A Simple Guide of Liver Cirrhosis II

A Simple Guide of Liver Cirrhosis II
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What are the complications of Liver Cirrhosis?
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Complications may develop with progression of the cirrhosis.

1.Bruising and bleeding due to decreased production of coagulation factors.

2.Jaundice due to decreased processing of bilirubin

3.Itching (pruritis due to bile products deposited in the skin).

4.Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous substances from the blood, which are carried to the brain, affecting cerebral functioning:

a.neglect of personal appearance,
b.unresponsiveness,
c.forgetfulness,
d.trouble concentrating,
e.changes in sleep habits.
f.Sensitivity to medication due to decreased metabolism of the active compounds.

5.Hepatocellular carcinoma is primary liver cancer one of the common complication of cirrhosis and has a high mortality rate.

6.Portal hypertension - blood normally carried from the intestines and spleen through the hepatic portal vein flows more slowly and the pressure increases causing :

a.Ascites - fluid leaks through the vasculature into the abdominal cavity.
b.Esophageal varices - collateral portal blood flow through vessels in the stomach and esophagus. These blood vessels may become enlarged and are more likely to burst.

7.Immune system dysfunction, leading to

a.nonspecific infection in the body organs
b..Spontaneous bacterial peritonitis -fluid in the abdomen may become infected with bacteria normally present in the intestines

8.Hepatorenal syndrome - insufficient blood supply to the kidneys, causing acute renal failure and a very high mortality (over 50%).

9.Hepatopulmonary syndrome - blood bypassing the normal lung circulation leading to cyanosis and dyspnea (shortness of breath) characteristically worse on sitting up

10.Portopulmonary hypertension - increased blood pressure over the lungs as a consequence of portal hypertension.


What is the treatment of Liver Cirrhosis?
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In all cases of liver cirrhosis, the liver damage from cirrhosis cannot be repaired so treatment is aimed at reducing progression and complications of the disease.

1. A healthy fat free diet is needed as energy use in cirrhosis is high

2.Close monitoring of the liver function is important.

3.Antibiotics will be prescribed for infections,

4.Antihistamines can help with itching.

5.Laxatives such as lactulose decrease risk of constipation

6.Treating alcoholism
Alcoholic cirrhosis caused by alcoholism is treated by abstaining from alcohol.

7.Treatment for hepatitis-related cirrhosis involves medications to treat the different types of hepatitis, such as

a.interferon for viral hepatitis
b.corticosteroids for autoimmune hepatitis.

8.Cirrhosis caused by Wilson's disease in which copper builds up in organs is treated with chelation therapy (e.g. penicillamine ) to remove the copper.

9.Preventing complications:
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a. Ascites
Salt restriction
Diuretics may be necessary to reduce fluid in abdomen.

b. Esophageal variceal bleeding -
Vasopressin
surgical portacaval shunting

c. portal hypertension
propranolol lower blood pressure over the portal system.
Transjugular intrahepatic portosystemic shunting will relieve pressure on the portal vein as a temporary measure .

c. Spontaneous bacterial peritonitis
antibiotics.

10. Decompensated cirrhosis
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Decompensation in previously stable patients may occur due to various causes:

a.constipation
b.infection
c.increased alcohol intake,
d.medication
e.bleeding from esophageal varices
f.dehydration.

Patients with decompensated cirrhosis has to be admitted to hospital for
1.close monitoring of the:

fluid balance
mental status,

2.emphasis on adequate nutrition

3.medical treatment -

a.diuretics
b.antibiotics
c.laxatives
d.enemas
e.thiamine
f.steroids
g.acetylcysteine
h.pentoxifylline

Surgical Liver Transplantation
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Liver transplantation is necessary if:

liver stop functioning
severe complications cannot be controlled

Survival rate from liver transplantation has improved to 80% for five year postoperative period.

Transplantation necessitates the use of immune suppressants for life.

What is the prognosis for Liver Cirrhosis?
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Prognosis is generally not good unless detected at very early stage.

Most liver cirrhosis patient are in the moderate to advanced stage of the disease when detected.

If there are complications, the prognosis is poor.


What is the best prevention for Liver Cirrhosis?
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1. Alcohol- stop the abuse of alcohol

2. Vaccination against hepatitis B

3. Reduce fat in obese -fat cells in liver can lead to cirrhosis

A Simple Guide to Uterine Fibroids

A Simple Guide to Uterine Fibroids
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What are Uterine Fibroids ?
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Uterine Fibroids are solid benign tumours(non-cancerous) of the smooth muscles and fibrous tissues of the uterine cavity.

The name fibroid is derived by the fibrous tissue present in the tumour.

They are the commonest tumours (25%)found in women especially after the age of 35.

What are the different types of Uterine Fibroids?
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They are classified according to their location.

1.intramurally(inside the cavity of the uterus(70%)

2.subserous(on the outer wall of the uterus) on the external wall(20%)

3.Submucous (in the lining of the uterus) 10%

4.pendunculated subserous(like a polyp outside the uterus)

5.cervical(at the cervix or beginning of the uterus)

What are the Causes of Uterine Fibroids?
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The cause of Uterine Fibroids is still not known.

It is believed that oestrogen has a part to play in the formation since fibroids are not present before puberty and sometimes shrinks after menopause.

Generally it is believed that during the thickening and shedding of the endometrium of the menstrual cycle, some uterine muscles and connective tive tissues overgrow and form a swelling in the wall of the uterus.

Fibroids are generally relatively avascular and may degenerate forming cysts and becoming calcified.

What are the Symptoms of Uterine Fibroids?
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Most women with fibroids are asysptomatic.

Symptoms and signs varies with the size and location of the fibroid.

Common symptoms include:

1.Heavy menstrual flow sometimes with blood clots

2.Irregular menstrual periods

3.Painful menses

4.Backache

5.Painful and frequent urination

6.Bloating

7.Constipation

8.Fatigue

Signs:
1.Enlarged uterine mass on abdominal palpation

2.Anaemia and pallour due to blood loss

How do you made the Diagnosis of Uterine Fibroids?
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Pelvic examination may show enlarged uterine swellings

Ultrasound scan showed presence of fibroids

Colposcopy may show the location of the fibroid.

What are the complications of Uterine Fibroids?
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1.sarcoma

2.degeneration

3.necrobiosis

4.cystic degeneration

5.torsion of pendunculated fibroid

What is the Treatment for Uterine Fibroids?
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If small no treatment is required.

If larger,then treatment depends on the
1.size,
2.extent of the lesions,
3.age of the patient and
4.the desire for pregnancy.

Surgery
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is required if
1.extremely heavy bleeding occurs during the menstrual cycle

2.anemia follows heavy menses

3.pain has become intolerable

4.discomfort due to the pressure of the fibroids on another organ

a.Myomectomy is the surgical removal of the fibroid without damage to the uterus thus allowing a woman to be pregnant.
However recurrence of fibroids is quite common after myomectomy

b.Hysterectomy is preferred for fibroid tumors

1.when a women has severe symptoms,

2.has completed her family

3.excessively large fibroid tumors;

4.severe abnormal bleeding is present

5.fibroids are causing problems with the bladder and bowels.

Non surgical treatment:
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a.uterine artery embalization is a non-surgical procedure.
Polyvinyl particles are allowed to flow into the uterine artery and clog the nexis of vessels spread out into the uterine tissue.
The fibroids are unable to receive the constant blood supply and thus shrink over time.

b.Lupron is a drug which shrinks fibroids in most women.
Unfortunately the fibroids will grow back when Lupron treatment is stopped.