السيروز الكبد: التعريف والأعراض

Liver Cirrhosis: Definition

• Liver cirrhosis is a condition where hepatocytes (liver cells) are destroyed and replaced by fibroblasts.
• This replacement reduces the number of healthy liver cells.
• The liver's ability to process nitrogenous toxins, especially ammonia, decreases significantly.
• Early-stage cirrhosis diagnosis is challenging, often requiring a liver sample.

Liver Cirrhosis: Fibrous Tissue and Blood Flow

• Fibrous tissue formation surrounds healthy liver cells, causing them to clump together (nodular).
• This tissue blocks blood flow from the intestines to the liver.
• This blockage increases pressure within the portal vein (a main vein connecting the intestines to the liver).
• Increased pressure causes fluid buildup in the body and potential bleeding from swollen blood vessels in the gastrointestinal tract.

Liver Cirrhosis: Symptoms

• General symptoms: Severe fatigue, loss of appetite, nausea, vomiting, weight loss.
• Liver-related symptoms: Enlarged liver, gallstones, yellowing of the whites of the eyes (jaundice), swollen feet, abdominal fluid buildup (ascites), reduced albumin levels in the blood, increased ammonia levels in the blood, esophageal varices (enlarged veins in the esophagus) and the palm of the hand becomes red.

Liver Cirrhosis: Causes and Progression

• Many factors can cause liver cirrhosis, some are unknown, and often it takes years for cirrhosis to develop.
• Cirrhosis progression varies depending on the type and severity of the initial condition affecting the liver (i.e., virus type, activity, level of hepatitis).
• Factors can include viral infections, toxic substances (drugs, pollution, preservatives, herbs), and medications.

Liver Cirrhosis: Treatment of Ascites

• Ascites: Fluid accumulation in the abdomen.
• Treatment: Includes reducing salt intake, using diuretics (medications to increase urination and get rid of extra fluid), paracentesis (removing abdominal fluid using a needle), and antibiotics.

Liver Cirrhosis: Stages

• First degree (20%): Mild or no visible changes, liver enzymes may be normal in half of the cases.
• Second degree (40%): Noticeable increase in bile in the blood and lower-than-normal albumin levels.
• Third degree (80%): Fibrosis (scarring) is significantly advanced likely to be accompanied by ascites and swelling in the feet.

Liver Cirrhosis: Dietary Management

• Energy (cal/kg body weight): 35-40 calories per kilogram of body weight (adjusts based on carb and fat intake).
• Protein (g/kg): 1.0-1.5 gram per kilogram of body weight (choose easily digestible proteins like egg white or boiled chicken).
• Fat (g/day): 30-40 gram per day (from vegetable sources when liver bile production is low).
• Carbohydrates (percentage): 55-60% of total daily calories (consider bee honey as a source).
• Fluid intake determination strategies: Adjusting fluid intake based on urine excretion.
• Sodium (mg/day): In the absence of ascites, sodium intake is between 1000 and 2000 mg. If there is ascites or edema, sodium intake is restricted to 200-500 mg.
• Hepatic Coma: Restriction of protein is a key consideration.

Hepatic Coma: Management

• Protein restriction: The amount of protein must be determined according to the patient's body weight.
• Protein source: Egg whites and milk are preferred as they contain fewer amounts of ammonia.
• Nutritional support (advanced): In serious cases, tube feeding with glucose and fat supplements may be employed with carefully monitored gradual increases in protein intake.
• Vitamin and mineral supplementation: Patients require vitamins (such as Vitamin B complex) and minerals (iron) to maintain general wellness.

Additional Notes

• The study material does not present full-on dietary prescriptions.
• The information on dietary management provided is essential to avoid potential health problems linked to cirrhosis.