopathy. ■ Ascites (manifestation of portal hypertension): an increase in the abdomen in volume due to accumulated fluid (more than 10–15 liters of fluid can accumulate, a “frog belly” is typical); with a large amount of it, a picture of “tense ascites” is created, bulging of the navel, sometimes with its ruptures, percussion signs of fluid in the abdominal cavity, positive symptom of fluctuation. ■ Other signs characteristic of liver cirrhosis: ✧ telangiectasia on the upper half of the body and face; ✧ palmar erythema; ✧ gynecomastia; ✧ testicular atrophy/amenorrhea; ✧ swelling of the legs (with ascites); ✧ Cruvelier-Baumgarten noise - venous noise over the abdomen associated with the functioning of venous collaterals; ✧ Dupuytren's contracture, more typical of liver cirrhosis of alcoholic etiology; ✧ changes in the terminal phalanges of the fingers like drumsticks; ✧ atrophy of skeletal muscles, lack of hair growth in the armpit; ✧ enlargement of the parotid salivary glands (typical for patients suffering from alcoholism); ✧ hepatic odor occurs during decompensation of liver functions, precedes and accompanies the development of hepatic coma; ✧ flapping tremor is also characteristic of decompensation of liver functions. Particular attention should be paid to signs of developed complications: ■ symptoms of gastrointestinal bleeding: hematemesis, melena, systolic blood pressure less than 100 mm Hg. with a decrease of 20 mm Hg. when moving to a vertical position, heart rate is more than 100 per minute; ■ signs of spontaneous bacterial peritonitis - diffuse pain of varying intensity in the abdominal cavity, fever, vomiting, diarrhea, signs of intestinal paresis; ■ confusion, reflecting the development of hepatic encephalopathy; ■ a decrease in daily diuresis - a likely sign of the development of renal failure.

Severe liver pathologies that lead to the degeneration of organ cells into scar tissue are called cirrhosis. The disease is irreversible and difficult to treat.

There are several types of cirrhosis, which differ in the causes of the disease and the degree of progression. Our article will tell you what cirrhosis is and what signs of the onset of this pathology to pay attention to.

ICD-10 code

In the International Diseases, cirrhosis occupies several positions at once.

Designation of cirrhosis according to the ICD:

• By 70.3 - alcoholic cirrhosis of the liver.
• P 78.3 - congenital cirrhosis of the liver.
• K 74.3 - primary.
• K 74.4 - secondary biliary cirrhosis.
• By 74.5 - unspecified biliary cirrhosis.
• By 74.6 - other and unspecified cirrhosis of the liver.
• K 71.7 - cirrhosis with toxic liver damage.

Causes of the disease

Statistics state that the mortality rate from liver cirrhosis reaches 1% in the world. Most often, patients are men (ratio 3:1), over 40 years of age, but there are also cases of childhood morbidity.

Main causes:

• Infection with viral hepatitis.
• Abuse and .
• Autoimmune diseases.
• Toxic liver poisoning.
• Long-term use of certain medications.
• Chronic diseases of the bile ducts.
• Unexplained reasons.

In many cases, the complex impact of several factors is revealed. This is systematic malnutrition, abuse of “harmful” foods, heavy physical activity and stress.

In children, cirrhosis often develops against the background of intrauterine infections and severe developmental pathologies. The harmful effects of alcohol consumption during pregnancy and breastfeeding have been proven, when even small portions of alcohol led to liver dysfunction with the development of cirrhosis.

Kinds

Depending on the causes and degree of liver damage, the following types of this disease are distinguished.

Classification of cirrhosis:

• Alcoholic.
• Viral.
• Primary biliary.
• Secondary biliary.
• Drug.
• Congenital.
• Metabolic - nutritional.
• Stagnant.

In approximately 20% of cases, the occurrence of cirrhosis is of unknown etiology.

How quickly does the pathology develop?

The progression of the disease occurs at different rates and depends on many indicators.

These include:

1. Causes of the disease.
2. Patient's age.
3. Compliance with medical recommendations.
4. Additional health problems.
5. Alcohol and drug use.

Sometimes the disease progresses very quickly, and patients do not survive even several months after diagnosis. Basically, with adequate treatment, compliance and doctor’s recommendations, patients with liver cirrhosis have every chance of 5 to 20 years of life.

Manifestations of the disease

The development of cirrhosis is not asymptomatic and the disease can only be detected during regular examinations or by chance (for example, during hospitalization for another disease).

At the same time, with a significant volume of affected cells, the first alarming signs gradually appear, which must be paid attention to.

Symptoms of cirrhosis:

• Pain on the right side in the hypochondrium. They appear periodically, usually after drinking alcohol or eating too heavy (fatty, spicy) food. Over time, the frequency and intensity of attacks increases.
• Swelling appears not only in the evening, but also during the day. Often, patients with cirrhosis experience an enlarged abdomen due to swelling of the abdominal cavity ().
• An increase in temperature, and the values ​​​​are not high (37 - 37.5 degrees), but such conditions last for quite a long time.
• Digestive disorders: vomiting, or constipation.
• Bad breath, characteristic of liver diseases.
• , manifested due to liver dysfunction and occurring throughout the body without precise localization.
• Redness of the palms and feet is one of the most characteristic signs of cirrhosis.

The photo shows the palms of a patient with cirrhosis of the liver

• Bloating and flatulence.
• A decrease in pressure occurs due to portal hypertension - common.
• General intoxication of the body, which has many manifestations. Most often, the patient feels apathy, decreased concentration and memory. With severe brain damage (), the patient may show aggression and atypical behavior, periods of apathy are replaced by excitement.
• Nosebleeds.
• Weight loss, body disproportion (bulging belly and emaciated limbs).
• Yellowing of the skin and sclera of the eyes, as one of the signs of liver dysfunction.

When the increased size of the liver is determined. In some cases, its edge may even protrude. To confirm the diagnosis, it is also necessary to undergo a full examination and undergo the necessary tests to accurately determine the cause of the pathology.

Symptoms in men

Considering that men are more likely than women to suffer from this disease, the following characteristic signs should alert you.

Features of the manifestation of cirrhosis in men:

• The mammary glands become enlarged.
• The belly begins to grow sharply.
• There is often a decrease in libido.
• Potency problems arise.
• Pubic hair falls out in the armpits.
• Behavior changes, attacks of aggression often occur.

Of course, such signs can also occur against the background of other diseases, for example, problems in the endocrine system.

Coupled with the characteristic manifestations of cirrhosis (yellowing of the skin, “liver” odor from the mouth, etc.), cirrhosis can be suspected. Additional tests and instrumental examinations will help make an accurate diagnosis.

In children

Unfortunately, this pathology is increasingly being diagnosed in childhood. The reasons for the development of cirrhosis can be very diverse, most often these are hereditary diseases, developmental pathologies and poisoning with toxic substances.

Most often it is manifested by jaundice of the skin and sclera, itching and general exhaustion of the child. A vascular pattern is clearly visible on the abdomen; it is sharply enlarged, which is especially noticeable against the background of sudden weight loss.

The disease develops over several months and even years, with the exception of liver cirrhosis in newborns, which appears as a result of hereditary diseases and pathologies of intrauterine development.

Main syndromes

Impaired liver function leads to the development of additional syndromes. The most common are hepatorenal and hemorrhagic.

In the first case, there is also kidney dysfunction, which occurs under the influence of intoxication of the body. This pathology has two forms: hidden, when only tests will help determine the dysfunction of the renal system.

The second type of hepatorenal syndrome develops more rapidly and is characterized by a decrease in the patient’s physical activity, increased fatigue and skin rashes.

Hemorrhagic syndrome develops by disturbances in the hematopoietic function of the liver and normal blood clotting.

In this case, heavy bleeding, long-lasting bruises and the formation of hematomas for no apparent reason are common. Women experience long and painful menstruation, as well as frequent nosebleeds and slow healing of wounds and abrasions.

Consequences

Liver damage and the gradual death of its cells lead not only to the appearance of the above symptoms. Over time, other irreversible processes occur in the body, the end result of which is death.

Complications of cirrhosis:

1. Development of bacterial infection (peritonitis).
2. Development .
3. Hepatic encephalopathy and.

With complete liver failure, the patient's condition quickly deteriorates and coma and death occur.

How to test your liver for cirrhosis?

The methods are varied and are carried out according to the doctor’s indications. Usually, even a simple blood test gives a signal for a detailed study of liver functions.

Methods for detecting cirrhosis:

• The blood levels of bilirubin, ALT, AST, leukocytes and alkaline phosphatase are increased.
• Normal blood clotting (prothrombin index) is disrupted.
• shows a change in structure, an increase in the size of the liver and disruption of the bile ducts.

Special studies will also help determine cirrhosis - and. Usually, with any dysfunction of the liver, disturbances in the functioning of other organs occur, and the brain is also affected.

Diagnosis in the early stages will help slow the progression of the disease and give the patient a chance to live longer.

Standards of treatment

Main treatment methods:

1. Special diet, including strict control and avoidance of fatty, spicy and stomach-heavy foods. You will also have to give up bad habits, store-bought sweets and other gastronomic “violations”. The diet reduces the load on the affected organ and promotes normal functioning of the gastrointestinal tract.
2. Blood transfusion. Performed for severe hemorrhagic syndrome.
3. Taking hepatoprotectors. These are special drugs that enhance the functioning of liver cells and restore their function.
4. Glucocorticoids used to slow down pathological processes in liver cells.
5. Vitamin complexes, compensating for the lack of valuable substances in the body.
6. Pancreatic enzymes, ensuring the normal digestion process.
7. Adsorbents, relieving symptoms of intoxication of the body.
8. Prokinetics, which eliminate bloating and stimulate intestinal motility.
9. Preparations with bile acids help the secretion of bile and improve liver function.
10. Diuretic will help remove excess fluid during ascites. In severe cases, instrumental removal using puncture is used.
11. Probiotics help improve digestion processes.
12. used for the definitive treatment of patients with cirrhosis. This surgical intervention is characterized as one of the most difficult, has contraindications and high cost. For a number of reasons, it is not suitable for all patients.

Only joint work between the doctor and the patient, as well as strict restrictions and changes in the usual lifestyle will help slow down the development of the disease. Careful health care, as well as a nutritious diet, will provide strength for the fight.

How long can you live?

The prognosis for different forms of cirrhosis can differ dramatically. There are no two identical cases of the disease in the world, so an individual approach is applied to each patient.

There is a special scale for assessing the patient’s condition and predicting the possible period of life.

The calculation is carried out according to the Child-Pugh system, which analyzes basic vital signs, the presence of ascites and hepatic encephalopathy.

Patients with class A can expect 15 to 20 years of life if no new symptoms are added to the accompanying symptoms. Class B characterizes lower chances, approximately 5 – 7 years with proper treatment.

Class C determines the most severe development of the disease; the life expectancy of such patients rarely exceeds three years.

Prevention

Proper methods for preventing cirrhosis have not yet been invented. Of course, a healthy lifestyle, avoidance of alcohol and adequate nutrition will help reduce risk factors, but cannot be guaranteed to prevent the disease.

There is a certain dependence of hereditary factors, therefore, if there have already been cases of cirrhosis (not alcoholic) in the family, you should undergo regular examinations and test your blood at least once a year for characteristic changes.

What questions do patients care about:

1. Is it possible to get cirrhosis of the liver from a patient? Cirrhosis is not an infectious disease, but if a viral origin of the disease is detected (if the cause of development is viral hepatitis), measures must be taken to isolate the patient.
2. Is it possible to cure cirrhosis of the liver? Unfortunately, at this stage of medical development, no effective treatment for cirrhosis has been invented. The exception is liver transplantation, but even in this case there is a high risk of relapse of the disease.
3. Which doctor treats and where? If you suspect the occurrence of cirrhosis, you must contact your local physician and undergo an examination. Further treatment is best carried out by a specialist doctor - a hepatologist and in an inpatient setting.
4. Is it possible to sunbathe? Active ultraviolet irradiation is extremely undesirable for this disease. The fact is that with liver dysfunction, irreversible consequences occur in the body, and additional stress will lead to the emergence of new problems. In addition, with cirrhosis, bile acids accumulate in the skin, which cause itching and soreness, and in the sun or in a solarium, the discomfort will only intensify.
5. What is the difference between fibrosis and hepatitis and cirrhosis of the liver? With any damage to the liver, its functions are inhibited and liver cells - hepatocytes - die. and cirrhosis is also characterized by the proliferation of connective tissue and the degeneration of hepatitis. The difference is the irreversibility of the process in cirrhosis, but at the same time, liver fibrosis in the final stages leads to the development of cirrhosis.
6. Is there any disability for liver cirrhosis? With this disease, it is possible to register a disability and receive a temporary disability pension. Usually, at the first stage, the third group is assigned, and with the development of the second and third, the second group is assigned. At the thermal (last) stage, the patient receives the first group. The preparation of the relevant documents is carried out in the prescribed manner on the basis of the conclusion of specialists and a medical commission.

Cirrhosis is a severe pathology of the liver, in which irreversible changes occur in the structure and the functions of the organ are disrupted.

The onset of the disease is usually asymptomatic, so patients turn to the doctor already at advanced stages. Knowing the main symptoms and possible causes of the development of this terrible disease, you can recognize the body’s alarm signals in time and delay the progression of the disease.

Video program about alcoholic cirrhosis of the liver: