An inflammatory disease of the liver with a chronic course, in which the tissue of the gland is completely rebuilt and its functionality is disrupted, is called portal cirrhosis. This pathology is associated with impaired blood flow in the portal vein system and an increase in pressure in it. Most often, the disease is provoked by alcohol and poor nutrition.

Portal cirrhosis of the liver (atrophic, mulonodular and Laennec cirrhosis) is divided into 3 stages, each of which is manifested by specific symptoms. This life-threatening disease is most often diagnosed in patients between 40 and 60 years of age. When the first suspicious signs appear, you should consult a doctor who will identify the cause of cirrhosis and determine treatment tactics.

Basic information

Portal cirrhosis of the liver (PLC) is one of the most common types of this disease. The pathology is manifested by all the symptoms of portal hypertension, which is characterized by poor circulation and increased pressure in the portal vein.

In this disease, connective tissue grows around the liver lobules.

Reference. According to medical statistics, PCP occurs more often after prolonged and excessive use alcoholic drinks. The risk group includes men aged 40 years and older.

The disease is provoked various factors, after which the structure of the liver tissue changes. There is a proliferation of connective tissue around the liver lobules. After which the functionality of the gland gradually decreases, portal hypertension develops. The disease has a gradual course, especially in the initial stages.

Normally, a central vein is located in the center of each liver lobule. But as the fibrous tissue grows, the vessel moves to the side. As a result, blood circulation is impaired and life-threatening symptoms occur.

Development factors

As mentioned earlier, there are different causes for the development of portal cirrhosis. But most often, the pathology develops after prolonged consumption of strong drinks or against the background of hepatitis B or C.

Portal cirrhosis often occurs after prolonged alcohol abuse

Reference. With regular consumption of alcoholic beverages in a dose of 80 to 160 ml ethyl alcohol Alcoholic liver disease occurs; in the absence of proper therapy, the disease progresses to cirrhosis. 35% of patients who regularly drink alcoholic beverages for 5–10 years were diagnosed with cirrhosis.

Chronic hepatitis also often provokes fibrotic changes in gland tissue. Most often, PCP develops with hepatitis C and B. In addition, the disease is provoked by the following diseases: autoimmune hepatitis in chronic form, sclerosing cholangitis (scarring of the bile ducts), primary cholestatic cholangitis, stricture (narrowing) of the bile ducts, cholestasis (stagnation of liver secretions).

Portal hypertension in cirrhosis can be triggered by the following factors: neoplasms, the presence of adhesions after surgery, blockage of the portal duct (obstruction in the trunk of the portal vein or its branches), blockage of the hepatic veins by a thrombus.

PCP can occur due to a lack of vitamins or proteins in the body. The main causes of vitamin and protein deficiency: congenital developmental anomalies, poor nutrition, frequent hemorrhages, infections. Toxic-allergic reactions can also cause portal cirrhosis.

Symptoms of the preascetic stage

Portal cirrhosis is divided into 3 stages: pre-ascetic, ascetic, cachetic. The clinical manifestations of each phase of the disease are different.

Attention. With portal cirrhosis at stage 1 there may be no signs of this disease or be insignificant.

Digestive disorders are one of the signs of illness

As a rule, cirrhosis is manifested by nasal, esophageal or hemorrhoidal hemorrhages and general weakness of the body.

As the pathology develops, weakness becomes more pronounced, the patient quickly gets tired of minor physical activity and begins to lose weight. The patient complains of digestive disorders: a feeling of heaviness in the abdomen, nausea, excessive gas formation in the intestines.

Some patients exhibit symptoms of hormonal imbalances: decreased potency in men, disrupted menstrual cycles in women. During a medical examination and palpation (palpation), the doctor discovers hypotomegaly (enlarged liver), splenomegaly (enlarged spleen). Sometimes cirrhosis manifests itself only as the last symptoms.

The patient's skin turns pale, and icteric syndrome (yellowing of the skin and visible mucous membranes) is rarely observed at this stage. Telangiectasia appears ( spider veins), palms turn red. Some males experience gynecomastia (breast enlargement), which indicates a hormonal imbalance.

Signs of the ascetic stage

At this stage, all the specific symptoms of cirrhosis appear. The patient's weight decreases, severe weakness appears, he partially loses his ability to work, and ascites occurs (fluid accumulation in the abdominal space). The skin becomes dry and flaky. In some patients, peripheral nerves become inflamed, which is accompanied by pain, loss or decreased sensitivity, paralysis, and paresis.

At the second stage of portal cirrhosis, ascites appears

Important. During the ascetic stage of portal cirrhosis, the patient’s abdominal circumference increases, and dilated veins protrude from under the skin; this symptom is called “head of the jellyfish”.

During percussion (tapping) of the abdomen, a dull sound appears, which healthy people should be loud. In addition, there is a possibility of an inguinal or umbilical hernia due to the increased size of the abdomen.

Hepatomegaly and splenomegaly are observed if the organs can be palpated.

Manifestations during the cachetic stage

At the last stage of PCP, the prognosis for the patient is unfavorable

Attention. At the last stage, the prognosis for the patient is unfavorable; as a rule, death occurs within 6 months to 2 years. At this stage, the patient is emaciated, his abdomen reaches a large size due to ascites.

The patient may die due to exhaustion of the body, hemorrhages from varicose vessels. Patients often fall into a coma and then die.

In addition, the risk of death from concomitant diseases increases, since the exhausted body is not able to fight them. In some cases, death occurs due to blockage of the portal vein by a thrombus.

Establishing diagnosis

If suspicious symptoms appear, you should contact a gastroenterologist or hepatologist. Specialists will collect anamnesis, conduct a visual examination, laboratory and instrumental studies that will help determine the disease and identify its cause.

A clinical blood test will help determine anemia, a decrease in the number of leukocytes and platelets. These indicators indicate an enlarged spleen. Using a hemostasiogram (analysis of blood clotting indicators), a decrease in the prothrombin index is determined, which indicates the likelihood of bleeding. Using blood biochemistry, an increase in the concentration of ALT, AST, alkaline phosphatase (liver enzymes), an increase in the amount of bilirubin, and a decrease in albumin levels are detected. This study also allows you to determine the increase in the following indicators: potassium, sodium, urea, creatinine. In addition, the blood is examined for the presence of antibodies to hepatitis viruses and the concentration of α-fetoprotein is determined.

When the first signs of portal cirrhosis appear, you should consult a doctor

To complement the clinical picture of cirrhosis, instrumental diagnostics are performed. Using ultrasound diagnostics of the abdominal space, the size, shape, and sound permeability of the liver are assessed, and symptoms of increased pressure in the portal vein basin are identified. CT is used for more detailed visualization of the gland, its vessels, and bile ducts. Elastography using the Fibroscan device allows you to determine the elasticity of liver tissue. If necessary, magnetic resonance imaging of the liver and Doppler examination of its vessels are prescribed.

Reference. A biopsy (sampling of gland tissue fragments) will help to definitively establish the diagnosis and determine a treatment regimen. This highly informative study allows you to evaluate the morphological changes in the liver tissue and determine the causes of PCP.

Treatment methods

Treatment begins with identifying the underlying cause of portal cirrhosis. Depending on the origin of the pathology, the doctor draws up a treatment strategy taking into account its stage.

Attention. With portal hypertension and ascites, medical attention cannot be avoided, as these complications are life-threatening.

The liver is capable of repairing itself, but only by early stages diseases. Later, the main goal of therapy is to slow down or stop the destruction of the gland. The patient is prescribed complex treatment, taking into account all the features of the clinical case.

During portacaval shunting, an artificial channel is created between the portal and vena cava to drain blood bypassing the liver.

During therapy, it is necessary to control the amount of salt in the body, since its excess provokes the accumulation of excess fluid. From time to time, the patient is prescribed diuretics to prevent ascites. For the same purpose, it is recommended to follow a diet that involves reducing the amount of salt in the diet and limiting the daily volume of liquid.

From the diet you need to exclude spicy, fatty, fried foods, canned food, sausages, smoked products. This restriction applies to confectionery products, tomatoes, mushrooms, and garlic. The patient should supplement his daily diet with cereals, legumes, and dairy products with a low fat content. It is not prohibited to eat dietary meat (turkey, rabbit). It is recommended to eat apples and natural crackers.

Reference. Meals for PCP should be fractional, that is, the patient eats food 4 to 6 times a day in small portions.

In addition, the patient should take vitamin-mineral complexes, since the synthesis of useful substances in pathology is reduced. Another important condition Therapy means a complete abstinence from alcohol.

Treatment regimen for portal cirrhosis:

• Refusal of excessive physical activity.
• Maintaining bed rest.
• Taking hepatoprotectors. These drugs accelerate the regeneration of liver tissue and protect hepatocytes from negative factors.
• Taking diuretics. Diuretics accelerate the removal of excess fluid during edema and ascites.
• Symptomatic therapy will help get rid of the unpleasant manifestations of PCP.

As part of complex treatment, you can use herbal decoctions, as well as liver preparations. However, before use medicinal herbs you need to consult a doctor.

Reference. To block the mechanism of development of pathology, antiviral drugs (Interferon) and agents that prevent fibrotic changes in liver tissue (Colchicine) are prescribed. The patient must take anti-inflammatory medications (Aziotropin) and immunosuppressants (drugs that suppress the immune system).

To eliminate the symptoms of ascites, portal hypertension and hepatic coma, hepatoprotectors, vitamins, hemostatics, diuretics, and iron supplements are prescribed.

If PCP worsens, the patient is hospitalized. In some cases, a decision is made to perform an operation:

• Portocaval shunting. During the operation, the surgeon creates an artificial channel between the portal and vena cava to drain blood bypassing the liver.
• Laparocentesis is a surgical procedure that involves puncturing the abdominal wall to evacuate fluid.
• Liver transplant from a donor.

These are the main methods of treating PCP, which can be supplemented with preventive measures. Psychotherapy sessions will help you get rid of alcoholism. It is necessary to reduce contact with toxic substances, for example, if the patient works in hazardous work. It is also recommended to eat right and lead a healthy lifestyle.

Complications and prognosis

Portal cirrhosis is most dangerous disease, which in the absence of timely treatment threatens with dangerous consequences:

• Portal hypertension syndrome in cirrhosis can be complicated by bleeding from varices of the esophagus, stomach or anus.
• Ascites is complicated by PCP in more than 50% of patients.

Portal cirrhosis of the liver is complicated by ascites in 50% of patients

Carefully. Acute liver failure requires emergency medical care. The chronic form of the disease provokes severe disorders nervous system. In the absence of proper therapy, liver failure progresses to hepatic coma.

Attention. With PCP, the likelihood of infection, the appearance of a malignant tumor in the liver, or the development of renal failure increases.

The survival prognosis for ascites ranges from 3 to 5 years. With the development of bleeding from varicose veins, death occurs in 30–50% of cases. With profound depression of liver function, death occurs in 80–100% of cases.

Portal cirrhosis of the liver is an incurable disease, but with timely diagnosis and successful treatment of its cause, the patient can prolong his life by 10 years or more. It is important to consult a doctor when the first suspicious symptoms appear, follow a diet, and refuse bad habits and follow your doctor's recommendations. It should be remembered that prevention is the only way to avoid a terrible disease.

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Potential cirrhosis of the liver is the most common type of this disease. It is characterized by all the symptoms of portal hypertension, when blood circulation in the portal vein is disrupted. According to research, the main cause of this serious illness is alcohol abuse. Pathology develops in most cases in men over 40 years of age.

Under the influence of an etiological factor, the structure of liver tissue begins to change. Gradually, connective tissue grows around the liver lobules. Thus, the liver gradually loses its ability to fully perform its functions, and hypertension appears. Symptoms of cirrhosis develop gradually and often go unnoticed in the early stages.

When a person is healthy, in the center of each hepatic lobule there is its own central vein. But if fibrous tissue grows, the vessel is forced to change its position to the side. Naturally, blood flow is radically disrupted. This process causes life-threatening symptoms for the patient.

Symptoms of portal cirrhosis

The clinical picture of the disease mainly consists of manifestations that characterize portal hypertension and complications of this pathological condition. It represents an increase in pressure directly in the area of ​​the portal vein to critical levels - more than 12 mm Hg. Type portal cirrhosis is divided into three main stages, each of which has its own symptoms.

Pre-ascitic stage

This is the time when liver dysfunction is moderate, so manifestations of the disease are absent or mild. Over time, the first “alarm bells” become noticeable:

• Fatigue;
• Weakness;
• Bad feeling;
• Weight loss;
• Nosebleeds.

As portal cirrhosis progresses, the liver becomes increasingly affected. The patient begins to be bothered by severe symptoms of dyspesia, which is characterized by increased gas formation, nausea, and heaviness in the abdomen. There is also a high likelihood of hormonal imbalances. Men's potency decreases, and women notice menstrual irregularities. Upon examination, the doctor notes an increase in liver volume upon palpation, the size of the spleen also changes, but portal hypertension at this stage rarely appears.

Attention: with portal cirrhosis of the liver, jaundice, characteristic of liver pathologies, is extremely rare: the skin remains pale.

Also in men, mammary glands become enlarged due to impaired hormone secretion. Spider veins appear on the skin of patients, which indicates obvious problems with blood circulation and coagulation of the blood itself. The palms and soles of the feet are synchronously red. After passing laboratory tests for portal cirrhosis, the following deviations from the norm are revealed:

• Low levels of total protein in the blood;
• Anemia (lack of hemoglobin);
• Decrease in the amount of albumin;
• Increased concentration of gamma globulins;
• Urobilin in urine;
• In some cases, increased bilirubin.

An additional diagnostic method is x-ray. Thanks to it, portal cirrhosis can be confirmed and treatment prescribed. An X-ray examination can detect dilated veins in the esophagus and stomach, which is characteristic of pathological processes in the liver. Sometimes patients are prescribed rectoscopy to determine the dilation of hemorrhoidal veins.

Ascitic stage

There is already a full range of symptoms here. Treatment is required immediately, since the process is not reversible, and the liver performs less and less of its tasks every day. The main manifestations of this stage:

• Loss of ability to work;
• Constant weakness;
• Weight loss;
• Presence of ascites;
• Portal hypertension;
• Dryness and flaking of the skin;
• Disorders at the level of the peripheral nervous system.

Hemoglobin continues to drop steadily, which is noticeable from the patient’s tests. The level of platelets and leukocytes also decreases. If it is possible to palpate the liver and spleen, they remain enlarged. The abdomen also increases significantly in volume, against this background patients develop hernias, both umbilical and inguinal. The “head of a jellyfish” becomes noticeable on the abdomen, a symptom characteristic of portal cirrhosis when the veins in the abdomen dilate. Due to ascites, the sound when percussing the affected area is dull.

Cachectic stage

This stage of portal cirrhosis is also called terminal. Treatment is aimed at complications of the disease, which during this period are quite life-threatening. The prognosis for patients with ascites is disappointing: they live from six months to two years. The cathectic stage is characterized by severe exhaustion of the patient, portal hypertension and maximum size of ascites. The situation is complicated by esophageal and gastric bleeding. Jaundice may develop or the skin will appear pale.

Treatment of ascites gives a short-term effect: after treatment, the fluid returns over time. Often a person dies not from cirrhosis itself, but from third-party diseases. This is due to the fact that without a healthy liver, the body is unable to fight infections. But most often, death occurs from extreme exhaustion, severe internal bleeding (leading to portal hypertension) or after the onset of hepatic coma.

Causes of the disease

Portal cirrhosis usually develops due to the following factors:

• Most often (about 40% of cases) the disease is caused by banal alcohol abuse. Alcohol (regardless of what type of alcoholic drink it is) leads to the gradual death of liver cells. They are replaced by fibrous tissue, and the organ ceases to fully perform its functions.
• Portal hypertension itself, hypertension or the impossibility of natural blood flow.
• The presence of extrahepatic blockade, adhesions, tumors, thrombosis of the hepatic veins.
• Botkin's disease.
• Impacts of toxic-allergic nature.

Treatment of portal cirrhosis

Treatment of the disease begins with an accurate establishment of its origin. Depending on the etiology, a set of measures is prescribed. The stage must also be taken into account. If it is detected on time, the patient can live 10 years or more, maintaining a healthy lifestyle. It is imperative that all concomitant diseases are treated simultaneously with cirrhosis. Complications such as portal hypertension and ascites require medical intervention, as they are potentially life-threatening.

The liver is an organ that is capable of self-healing. But this is possible only in the very early stages of its defeat. Further treatment of portal cirrhosis is to stop or delay further destruction of the liver and the entire body. A high-quality and long-lasting liver complex is prescribed, taking into account all the features of the clinical case.

Be sure to monitor the level of salt in the patient’s blood, since if there is too much of it, excess fluid accumulates in the body. At certain intervals, the doctor recommends taking diuretics to prevent ascites. An additional preventive measure is a strict diet with a low sodium content and limited fluid volumes. But food should fully replenish the supply of carbohydrates, fats, and proteins, just like daily norm calorie content. Additionally, vitamins and minerals are prescribed, since their synthesis in the body is reduced.

Preventive measures should complement the basic treatment, including:

• Psychotherapy – it should help, first of all, to get rid of alcohol addiction;
• Excluding the possibility of poisoning by any other toxic substances (for example, in connection with the patient’s professional activities);
• Compliance strict regime in nutrition, and in general - healthy image life.

A patient with liver cirrhosis should be protected from unnecessary stress. The point here is not only that portal hypertension can develop. In general, medical practice confirms that excessive physical activity of the patient has an adverse effect on the course of the disease. Researchers have also proven the fact that it is possible to increase blood supply to the liver and increase enteroportal blood flow by observing bed rest. A quiet life will also help launch natural regeneration processes.

To improve the metabolism of hepatocytes, the patient is prescribed specific treatment. It consists of taking glucocorticosteroid hormones. Your doctor will tell you exactly how and in what quantity to take these medications. All drug therapy for portal cirrhosis is divided into two main groups:

• Pathogenetic and etiotropic treatment consists of taking antiviral drugs (this is interferon), and drugs that help prevent the formation of scar tissue in the liver (for example, colchicine). Anti-inflammatory drugs (azathioprine and glucocorticosteroids) and immunosuppressants are also necessary.
• Symptomatic therapy can prevent complications such as ascites, portal hypertension, and hepatic coma. These are hepatoprotectors, vitamins, hemostatic drugs, diuretics, iron. The list of medications in the course is selected individually.

Portal cirrhosis of the liver requires not only treatment, but also mandatory abstinence from alcohol. If the patient continues to take alcohol, the organ will completely collapse. If you need to consult with a competent specialist, be sure to write to us. We will quickly answer your question.

– the most common form of this disease, characterized by damage to liver tissue with its replacement by fibrous fibers and death of hepatocytes. These changes occur as a result of the influence of a number of morphological factors, the leading positions among which are alcohol abuse and poor nutrition. Although Botkin's disease can also cause liver dysfunction, according to statistics, it causes cirrhosis in only 20% of cases.

Most often, portal cirrhosis affects older people: from 40 to 60 years. Moreover, males are twice as susceptible to this pathology as females. In medicine, you can also find other names for portal types of cirrhosis, for example, alcoholic, septal, fatty, Linek's cirrhosis.

The disease proceeds latently, the symptoms are blurred, as in the initial stages of other cirrhosis.

The clinical picture is similar to the manifestations of chronic hepatitis:

The patient complains of digestive disorders: he suffers from heaviness and bloating, cannot tolerate fats and spicy foods, and loses his appetite. Frequent diarrhea may be replaced by constipation, which intensifies;

The pain is localized in the right hypochondrium and tends to intensify after eating, as well as after physical activity. The nature of the pain is aching, not sharp;

There is a general feeling of poor health, weakness and fatigue;

The liver is compacted and painful, its sharp edge can be felt, the spleen is enlarged;

Spider veins form throughout the body and face, characteristic of the palms. These signs occur early in the disease;

Unexpressed yellowing of the skin is rarely observed, in no more than 12% of patients;

As the disease progresses, the patient begins to lose body weight and signs of hypovitaminosis appear;

The skin begins to itch and scratches appear;

Hemorrhoids and nasal problems may occur;

Collaterals are dilated veins that appear from under the skin of the abdomen, often located in the navel area and diverge from it in different directions.

The final stage is characterized by the appearance of severe complications; gastric and intestinal bleeding may occur. It is at this stage that jaundice develops, the risk fatal outcome increases if organ transplantation is not performed. It should be noted that portal cirrhosis can develop over a long period of time and begin to bother the patient only after 20 years. In this form of the disease, it is advisable to distinguish three stages: pre-ascetic, ascetic and cachectic. As they pass, the patient's condition worsens more and more.

Causes of portal cirrhosis of the liver

The reasons for the development of this form of cirrhosis may be as follows:

The root cause of the development of portal cirrhosis is alcohol abuse. Frequent drinking of alcoholic beverages, regardless of their type, leads to the fact that liver cells gradually die, and its tissue is replaced by connective tissue, and the organ is no longer able to perform its functions to the required extent;

Portal hypertension, or increased pressure in the portal vein and the inability of normal blood flow. May be caused by growth, formation of adhesions after surgery, development of extrahepatic blockade, thrombosis of the hepatic veins;

Vitamin and protein deficiency caused by congenital malformations, inattention to nutrition, frequent bleeding or infectious diseases;

Toxic-allergic effects on the body;

Hepatitis.

Treatment of the disease should be based on its etiology. In addition, the stage of development of the pathology, the degree of necrotic activity of cirrhosis and the presence of concomitant diseases will have a significant influence on the course of the therapeutic effect.

It is necessary to control the amount of salt that the patient consumes, since sodium chloride promotes fluid retention in the body. Periodically, the patient will need to take diuretics. In this regard, a diet with limited fluid and salt is no less important. At the same time, the diet should provide the patient with the necessary amount of calories and replenish the reserves of fats, proteins and carbohydrates.

Since the synthesis of vitamins in portal cirrhosis is reduced, the patient is recommended to take vitamin-mineral complexes.

It is necessary to carry out preventive measures with patients aimed at eliminating complications of the disease, which is especially important in the early stages of cirrhosis:

Firstly, this is psychotherapy, the goal of which is to relieve addiction and completely eliminate alcoholic beverages from the patient’s life;

Secondly, it is avoiding the possibility of poisoning with other toxic substances, for example, at work;

Thirdly, it is adherence to a diet and a healthy lifestyle in general.

It is important that the patient is not exposed to significant physical exertion, since medical practice indicates that overexertion significantly aggravates the course of cirrhosis. In addition, it has been scientifically proven that bed rest enhances blood supply to the liver, increases enteroportal blood flow and triggers regeneration processes.

Treatment of cirrhosis with drugs is divided into two large groups:

Symptomatic therapy: taking hepatoprotective membrane-stabilizing agents (Essentiale Forte, LIV-52, etc.), vitamin therapy (vitamins B12, B6, ascorbic acid, rutin, etc.), diuretics (Furosemide, Lasix, Veroshpiron), hemostatic agents (Vikasol, Vitamin K, calcium chloride), iron supplements (Sorbifer Durules). The choice of a specific drug will depend on the nature of the disease and its clinical manifestations;

Pathogenetic and etiotropic therapy comes down to taking antiviral drugs (interferon), drugs aimed at preventing the formation of scar tissue (colchicine), immunosuppressive drugs and anti-inflammatory drugs (glucocorticosteroids and azathioprine).

The most important thing in treating portal cirrhosis is preventing a return to alcoholism and maintaining a healthy lifestyle.

Education: Diploma of the Russian State Medical University named after. N.I. Pirogov, specialty “General Medicine” (2004). Residency at the Moscow State Medical and Dental University, diploma in Endocrinology (2006).

Portal cirrhosis of the liver occurs relatively often: according to our data, in 40% of all cases of liver cirrhosis.

This morphological type of cirrhosis develops due to the influence of many hepatotropic factors. The leading place among them belongs to eating disorders and alcoholism. In 39% of the patients with portal cirrhosis we observed, the undoubted cause was Botkin's disease.

Portal cirrhosis is observed mainly in elderly people. Among our patients, three quarters were over 50 years of age.

Manifestations of the initial stage of portal cirrhosis are almost identical to the symptoms of chronic hepatitis. First of all, these are dyspeptic complaints: fat intolerance, a feeling of fullness and heaviness in the epigastric region after eating, bloating, loss of appetite. Often bowel disorders are constipation followed by diarrhea. Often such patients are treated for several years as suffering from chronic gastritis or colitis. Half of the patients experience dull, aching pain in the right hypochondrium, worsening after eating or physical exertion. General health is disrupted early. Patients complain of weakness, adynamia, and psychasthenic states are detected. An enlarged, dense liver with a sharp edge can be felt in at least 85% of patients in the initial stage of the disease. An enlarged spleen is also often palpated. As it progresses, it becomes less and less possible to identify both the liver and spleen. The latter is caused by both a true reduction in the size of the liver and the appearance of flatulence and ascites, which make palpation of the organs difficult. In such cases, percussion examination and the balloting technique help.

Spider veins and palmar erythema are observed in a third of patients already in the initial stage of portal cirrhosis. Often they are the only symptom that attracts the doctor’s attention to liver disease. Unlike other types of cirrhosis, manifestations of portal hypertension are observed in almost a third of patients already in the initial stage of the disease. In the same time external signs liver dysfunction is rare. Slight jaundice in the initial stage of portal cirrhosis is observed in only 12% of patients, and only in cases etiologically related to Botkin's disease. As it progresses, the syndrome of portal hypertension becomes more prominent. In the stage of established portal cirrhosis, ascites is observed in 78% of patients, in the final stage - in all. Along with ascites, hydrothorax is often observed, and swelling in the lower extremities also occurs. More than half of the patients have esophageal varicose veins and hemorrhoids; Esophageal bleeding is also common, often followed by hepatic coma. Visible venous collaterals develop in the skin of the anterior abdominal wall. Sometimes particularly severely dilated veins and an audible vascular noise appear in the navel area, known as Cruvelier-Waumgarten syndrome. Vascular murmur and tremors that can be felt by the hand can occur not only in the navel area, but also over other highly dilated veins. We observed these phenomena over venous varicose veins that usurized the xiphoid process.

Along with the progression of portal hypertension, signs of endogenous dystrophy appear: emaciation, signs of polyhypovitaminosis. In some cases, peripheral neuritis occurs as a consequence of thiamine deficiency. Sometimes hemeralopia and hyperkeratosis are detected, indicating hypovitaminosis A. Symptoms of endocrine disorders are also characteristic, such as loss of hair in the axillary and pubic areas, sometimes testicular atrophy, gynecomastia (often one-sided). True, this does not occur too often and mainly in young patients. In persons who became ill in early age, secondary sexual characteristics do not develop, patients become infantile. The latter is associated with a shift in the androgen-estrogens ratio in favor of estrogens (I. Magyar, 1962). More frequent manifestations of a violation of this ratio are stellate telangiectasia and palmar erythema, observed in the final stage of portal cirrhosis in 70% of cases.

In portal cirrhosis, hematological changes are significant. Hypochromic anemia was found in half of the cases. Contrary to existing guidelines, we never found macrocytic anemia. This is apparently explained by the fact that in modern conditions, patients with liver cirrhosis were intensively saturated with vitamin B12.

The appearance of anemia is caused by bleeding and severe hypersplenism. There is an obvious tendency towards leukopenia and thrombocytopenia. Severe hypersplenism syndrome (a combination of anemia, leukopenia and thrombopenia) is observed in more than one third of cases.

The frequency of these hematological changes increases as the disease progresses. ROE is accelerated in the vast majority of cases. It is generally accepted that portal cirrhosis is characterized by hypothermia. In a number of patients this actually occurs. But along with this, in approximately a quarter of cases, fever is detected due to the activity of the cirrhotic process.

Indicators of biochemical studies depend on the activity and stage of development of the disease. In portal cirrhosis, progression of the process into the first two stages is much less likely than in postnecrotic cirrhosis and affects the functional state of the liver. The degree of dysfunction is usually not so great either. Severe manifestations of hepatocellular failure, as a rule, appear only in the final stage of the disease.

Bilirubinemia occurs only in half of the cases of exacerbation of the cirrhotic process, and rarely the bilirubin content in the blood serum exceeds 3 mg% according to van den Berg.

A high degree of bilirubinemia is observed only in the final stage of portal cirrhosis and is prognostically unfavorable.

Urobilinuria is almost always detected during the active phase of the disease. The prothrombin index, as a rule, is reduced in the active phase, and in half of the cases - in the inactive phase, even in the first two stages of portal cirrhosis.

The results of tests with a sugar load and the Quick-Pytel test are very inconsistent; they usually become positive already with severe decompensation.

Whey proteins undergo significant changes.

The tendency towards hyperproteinemia, expressed in the initial stage of portal cirrhosis, gives way to hypoproteinemia as it progresses. Low protein levels in the blood serum are determined only in patients with ascites.

The progression of portal cirrhosis is characterized by a decrease in serum albumin and an increase in gamma and beta globulins. With the subsidence of the activity of the cirrhotic process in its initial stage, the serum protein formula is restored to normal; in later stages, changes in the proteinogram persist more and more persistently.

Sedimentary reactions are often positive due to the presence of severe dysproteinemia.

It is of interest to study some hormonal substances, such as glucocorticoids and estrogens. Studying them allows us to clarify the state of some physiological systems (in particular, the pituitary-adrenal system), which are essential in the pathogenesis of liver cirrhosis. Zondek (1934) found that estrogens are inactivated by the liver, and when it is damaged, this function is impaired. The evidence is an increase in the content of free (unbound) estrogen in the urine (Glass et al., 1940; Dochan et al., 1952; T.N. Zabelina, 1963), and T.N. Zabelina (1963) showed that violations of estrogen inactivation are detected early, even in the precirrhotic stage, in the absence of any other manifestations of chronic liver disease.

Numerous studies (Dochan et al., 1952; Warter et al., 1953; E.V. Krutskikh, 1961, etc.) have shown that in patients with chronic hepatitis, the excretion of 17-ketosteroids in the urine decreases. A decrease in the excretion of 17-ketosteroids in the urine is caused not only by a violation of the inactivation of steroid hormones, established by Vermenlen and Demeulenare (1956), but, in contrast to acute hepatitis, and by suppression of the adrenal cortex (Wahi, Ramachandran, 1958; E.V. Krutskikh, 1961) .

These changes occur in liver cirrhosis, regardless of morphological type, but with portal cirrhosis, due to its long course, they manage to be realized in clinical manifestations, such as the disappearance of secondary sexual characteristics, gynecomastia, testicular atrophy, etc.

The course of portal cirrhosis varies.

In the vast majority of cases, portal cirrhosis develops and progresses slowly over several years. There are cases of a very long course - up to 10 and even 20 years.

The outcome of the disease largely depends on the stage at which treatment is started. E. N. Ter-Grigorova (1963) emphasizes that the process is reversible at the initial stage. In her opinion, incipient portal cirrhosis more often undergoes reverse development than evolves into full-blown cirrhosis. Even at the stage of established portal cirrhosis, the patient can be saved from life-threatening manifestations of portal hypertension by timely and rational surgical intervention. Early and vigorously administered therapy can achieve, if not reverse development, then long-term stabilization of the pathological process. And yet, the outcome of the disease remains unfavorable.

Prognostically unfavorable are the rapid development of hepatocellular insufficiency, a sharp decrease in liver size, the occurrence of massive esophageal-gastric bleeding, oliguria, and exhaustion.

The prognosis is significantly worsened by the appearance of complications. The most common of them include intercurrent infections (bronchopneumonia, peritonitis, tuberculosis), glomerulonephritis, peptic ulcer. The most severe complication is portal vein thrombosis, which, according to various sources, occurs in 1% (A. L. Myasnikov, 1956) to 13% (Hunt, Whittrad, 1954) of cases. More than 4% of patients with portal cirrhosis may develop primary liver cancer (Patek, 1956).

The death of patients with portal cirrhosis more often occurs from complications than from “pure” liver failure. According to Patek (1956), who summarized a large amount of material from various researchers, the cause of death was liver failure in 15-50% of all fatal cases, bleeding in 20-40% and intercurrent infections (especially pneumonia and peritonitis) in 10-25%. cases. Postoperative mortality in patients with liver cirrhosis remains high.

When we talk about portal cirrhosis, we mean a set of complications that affect the worsening of cirrhosis. In addition to the growth of fibrous or connective tissue in the liver, disruption of the portal vein is associated. It is the main “supplier” of blood to the organ. An increase in blood flow leads to serious consequences for the patient.

According to the data clinical trials There are 3 types of portal hypertension. It is important to understand that all types affect not only the blood supply to the liver and the nutrition of its tissues due to beneficial substances in the bloodstream. In addition, the blood supply to other organs of the gastrointestinal tract is disrupted.

Prehepatic portal hypertension	Intrahepatic	Posthepatic
· Congenital pathologies of the formation of the portal vein or its complete absence; · Anatomical fusion of artery and vein; · Narrowing of the lumen of the portal vein by a neoplasm; · Thrombosis.	· Polycystic disease; · Non-infectious hepatitis; · Sarcoidosis; · Tuberculosis; · Schistosomiasis; · Metastases; · Billiary cirrhosis of the primary type.	· Failure of the right ventricle of the heart; · Confluence of vein and artery at the site of passage through the liver; · Obstruction of the inferior vena cava; · Persistent hypertension in the portal vein.

In any of the types, portal cirrhosis is accompanied by an increase in blood circulation in the liver. And in 95% of cases, the reasons do not depend on a person’s lifestyle. Often the causes are independent factors, such as incorrect anatomical structure of the vein during fetal formation. In this case, the destructive process for the liver develops gradually, and symptoms become noticeable with extensive liver damage.

Symptoms and signs of the disease

Portal cirrhosis has a blurred picture of the disease, in which there are no symptoms that accurately indicate liver damage. This is the “distinctive card” of portal cirrhosis from other types of cirrhosis. Only on the basis of diagnostic data is it possible to confirm the presence of the disease.

The patient has a significant enlargement of the spleen, which can only be detected during examination. Increased pressure in the portal vein during cirrhosis causes abnormalities in other massive veins of the body: the veins of the esophagus and stomach. Along with this, the anus also suffers - the veins increase in size, itch, hurt and can cause spontaneous bleeding.

Due to hypertension, it leaks into the abdominal cavity through the walls of blood vessels and veins. a large number of liquids. She remains in the abdominal cavity and is unable to evacuate on her own. The stronger the pressure in the portal vein and the thinner the walls of the vessels, the more fluid seeps into the abdominal cavity, causing pain near the navel. This phenomenon is called ascites.

Dyspeptic disorders are also signs of the disease. The patient's appetite decreases on a constant basis, which is why patients are exhausted. Bloating, rumbling and rumbling sounds in the stomach indicate digestive problems.

Diagnostics

Based on complete blood, urine and stool tests. In case of portal cirrhosis, an examination of the esophagus and stomach is required to determine the condition of the veins. Ultrasound is used to check the condition of the liver, spleen and the presence of free fluid in the abdominal cavity.

To check the blood flow in the portal vein, an X-ray, CT or MRI with mandatory contrast is performed. Dopplerography of the vessels and veins of the lower extremities makes it possible to assess the patency of the venous complex.

The number of diagnostic measures depends on the patient’s complaints, accompanying symptoms and the neglect of the process. If portal cirrhosis is accompanied by chronic diseases, a consultation with a specialized specialist is scheduled to create a safe and effective drug therapy plan.

Description of the microslide

Constant plethora internal organs leads to changes in their tissue structures. This process is called nutmeg liver and occurs in three stages, when first the organ becomes denser and becomes enlarged. On a section, such a liver looks like a nutmeg, due to the variegated color of the cells with dark areas where stagnant blood accumulates.

In the middle stage, red fibrous veins with gray areas of fibrous tissue are visible on the microslide section. The liver becomes denser and enlarged. The final stage is called cardiac congestive cirrhosis, because in addition to the appearance of tuberosity of the liver, thickening of the heart muscle occurs.

Treatment of portal cirrhosis

Includes complex therapy aimed at eliminating the causes of atrophy in cirrhosis. Therefore they appoint medications to reduce pressure in the portal or inferior vena cava:

• To reduce the number of heart contractions, beta-blockers are prescribed. At the same time, the strength of myocardial contractility decreases;

• Nitrates tone the vascular wall, due to this, stagnant blood flows into the central channel and the pressure in the portal vein decreases;

• To narrow the lumen of the arteries, Terlipressin or Vasopressin is used;

• If hemorrhages are detected, Octreotide injections are prescribed. It is able to partially stabilize the pressure in the portal vein;

• Diuretics reduce the amount of excess fluid in the body and bloodstream, lowering blood pressure naturally.

It is important that drugs for narrowing the arteries can only be taken during hospitalization and supervision of medical personnel. These medicines dangerous due to the development of ischemia of the myocardium or intestine. In the treatment of portal hypertension in cirrhosis, many toxins and unnecessary substances accumulate in the liver and intestines. To remove them, use Lactulose or other laxatives to cleanse the intestines of toxins.

If necessary, surgery is performed to remove areas of varicose veins. When diuretics are prescribed, the amount of ascites also decreases. If diuretics do not cope with the task, the fluid is evacuated by installing drainage. If the treatment for cirrhosis is ineffective, a liver transplant is performed.

In addition to drug therapy, a diet aimed at cleansing the body is used. The diet is dietary, excluding the consumption of a large number of foods familiar to the patient. The diet is indicated not only during treatment and in the hospital, but also after it a person has to change his diet in order to prevent complications.

Complications and prognosis

Portal hypertension syndrome is fraught with massive bleeding and hemorrhage. If the symptoms and signs of bleeding are not noticed in time, the patient can die in a fairly short time. Atypical cell functioning and the proliferation of fibrous tissue contribute to the development of oncology. When the organ is severely damaged, a common complication is hepatic coma.

Extrahepatic portal hypertension develops and is treated with beneficial consequences. If the liver is affected in the process, the outcome is often unfavorable, leading to death. Surgical treatment of cirrhosis can prolong the patient’s life by 10-20 years with continued diet and taking all necessary medications.