Normal count for liver: Fatty Liver Disease (NASH) Symptoms, Treatment, Causes & Diagnosis
12 Health Risks of Chronic Heavy Drinking
Alcohol and Health Risks
Alcohol consumption can cause numerous diseases. Many people know that heavy drinking can lead to cirrhosis of the liver and is a leading cause of automobile accidents. But did you know chronic drinking can also lead to cancer and heart attack? Read on to find out consequences of heavy drinking.
Excessive alcohol use can affect the hematologic system, which is made up of the blood, spleen, bone marrow, and the liver. It can cause your red blood cell count to be abnormally low, which is a condition called anemia. Symptoms of anemia include fatigue, shortness of breath, and lightheadedness.
Chronic alcohol drinking can increase your risk for developing cancer. The body converts the alcohol you drink into acetaldehyde, which is a known carcinogen (substance that causes cancer). Cancers often found in heavy drinkers include those of the mouth, pharynx (throat), larynx (voice box), esophagus, liver, breast, and colorectal region. Many heavy drinkers also smoke, which further increases cancer risk.
3. Cardiovascular Disease
Heavy drinking and binge drinking can cause heart disease or stroke. It can raise the levels of fats in the blood (triglycerides), lead to high blood pressure, and stroke. It can also cause cardiomyopathy (weakening of the heart muscle), and the heart-rhythm abnormalities atrial and ventricular fibrillation.
Alcohol causes inflammation of the liver, and chronic drinking can cause scarring of liver tissue that leads to cirrhosis, a potentially fatal condition in which the liver is so scarred it can no longer function. The risk increases the longer you have been drinking. Not all heavy drinkers will develop cirrhosis, though it seems to run in families, and women get it more often than men.
Heavy drinking can affect the brain and can lead to memory loss and some symptoms of dementia. Alcohol-related brain damage can mirror some symptoms of dementia, like poor judgment and difficulty in decision-making. Heavy alcohol drinking over a long period of time may result in Korsakoff’s syndrome, a condition in which people may suffer short-term memory loss. In addition, heavy drinking may result in nutritional deficiencies that can also lead to symptoms of dementia.
Alcohol abuse and depression are often associated. In some cases, people are depressed and turn to alcohol to self-medicate. However, studies show that many people who drink heavily develop depression.
Heavy or binge drinking, or alcohol withdrawal, can lead to a form of epilepsy called status epilepticus, or an acute, prolonged epileptic seizure, which is a life-threatening condition. Excessive alcohol use can also trigger epilepsy in some people who did not have the condition before they started drinking. Some epilepsy medications may make you more sensitive to the effects of alcohol, and alcohol may interfere with some medications used to treat epilepsy.
Gout is a type of arthritis caused by the formation of uric acid crystals in the joints. It can be very painful. Alcohol intake may increase the risk of developing gout, particularly in men, and beer seems to cause the condition more than other types of alcohol. If you already have gout, drinking alcohol may worsen your symptoms.
9. High Blood Pressure
Alcohol can cause high blood pressure (hypertension). The more alcohol a person drinks, the greater their risk for developing high blood pressure. Hypertension can become chronic, and can lead to other medical conditions including heart disease, stroke, and kidney disease.
10. Infectious Diseases
Excessive alcohol use can weaken the immune system, and make it easier for you to get infections. Chronic drinkers are more likely to contract diseases such as tuberculosis, pneumonia, HIV/AIDS, and sexually transmitted diseases (STDs). STDs are a concern because heavy drinkers are also more likely to engage in risky sexual behaviors. Even binge drinking on one day can affect your body’s ability to fight off infection for up to 24 hours.
11. Nerve Damage
Alcoholic neuropathy is a form of nerve damage caused by heavy drinking. The combination of alcohol being toxic to nerve cells, combined with the poor nutrition that often accompanies alcohol abuse is believed to cause this condition. Symptoms include numbness, tingling and pain, muscle weakness usually in the extremities, loss of bladder or bowel control, impotence, diarrhea, nausea and vomiting, or constipation.
Heavy drinking can lead to pancreatitis, which is a dangerous condition involving inflammation of the pancreas. Symptoms may include acute abdominal pain, nausea, and vomiting. Chronic pancreatitis from chronic drinking may lead to malabsorption of nutrients and diabetes.
Chronic heavy alcohol use can have many damaging effects on the body. Talk to your doctor about ways to cut down on your drinking or stop drinking entirely to reduce your chances of developing health complications from drinking.
Liver function tests (LFT) | Health Navigator NZ
A liver function test (LFT) is a blood test that measures the levels of several substances (enzymes and proteins) excreted by your liver. Levels that are higher or lower than normal can indicate liver problems.
- The liver function test (LFT) is also called a hepatic function panel (hepatic refers to the liver).
- The liver function test is not done routinely, but is requested to establish the presence of damage or inflammation in your liver.
- To perform a liver function test, a blood sample is drawn from a vein in your arm and collected in a tube. This tube is sent to the laboratory for analysis.
What is a liver function test (LFT)?
The liver function test measures the levels of different substances (enzymes and proteins) excreted by your liver, such as:
- alanine aminotransferase (ALT)
- alkaline phosphatase (ALP)
- aspartate aminotransferase (AST)
- gamma-glutamyl transferase (GGT)
- total protein.
When is a liver function test done?
A liver function test is not done routinely but is requested in certain situations, to establish the presence of damage or inflammation in the liver. Your doctor may ask for this test to be done to:
- screen for potential liver problems or infections affecting your liver, such as hepatitis A, hepatitis B and hepatitis C
- help in the diagnosis of other conditions such as gallstones
- monitor the progression and severity of liver disease and to determine how well a treatment is working
- monitor side effects if you are taking prescription or non-prescription medicines that can affect liver functioning.
How do I prepare for a liver function test?
For the most part, you don’t need to do anything before having this test. It can be done at any time of the day. Some medicines may affect the test so tell your doctor about all prescription and non-prescription medicines (such as herbal products) you take.
How is the sample collected for testing?
A blood sample is taken by a needle placed in a vein in your arm. An elastic band is wrapped around your upper arm. It may feel tight for a few seconds. You may feel nothing at all from the needle, or you may feel a small brief sting or pinch. The blood sample is collected in a tube, which is sent to the laboratory for analysis.
What do my results mean?
Interpreting liver function test results is not always easy and is best done in consultation with your healthcare team. They will know what is normal for you and how these results relate to your clinical picture. Often, if there is a mild abnormality, all that may be needed is to repeat the test in a month or two’s time as many changes can be temporary and return to normal.
On its own, a liver function test cannot usually provide a definitive diagnosis of a condition, but it can provide important clues about possible problems with your liver
- Alanine aminotransferase (ALT) – when your liver is damaged, ALT is released into your bloodstream and levels increase.
- Alkaline phosphatase (ALP) – higher than normal levels may indicate liver damage or disease, such as a blocked bile duct, or certain bone diseases.
- Aspartate aminotransferase (AST) – an increase in AST levels may indicate liver damage or disease.
- Bilirubin – bilirubin is produced during the normal breakdown of red blood cells. Raised levels of bilirubin (called jaundice) may indicate liver damage or disease.
- Albumin and total protein – lower than normal levels of albumin and total protein may indicate liver damage or disease.
- Gamma-glutamyl transferase (GGT) – higher than normal levels may indicate liver or bile duct damage.
The following is further reading that gives you more information on the full blood count test. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.
Blood test safety information Labtests, NZ
Liver function tests Patient Info, UK
Lab tests online Australasian Association of Clinical Biochemists
Higher Level of SGPT Risks | Causes | Symptoms
What is Higher Level of SGPT?
SGPT exists predominantly in the liver and leaks into the bloodstream when produced in excess. The SGPT normal range is about 7 to 56 units per liter of blood serum. Thus, very high level of SGPT in the blood can be an indication of damage or problems related to the liver. Certain diseases like cirrhosis and hepatitis raise the blood serum SGPT levels, so do specific medications including statin used to lower cholesterol.
What Causes High SGPT?
There are many conditions and diseases, which can result in increased SGPT level.
- Drinking Alcohol
- Acute viral hepatitis A and B
- Celiac disease
- Heart attack
- Hepatitis C
- Epstein-Barr virus
- Gallbladder inflammation (cholecystitis)
Symptoms of High SGPT Level:
The high SGPT level symptoms include –
- Vomiting and nausea
- Leg swelling
- Shortness of breath
- Excessive bleeding or bruising
If you find these warning signs, you need to immediately consult your doctor and undergo SGPT blood test which will help you know whether your SGPT level is normal.
To reduce the SGPT level, diet modifications are needed. Your daily diet should consist of at least one fruit containing vitamin D. Alternatively, you can simply stand out in the sunlight for at least 20 minutes per day to get vitamin D. Couple it with some exercises that will help you stay healthy.
It is always recommended to have a regular whole body checkup with your doctor. The signs and symptoms of high SGPT level may not be noticeable immediately and hence, it is always better to have a preventive approach rather than taking action after the high-level findings. You can get the SGPT blood test done in a renowned hospital where it is a part of preventive health checkups.
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Liver function tests – Lab Tests Online AU
Liver Function Tests (LFTs) may be used to screen a person for liver damage, especially someone who has a condition, or is taking a drug, that may affect the liver.
LFTs or one or more component tests may be used to help detect liver disease if a person has symptoms that indicate possible liver dysfunction or if a person is being monitored or treated for a known condition or liver disease. A bilirubin test, for instance, may be ordered to evaluate and monitor a jaundiced newborn.
Abnormal tests on a liver function tests panel may prompt a repeat analysis to see if the elevation or decrease persists and/or may indicate the need for additional testing to determine the cause of the liver dysfunction.
The group of tests may also be ordered to monitor liver function and the effectiveness of treatment in someone who has a liver disease.
LFTs, or one or more components, may be ordered when someone is at risk for liver dysfunction. Some examples include:
- people who have a history of known or possible exposure to hepatitis viruses
- those who are heavy alcohol drinkers
- individuals whose families have a history of liver disease
- people who take drugs that might occasionally damage the liver
LFTs may be ordered when a person has and of liver disease. Some of these include:
- Weakness, fatigue
- Loss of appetite
- Nausea, vomiting
- Abdominal swelling and/or pain
- Dark urine, light coloured stool
- Itching ()
Usually no one single set of liver tests are used to make a diagnosis. Often, several LFTs will be ordered over a few days or weeks to determine if a pattern is present and to help determine the cause of the liver disorder.
When liver disease is detected, it may be monitored on a regular basis over time with the LFTs or with one or more of its components. LFTs may also be ordered regularly to monitor the effectiveness of treatment for the liver disorder.
LFT results are not diagnostic of a specific condition; they indicate that there may be a problem with the liver. In a person who does not have symptoms or identifiable risk factors, abnormal liver test results may indicate a temporary liver injury or reflect something that is happening elsewhere in the body – such as in the skeletal muscles, pancreas, or heart. It may also indicate early liver disease and the need for further testing and/or periodic monitoring.
Results of LFTs are usually evaluated together. Several sets of results from tests performed over a few days or weeks are often assessed together to determine if a pattern is present. Each person will have a unique set of test results that will typically change over time. A doctor evaluates the combination of liver test results to gain clues about the underlying condition. Often, further testing is necessary to determine what is causing the liver damage and/or disease.
The table below shows examples of some combinations of results that may be seen in certain types of liver conditions or diseases.
Type of liver condition or disease
ALT and AST
ALP and GGT
liver damage (due, for example, to infection, toxins or drugs, etc. )
Normal or increased usually after ALT and AST are already increased
Usually greatly increased; ALT is usually higher than AST
Normal or only moderately increased
forms of various liver disorders
Normal or increased
Normal to slightly increased
Normal or increased
AST is usually higher than the level of ALT
Normal or moderately increased, GGT markedly increased
May be increased but this usually occurs later in the disease
AST is usually higher than ALT but levels are usually lower than in alcoholic disease
Normal or increased
Bile duct obstruction, cholestasis
Normal or increased; increased in complete obstruction
Normal to moderately increased
Increased; often greater than 4 times what is normal
Usually normal but if the disease is chronic, levels may decrease
Cancer that has spread to the liver (metastasized)
Normal or slightly increased
Usually greatly increased
Cancer originating in the liver (hepatocellular carcinoma, HCC)
May be increased, especially if the disease has progressed
AST higher than ALT but levels lower than that seen in alcoholic disease
Normal or increased
Normal or increased
Normal or slightly increased
Normal or decreased
If a person is taking drugs that may affect their liver, then abnormal test results may indicate a need to re-evaluate the dosage or choice of medication. When a person with liver disease is being monitored, then the doctor will evaluate the results of the liver panel together to determine if liver function in worsening or improving. For example, increasingly abnormal bilirubin, albumin, and/or PT may indicate a deterioration in liver function, while stable or improving results of these tests may indicate liver function preservation or improvement.
For individual tests:
Alanine aminotransferase (ALT)
A very high level of ALT is frequently seen with acute hepatitis. Moderate increases may be seen with chronic hepatitis. People with blocked bile ducts, cirrhosis, and liver cancer may have ALT concentrations that are only moderately elevated or close to normal.
Alkaline phosphatase (ALP)
ALP may be significantly increased with obstructed bile ducts, liver cancer, and also with bone disease.
Aspartate aminotransferase (AST)
A very high level of AST is frequently seen with acute hepatitis. AST may be normal to moderately increased with chronic hepatitis. In people with blocked bile ducts, cirrhosis, and liver cancer, AST concentrations may be moderately increased or close to normal. When liver damage is due to alcohol, AST often increases much more than ALT (this is a pattern seen with few other liver diseases). AST is also increased after heart attacks and with muscle injury.
Bilirubin is increased in the blood when too much is being produced, less is being removed, due to bile duct obstructions, or to problems with bilirubin processing. It is not uncommon to see high bilirubin levels in newborns, typically 1 to 3 days old.
Albumin is often normal in liver disease but may sometimes be low due to decreased production.
Total protein is typically normal with liver disease.
Gamma-glutamyl transferase (GGT)
A GGT test may be used to help determine the cause of an elevated ALP. Both ALP and GGT are elevated in bile duct and liver disease, but only ALP will be elevated in bone disease. Increased GGT levels are also seen with alcohol consumption and often in patients taking some drugs that are metabolized in the liver such as carbamazepine and phenobarbitone.
Prothrombin Time (PT)
A prolonged or increased PT can be seen with liver disease, vitamin K deficiency, and with coagulation factor deficiencies.
Tests for liver cancer | Hepatitis C Trust
Hepatocellular carcinoma (HCC or liver cancer) cannot be diagnosed by routine blood tests. There is only one specific blood test which can be used towards a diagnosis of HCC. This test specifically measures for the levels of the protein alfa-fetoprotein in serum (AFP).
Unfortunately only about half of all tumours will give a raised reading of AFP. So a normal AFP test does not exclude the presence of HCC. This is further complicated by the fact that AFP is also produced by proliferating liver cells so somebody with cirrhosis and liver regeneration is likely to have raised AFP levels already. As a consequence doctors will probably want to monitor whether the AFP levels are stable or not. Rising levels of AFP are more likely to indicate HCC.
Even where there is no detectable sign of HCC people with cirrhosis and an abnormal AFP still have a high risk of developing it. Anybody with cirrhosis and an elevated AFP, particularly with steadily rising AFP levels, will most likely either develop HCC or already have an undiscovered HCC.
There is no single imaging technique that will correctly identify all HCC’s. Current techniques each have their strengths and weaknesses.
Ultrasound is usually the first screening test carried out if HCC is suspected. The accuracy of an ultrasound depends very much on the technician or radiologist who performs the scan. Some experienced operators may be able to detect lesions (areas of abnormal tissue) as small as 0.5cm. Others may only be able to identify much larger lesions. An ultrasound has the advantages of not involving ionizing radiation and intravenous contrast material (injecting a chemical into the body to improve the contrast of the imaging). The cost of ultrasound is also lower than other types of scans.
Computerised Tomography (CT) scans
When performed with an enhancing contrast agent CT scans can be just as sensitive as ultrasound. This is because the agent improves the imaging of the arterial and venous systems. CT scans are much less operator-dependent than ultrasound. They also have the advantage of being able to provide images of more areas of the body. CT scans are considerably more expensive than ultrasound and expose people to ionising radiation.
In this procedure a catheter is inserted into the hepatic artery and intravenous contrast material is injected into the liver. It may be useful for evaluating difficult lesions but it also involves ionizing radiation risks, arterial puncture and the administration of contrast agent. Hepatic angiography is usually carried out on people who are considered to be at high risk but who have failed to show any signs of HCC with other imaging studies. At the time of angiography, if a tumour is detected, it may be decided to block the artery feeding the tumour and before injecting anticancer drugs into it (chemoembolisation).
Magnetic Resonance Imaging (MRI)
MRI is becoming increasingly popular for the diagnosis of hepatic tumours. Like a CT scan it can examine large areas of the chest and abdomen in a single session. But because no ionizing radiation is involved the imaging can be repeated many times with little risk. The technology has evolved to the point that the newer MRIs can reconstruct images of the bile ducts, the gallbladder and of the arteries and veins of the liver. The use of intravenous contrast agents significantly increases the sensitivity of the procedure, but also increases the costs. MRI is currently expensive and availability of MRI machines is limited.
The only clear way to tell the difference between a malignant or benign growth is to examine it by removing a sample of tissue and reviewing it under a microscope. This process is called biopsy. A biopsy may be undertaken at the same time as an ultrasound or CT scan.
In this procedure a surgeon places an instrument called a laparoscope (a thin, flexible tube with a camera and light at the tip) into the body via a small cut in the abdomen. The laparoscope allows the surgeon to look directly at the liver to assess for signs of HCC.
FATTY LIVER —- What is fatty liver?
FATTY LIVER —- What is fatty liver?
FATTY LIVER —- What is fatty liver?
What is fatty liver?
Fatty liver is not a disease, but a pathological finding. A more appropriate term is fatty filtration of the liver.
What causes fatty liver?
Fatty liver can be caused by certain chemical compounds, nutritional or endocrine disorders, and by genetic factors. Drugs and chemical compounds
that can cause fatty liver include alcohol, tetracycline, methotrexate, valproic acid, cortisone and cortisone-like medications, carbon
tetrachloride, and other solvents. Of these, alcohol is by far the most common cause. Liver inflammation may accompany exposure to these toxins and
is responsible for the associated symptoms of fever, fatigue and jaundice.
Nutritional causes of fat in the liver include starvation, malnutrition, or obesity. Fat in the liver can also occur with rapid or extreme weight
reduction such as might occur following an intestinal or gastric bypass operation for obesity. In some patients with fatty liver the fat is
accompanied by inflammation (steatohepatitis), and occasionally the fat and inflammation may lead to scarring of the liver (fibrosis).
The endocrine causes of fatty liver include diabetes mellitus, elevated cholesterol or triglycerides, and fatty liver of pregnancy. Fatty liver
during pregnancy occurs near the end of pregnancy and may result in premature delivery or termination of the pregnancy.
How can fatty liver easily be identified?
Fat in the liver usually does not produce any specific signs or symptoms. Occasionally patients will experience a dull pain in the right upper abdomen.
Blood tests may reveal an elevation of the liver chemistries (SGOT or AST, SGPT or ALT, GGT, Alkaline phosphatase). A fatty liver may be detected on an
ultrasound, CT, or magnetic resonance (MRI), examination of the liver. Confirmation of the diagnosis requires a liver biopsy. In mild cases, where
the patient has no symptoms and the liver chemistries are normal or minimally elevated, a biopsy may not be required.
How does fat get into the liver?
Fat enters the liver from the intestines after being digested and modified by the cells lining the intestinal wall. Fat derived from fatty tissues
elsewhere in the body may also enter the liver. Patients unable to break down or process fat being transported to the liver can develop abnormal fat
accumulations within liver cells and the entire liver (steatosis).
Can fatty liver lead to other liver diseases?
Fatty liver associated with alcohol ingestion can progress to more severe disease including alcoholic hepatitis and cirrhosis.
In people who do not drink, fatty liver associated with inflammation and scar tissue, nonalcoholic steatohepatitis (NASH), infrequently leads to cirrhosis.
How is fatty liver treated?
Treatment of fatty liver depends on the cause. A fatty liver due to alcohol can be reversed if alcohol ingestion is stopped. Likewise, a fatty liver
caused by drug ingestion or chemical exposure can be reversed if the drug is stopped or the chemical exposure stopped.
Fatty liver due to obesity is best managed with a program of weight reduction, consisting of a nutritious, low fat diet, and exercise. In
patients with diabetes, fatty liver is managed with diet and better control of blood sugar. In individuals with elevated cholesterol or
triglycerides, diet therapy is prescribed first. Patients not responding to diet, and in
those with severe elevations of cholesterol and triglycerides, specific medications to reduce the these levels may be prescribed (e. g., Questran,
Colestid, Lopid, Lipitor, Pravachol, Lescol, Zocor, Mevacor). Niacin is generally avoided because of its tendency to cause liver test elevations by
itself. Some patients may be treated with dietary supplements. (e.g., lecithin,
L-carnitine). L-carnitine may enhance fat metabolism by the liver, whereas lecithin may prevent some of the tissue damage caused when oxygen
reacts with fat during routine chemical reactions in the liver (lipid
Since many medications can cause liver test abnormalities, close follow-up with a physician is recommended.
How can I avoid fatty liver?
Do not drink to excess…
Watch your diet….
In particular, avoid concentrated sweets, saturated fats, and foods high in cholesterol (heart healthy diet). Whenever possible use monosaturated fats
(olive oil, canola oil), instead of polyunsaturated fats.
Seek medical advice…
Your physician or a nutritionist working with a physician can guide you as to appropriate diets to follow. Multivitamin supplements and vitamin E (< 1000
IU/day) may be used. Avoid large doses of vitamin A; vitamin A in large doses may cause liver damage.
If you have any questions or would like additional information, contact the Tulane Liver Center (504) 588-5344, or the American Liver Foundation, (800)
Liver elastometry – (Clinic Di Center)
The liver is considered one of the most important organs in humans, since it works almost for wear and tear, performing a huge number of functions at the same time every day. Exposure to viruses, malnutrition, obesity, the influence of negative environmental factors and internal pathological changes have a detrimental effect on the state of this important organ.The most common method of examining the liver for signs of pathology is the method of ultrasound diagnostics. Ultrasound makes it possible to determine the volume of the liver, to assess the contours of the organ and its tissue structure. With the help of ultrasound dopplerometry, the vessels supplying the liver are additionally evaluated – these are the portal and hepatic veins, the hepatic artery.
Liver elastometry is a modern method of obtaining and evaluating an ultrasound image. Elastometry is now considered the third ultrasound technology after ultrasound and Doppler imaging.Thanks to her, there has been a significant qualitative leap in the differential diagnosis of focal pathology of the liver and superficially located organs. This method opened up new and very promising possibilities of imaging – determination and comparison of the elasticity of body tissues.
The GE Logiq E9 expert ultrasound system used at the Medical Diagnostic Center is designed for a wide range of examinations, including shear wave elastometry and compression elastography.These methods expand the capabilities of the ultrasound system and increase the reliability of ultrasound diagnostics, including when examining patients with chronic liver diseases. The choice of a place for measuring tissue elasticity indicators is made using a test volume on a two-dimensional ultrasound image, and the numerical values of the elasticity indicator are given in kilopascals, therefore the method is called quantitative ultrasound elastography or elastometry.
Before the advent of elastometry, it was possible to examine the state of the cells of the liver tissue only histologically – a tissue sample was obtained by biopsy.
For a long time, biopsy was the only accurate method for determining the degree of liver fibrosis. The biopsy was replaced by an accurate and safe method – elastometry.
Benefits of liver elastometry:
does not injure the skin and internal organs;
can be performed multiple times;
elastometry is the observation of a process in dynamics;
inexpensive and informative procedure.
Liver elastometry is indicated if fibrosis is suspected. Using this method, it is possible to determine the stages of the fibrotic process in the liver, which makes it possible to understand what part of the functioning liver tissue is replaced by the connective tissue.
The following factors contribute to the development of fibrosis:
hepatitis B and C, autoimmune processes – biliary cirrhosis;
other viral diseases – cytomegalovirus, mononucleosis;
the action of arsenic, heavy metals, copper;
the action of some drugs – chlorpromazine, methotrexate, tolbutamide;
Liver elastometry is performed on an empty stomach. It is advisable to have with you the data of a biochemical blood test
The digital data obtained as a result of elastometry is transferred to the Metavir scale – a special scale that determines the degree of liver fibrosis.
There are several stages of the fibrotic process:
Stage F0 – 5.8 kPa or less – a positive result, indicating the absence of liver fibrosis.
Stage F1 – 5.9 -7.2 kPa – the initial stage of fibrosis.
Stage F2 – 7.3 – 9.5 kPa – moderate manifestations of fibrosis.
Stage F3 – 9.6 – 12.5 kPa – significant manifestations of fibrosis.
Results F1 – F3 mean an active decrease in the elasticity of the liver due to the replacement of the parenchyma with connective tissue, which occurs with hepatitis B and C. At this stage, it is necessary to start treatment as soon as possible. The main danger in patients with hepatitis is the progression of fibrosis. In just a couple of years, the F1 stage can go to F3. Therefore, patients with the result of elastometry in the F1 stage must be re-examined once a year. This will allow you to identify changes in time and begin treatment.
Stage F4 – 12.6 kPa or more – these are signs of liver cirrhosis – a condition in which normal hepatocytes are almost completely replaced by fibrous tissue. Liver cirrhosis is the most formidable complication of chronic hepatitis.
The term fibrosis is applied not only to the liver disease of the same name, it is a general medical concept that denotes an abnormal formation of connective tissue, accompanied by scarring.Thus, the tissue of the organ can react to an acute inflammatory process, trying to isolate the focus of inflammation from neighboring, while healthy tissues. It is important to understand that liver fibrosis and cirrhosis are not identical concepts. Fibrous changes can be stopped, and the affected organ can actually be restored. But without proper and timely treatment, the process of tissue change becomes irreversible.
Timely diagnosis and properly selected treatment will help maintain the normal state of the patient’s liver.In the earliest stages of fibrosis, it is still possible to restore the elasticity of the liver and maintain its function.
Ultrasound of the abdominal organs
Ultrasound examination is a diagnostic procedure during which pathological changes in organs can be detected. This manipulation is absolutely painless, which allows even small children to be diagnosed. In order for the ultrasound of the abdominal organs to become as informative as possible, you need to properly prepare for the procedure.What the research includes and what the preparation consists of, we will consider further.
Which organs are checked for ultrasound of the abdominal cavity
During diagnostic manipulation, the state of the following organs is assessed:
- Liver. It is possible to identify congenital or acquired anomalies in the development of the organ. Allows you to determine the size of the liver, the density of its tissues, to identify benign or malignant formations in the early stages. A qualified specialist will determine the presence of various degrees of cirrhosis and the threat of developing fatty hepatosis.
- Gallbladder. With the help of ultrasound examination, it is possible to detect the presence of stones or neoplasms of various etiologies in the bladder from 5 mm in diameter, as well as identify the inflammatory process and determine the degree of its severity.
- Pancreas. They reveal chronic or acute pancreatitis, organ developmental abnormalities, the presence of cysts and polyps, as well as neoplasms.
- Spleen. First of all, the size of this organ is assessed. An enlarged spleen may indicate various malfunctions in the patient’s body.For example, a change in the size of the spleen can occur with a microstroke. Inflammation and cancer can be detected in the early stages of development.
- Kidneys. Despite the fact that the kidneys are an organ of the retroperitoneal space, in most medical centers they are also included in the diagnosis. With the help of ultrasound, polycystic kidney disease, changes in size, inflammation and the presence of stones of various etiologies can be detected.
The stomach and intestines are not examined by ultrasound due to low information content.If no irregularities in the work of the above organs have been identified, then for further examination it is recommended to undergo a colonoscopy and gastroscopy procedure, which will reveal possible intestinal and stomach disorders.
Indications for conducting
This procedure is performed according to the doctor’s prescription. The reasons for the ultrasound examination may be suspicions of a particular disease. In some cases, an ultrasound scan can be performed for diagnostic purposes before the upcoming surgery.
Direct indications for diagnostics are the following factors:
- Patient complaints of increased gas production or nausea.
- The appearance of a bitter taste in the mouth, which does not disappear even after eating or cleaning the mouth.
- Unreasonable pain sensations of various nature in the abdomen.
- After eating, heaviness, nausea and other uncomfortable symptoms occur.
If any of these symptoms occur, visit a medical facility immediately and get the appropriate diagnostics.
Rules for the preparation of the patient
- The test is carried out on an empty stomach — you must not eat or drink 6 hours before the procedure.
- Light diet recommended 3 days before the upcoming study; products that enhance intestinal motility and gas formation (flour products, black bread, raw vegetables and fruits, legumes, milk, juices, carbonated and alcoholic drinks) are excluded.
- In case of increased gas formation, it is recommended that the patient take adsorbent preparations (activated carbon, hydrolytic lignin, colloidal silicon dioxide) within three days.
- Do not perform X-rays with injection 3 days before the procedure.
- The day before the study, do not carry out gastroscopy, colonoscopy, enemas.
How the survey is conducted
In most cases, an abdominal ultrasound is prescribed in the morning. This is due to the care that the patient does not feel hungry for too long. The procedure is performed by a qualified ultrasound specialist.On average, it will take about 30-40 minutes to identify an objective clinical picture of the state of the abdominal organs and prepare a conclusion.
This manipulation is extremely simple. The patient is required to lie motionless on his back. The person is laid on a flat horizontal couch, first asked to undress to the waist. The area to be examined is lubricated with a special gel, which will facilitate the movement of the ultrasonic transducer. At the request of the doctor, you may need to hold your breath for a few seconds, turn on your side or on your stomach.
Diagnostic manipulation is harmless and does not cause any discomfort. The only discomfort that a patient may experience during an ultrasound examination is a chill on the skin when the gel is applied.
After the diagnosis, the uzist issues a conclusion on the diagnostic procedure performed. Normally, the indicators should be as follows:
|Liver|| Echogenicity of the liver is normal.The length of the right lobe does not exceed 5 cm. The thickness is not more than 14 cm.
The thickness of the left lobe should not exceed 7 cm, length up to 10 cm.
|Spleen||The structure and surface of the organ without obvious changes. Length about 11-13 cm. Width and thickness up to 5 cm.|
|Kidneys||The width, depending on age, varies 4-6 cm. The length is not more than 11 cm. The thickness is 4-5 cm. Pathological changes in the structure of the parenchyma or pelvis were not identified.There are no foreign bodies.|
|Gallbladder||No foreign bodies. The shape is oblong. Wall thickness up to 0.5 cm. Volume does not exceed 70 cubic cm.|
|Pancreas||The contour is smooth, without pathologies. The tail is up to 3 cm, the head is up to 3.5 cm, the body is up to 2.5 cm. The Wirsung duct is not widened.|
If your readings vary within normal limits, this indicates that your abdominal organs are completely healthy.If any excess of the norm is observed, it is possible that some pathological process is present. Additional examinations will help determine the nature of the problem.
In addition, an ultrasound specialist can recommend that you contact specialized specialists.
- In case of kidney problems, it is necessary to consult a urologist, nephrologist
- In case of pathological changes in the liver, it is required to visit a hepatologist
- In case of any changes in the digestive tract, a consultation with a gastroenterologist is appointed
After identifying the pathological process, the doctor prescribes the necessary treatment. In most cases, the early stages of the disease are treated with medication. In extreme cases, surgery may be required.
In order to prevent the development of serious diseases that are fraught with complications that are life-threatening, contact a doctor in a timely manner when the first alarming symptoms appear.
Respiratory complications in liver cirrhosis. Ivashkin V.T.
Vladimir Trofimovich Ivashkin , Academician of the Russian Academy of Medical Sciences, Doctor of Medical Sciences:
– Let me then begin our session today by reporting on respiratory complications in cirrhosis of the liver.
This topic may raise certain questions for doctors who are inexperienced in the field of hepatology, but nevertheless, I think that in the process of our analysis we will come to the conclusion that in fact this is a very complex and very interesting section of both internal pathology, and hepatology, and transplantology.
What respiratory syndromes, respiratory complications in liver diseases are most common and most likely carry the risk of severe consequences? These are hepatopulmonary syndrome, portopulmonary hypertension and acute respiratory distress syndrome.
Hepatopulmonary syndrome.It occurs in about 20% of people awaiting a liver transplant, that is, on a waiting list for a liver transplant. This figure itself indicates that, of course, this is a category of severe patients.
What are the key symptoms or syndromes in these patients? First, as a rule, this is liver failure of at least moderate severity, and, as a rule, severe liver failure. Also in such patients, hypoxemia is noted: when breathing with ordinary air, the partial oxygen tension is no more than 70 millimeters in these patients without attempts to increase this oxygen tension by giving a gas mixture with a high oxygen content.The next criterion is the dilatation of the vessels of the lungs, which can be determined by X-ray and computed tomography. Also, in such patients with special studies, an increased alveolar-arterial oxygen gradient, more than 15 millimeters, is found. This indicates that in these patients a kind of block is formed at the level of the alveolar-capillary membrane, which leads to the fact that the diffusion of oxygen from the alveoli into the arterial blood is significantly hampered.Another key criterion is the presence of an intrapulmonary shunt in these patients, and an intrapulmonary shunt can be both functional and anatomical. Finally, these patients have arterial hypocapnia. This is primarily due to the fact that shortness of breath is always recorded in these patients, and hypocapnia is recorded due to hyperventilation.
In the clinic, hepatopulmonary syndrome is divided into two types: hepatopulmonary syndrome of the first type and the second type. In hepatopulmonary syndrome of the first type, dilatation of the precapillaries and capillaries of the lungs is observed, that is, dilatation of the microvascular bed of the pulmonary artery. There is a decrease in the time of contact of blood with the alveoli due to the acceleration of blood flow. As a rule, such patients have a hyperdynamic type of heart functioning, insufficient blood oxygenation, as we have already said, and an increase in blood oxygenation against the background of breathing with a mixture with an increased oxygen tension.
Hepatopulmonary syndrome of the second type. In these patients, arteriovenous connections and a real anatomical shunt are formed. In hepatopulmonary syndrome of the second type, inhalation of a gas mixture with a high partial pressure of oxygen does not lead to elimination of hypoxemia.We will now consider the reasons for this.
The slide shows a diagram of the normal interaction of the alveoli and capillaries of the lungs (non-oxygenated blood is shown in blue): blue erythrocytes through the pulmonary artery system through the precapillaries, capillaries reach the respiratory units of the lungs, alveoli, and due to the diffusion of oxygen from the alveoli through the alveolar-capillary membrane, this diffusion is carried out easily, the blood erythrocytes are saturated with oxygen, and the blood leaving the respiratory unit is saturated with oxygen. You see, red erythrocytes indicate that the process of blood oxygenation is carried out in full.
What happens in patients with hepatopulmonary syndrome? This front, dilated vessel, you see here a large number of blue-stained red blood cells – therefore, non-oxygenated red blood cells carrying reduced hemoglobin, and to a much lesser extent red blood cells saturated with oxygen. Why is this happening? We see that the vessel is dilated and, therefore, diffusion of oxygen to the center of the vessel and to the far periphery of the vessel is impeded.From this it already follows that from the total volume of flowing blood and flowing erythrocytes, only a certain, smaller part of erythrocytes is oxygenated. The blood is only partially oxygenated. And this is typical for hepatopulmonary syndrome of the first type. If such a patient is provided with breathing with a gas mixture with a high oxygen content, then due to the partial pressure of oxygen in the alveoli, oxygenation will occur to a greater extent, and this increased oxygenation will lead to the elimination of hypoxemia.
The inferior vessel is the vessel that essentially represents the pathogenesis of what occurs in type II hepatopulmonary syndrome.There is no vascular dilatation, but a shunt is formed between the pulmonary artery system and the pulmonary vein system. And, therefore, blood as a whole does not come into contact with the alveoli, and in a non-oxygenated state is transported from the pulmonary artery system to the pulmonary vein system. Therefore, it makes no sense to prescribe an oxygen mixture to such a patient, since oxygen will not reach the vessels that bypass the pulmonary artery and pulmonary veins. This is type II hepatopulmonary syndrome. So, in the first case we are talking about a functional shunt from right to left, in the second case we are talking about a real anatomical shunt from right to left.
Without dwelling on the pathogenesis of the formation of hepatopulmonary syndrome, I will only point out some mediators of pulmonary vasodilation in hepatopulmonary syndrome. These include nitric oxide and products of endotoxemia and tumor necrotizing factor. Due to hypoxemia, pulmonary angiogenesis is activated. Taken together, all this leads to hyperdynamic blood circulation due to an increase in cardiac output, due to a decrease in systemic vascular resistance, due to a decrease in pulmonary vascular resistance.The result is a decrease in the arterial-venous oxygen gradient.
The next slide shows, in a slightly different version, the lumen of the vessel as a result of the stress effects of the mediators I mentioned. Stimulation of the vascular endothelium with endothelin occurs, which leads to the activation of NO-synthase in the vascular endothelium. Under the influence of NO synthase, a large amount of nitric oxide is formed. Nitric oxide acts on the smooth muscles of the pulmonary vessels and leads to their dilatation, to expansion and to the formation of a functional shunt or anatomical shunt.
What are the main clinical symptoms? First of all, the appearance of shortness of breath. Shortness of breath in a patient with cirrhosis of the liver – at first glance, it seems like an inexplicable and difficult to understand event, but when a doctor in a severe patient with cirrhosis of the liver, in a patient with liver failure suddenly discovers the appearance, an increase in shortness of breath, then of course, the doctor should think about respiratory syndromes, one of which can complicate the course of cirrhosis in such patients.
Naturally, shortness of breath is accompanied by an increase in cyanosis, since the presence of a shunt, in fact, suggests the appearance of cyanosis.Drum fingers, telangiectasia of the nail bed are quickly formed.
A very important distinguishing symptom of hepatopulmonary syndrome is the appearance of shortness of breath in an upright position, this symptom is called platypnea. Why does platypnea appear? Due to the redistribution of blood in the lungs, due to a decrease in ventilation of a significant respiratory area of the lungs. Unlike, for example, shortness of breath in heart failure, which appears and intensifies in a horizontal position, with hepatopulmonary syndrome, we register platipnea – shortness of breath in an upright position.
At the same time, when measuring the oxygen tension in the blood in such patients, we find a decrease in saturation in the upright position, this symptom is called orthodeoxia. Its reason is the same as platypnea – an increase in poorly ventilated areas of the lung, an increase in the manifestations of a pulmonary-cardiac bypass from right to left. On X-ray examination, we find intrapulmonary dilatation. Contrast-enhanced echocardiography is also very important.
This slide shows hepatopulmonary syndrome in a 69-year-old patient with cirrhosis.A high-resolution computed tomography scan was performed, and we see dilated pulmonary vessels (white pulmonary vessels) diverging by the corolla. And what attracts attention is seen as a crown, dilatation of the distal pulmonary arteries with subpleural telangiectasias. That is, in addition to expanding the root of the lung on the left and on the right, dilatation of the pulmonary vessels, especially on the right they are visible, we see along the periphery, like the crown, indeed, dilatation of the distal pulmonary arteries with subpleural telangiectasias (shown by arrows on the slide).
The next slide shows hepatopulmonary syndrome in a 36-year-old female patient. The right picture shows a large liver, a large spleen, all signs of portal hypertension, varicose veins in the central part of the esophagus. On the lung image, we see nodular dilatation of the peripheral pulmonary vessels. As in the previous patient, the expansion of the roots of the lungs, diverging dilated pulmonary vessels are visible. And along the periphery, we see dilatation of the pulmonary vessels (arrows shown), connected to the feeding arteries and draining veins.Thus, on the face of the dilatation not only of the central, but also of the peripheral pulmonary vessels.
The following is the study that we talked about. This is a common echocardiogram showing the chambers of the heart. At the base is the left and right atrium, the left and right atriums, and above the left and right ventricles.
What happens if we inject a suspension of air into such patients. What is air suspension? A saline solution is taken and very vigorously shaken to the smallest air bubbles – this is approximately what we see when we open the faucet in the kitchen or bathroom, we pour and see that the water is whitish.This whiteness is due to the huge amount of small suspended air bubbles. We inject approximately the same suspension intravenously into the decubital vein, and we immediately get an image of these bubbles in the right chambers of the heart: in the right atrium and right ventricle. But unlike healthy people, in whom these bubbles dissolve in the vessels of the pulmonary artery, in people with dilated pulmonary vessels, in patients with hepatopulmonary syndrome, these tiny bubbles penetrate into the right chambers of the heart. Moreover, the filling of the right chambers of the heart with these microvesicles of air is observed very quickly: after two or three heartbeats. And the presence of these bubbles in the right chambers of the heart definitely speaks of the dilatation of the pulmonary artery, of the dilatation of the vascular bed of the pulmonary artery.
How do we approach the treatment of hepatopulmonary syndrome? Naturally, liver transplantation is the method of choice. Drug therapy is a kind of bridge to keep these patients on the waiting list for as long as possible, in order to prepare them or give them the opportunity to carry out liver transplantation.
Inhibition of NO-stimulated guanylate cyclase is carried out by regular intravenous administration of methylene blue. Somatostatin analogs are prescribed. These are anecdotal observations, literally isolated clinical representations, in which the authors have shown certain positive effects when prescribing analogs of somatostatin, cyclophosphamide, indomethacin, and so on. There is practically no systemic therapy for hepatopulmonary syndrome. The method of choice is liver transplantation.
Now the next syndrome that we observe in our patients is portopulmonary hypertension.It is less common: in about 5% of people awaiting liver transplantation. This is a very formidable complication, so to speak, of the final cycle or the final stage of liver failure – mortality reaches 50-90% within five years.
The key symptoms are an increase in mean pulmonary artery pressure of more than 25 millimeters at rest or 30 millimeters during exercise. The presence of portal hypertension – this is evidenced by ascites, enlargement of the spleen, dilatation of the portal vein, splenic vein, and most importantly, varicose veins of the esophagus.The last key criterion is high pulmonary vascular resistance.
The severity of portopulmonary hypertension is determined mainly by the mean pressure in the pulmonary artery (the higher, the more pronounced the severity) and pulmonary vascular resistance (as the severity increases, pulmonary vascular resistance also increases).
How can the development of portopulmonary hypertension be suspected? Again, the most important symptom is the appearance of shortness of breath in patients with liver cirrhosis.Shortness of breath is often severe. A rather rapidly developing dilatation of the jugular veins is observed. There is an emphasis of the II tone on the pulmonary artery, systolic murmur of tricuspid regurgitation and symptoms of right-heart decompensation. In fact, these are symptoms of a rapidly growing cor pulmonale.
Portopulmonary hypertension is based on the development of proliferative pulmonary vasculopathy. It includes vasoconstriction, hypertrophy of the muscular layer of the lung vessels and proliferation of endothelial cells.
In all likelihood, recurrent pulmonary embolism contributes to the development of portopulmonary hypertension. Moreover, pulmonary embolism in patients with liver cirrhosis has a somewhat unusual path. In particular, thromboembolism of the pulmonary artery can be carried out from the dilated veins of the esophagus. All this together leads to the overproduction of serotonin, interleukin-1, thromboxane, vasoactive intestinal peptide and severe spasm of the pulmonary arteries.
The diagnosis is based on changes in the electrocardiogram, indicating an overload of the right heart.X-ray examination shows signs of dilatation of the branches of the pulmonary artery, cardiomegaly. With transthoracic echocardiography, we detect an increase in mean pulmonary artery pressure.
An example of portopulmonary hypertension in a 57-year-old male with cirrhosis. In the left picture we see cardiomegaly – a large heart is quite distinct, and pulmonary arteries are dilated. The roots of the lungs are largely expanded, and the vascular pattern can be traced relatively evenly strengthened both in the upper and lower parts of the lung.And on the right, we see a cardinal sign – this is a large, dilated pulmonary trunk, from which the right and left pulmonary arteries depart, and the diameter of this pulmonary trunk is larger than the adjacent ascending aorta. In the same patient, a pronounced dilatation of the right ventricle is noted on the right. The interventricular septum, due to the high pressure in the right ventricle, bends towards the left ventricle, and you see significant hypertrophy of the wall of the right ventricle (indicated by the arrow). And on perfusion lung scintigraphy, we see with you multiple focal perfusion defects in both anterior and posterior projections.Of course, in such patients it is very difficult to differentiate what causes these perfusion defects: a really pronounced spasm, only a spasm, or a spasm in combination, for example, with recurrent pulmonary embolism.
Treatment includes the appointment of vasodilators, in particular Prostacyclin (Epoprostenol) and Sildenafil. The treatment is currently not developed, that is, the treatment is essentially the same as we use in patients with pulmonary hypertension due to recurrent pulmonary embolism.The method of choice is liver transplantation, and with an average pressure of less than 35 millimeters, we expect a good prognosis, and with a pressure of more than 35-40 millimeters, the prognosis becomes largely dubious.
And the last thing I wanted to tell you briefly is acute respiratory distress syndrome. Acute respiratory distress syndrome, which seems surprising to many doctors, is observed in 80% of patients with the final stage of liver failure, that is, it is a common complication.
The clinic of this complication includes, of course, severe shortness of breath and all manifestations of hypoxemia. On the roentgenogram, we see typical focal shadows at an early stage, at the stage of interstitial edema. Further, we observe diffuse bilateral consolidation in the exudative and proliferative stages, and then the stage of developing bronchioloalveolar fibrosis. On computed topography, we see with you diffuse bilateral changes in the shape of “ground glass”, confirming the presence of bronchioloalveolitis and fibrosis, and extensive bilateral consolidation as a final in patients who managed to arrest acute respiratory distress syndrome.And running ahead, I will say that the treatment is prostaglandin E and artificial ventilation of the lungs – we have no other approaches.
The next slide on the right shows a section of the alveoli seen in patients with respiratory distress syndrome. Pay attention, the lower part of the alveolus, here is the basement membrane, the alveolar wall is practically devoid of epithelial coating, because in such patients necrosis and apoptosis of the cellular elements of the alveolar lining occur. And as a compensatory mechanism, as a compensatory reaction in such patients, the inner surface of the alveoli is filled with hyaline membranes.Essentially, for pathologists, the detection of the hyaline membrane serves as a key criterion for the diagnosis of acute respiratory distress syndrome. The presence of a hyaline membrane replacing the epithelial lining, a significant expansion of the alveolar-capillary space due to edema and due to the emerging fibrosis, of course, explains the severe shortness of breath and hypoxemia that is observed in such patients.
The next slide shows the clinical presentation of acute respiratory distress syndrome in a 49-year-old woman with fulminant hepatitis. On the chest radiograph, we see bilateral diffuse shadows, which indicate the transition of the interstitial phase of edema to the alveolar phase of edema, and with computer topographic resolution – diffuse bilateral changes of both the “ground glass” type and the type of cellular lung. The air bronchogram is clearly visible, and against the background of this air bronchogram and dilated pulmonary vessels, we see these edematous-fibrotic changes in both pulmonary fields.
Morphology.In the left image, the arrow shows the famous hyaline membranes, which for pathologists are the main diagnostic key for recognizing acute respiratory distress syndrome. In the center, you see granular deposits around the alveoli, which indicate the formation of perialveolar inflammation and the formation of perialveolar fibrosis. In the right image, you see the blue deposits – these are large deposits of collagen in the alveoli that lead to consolidation of the lung in surviving patients and the development of diffuse pulmonary fibrosis.
Thus, we talked with you about three severe variants of respiratory complications in liver diseases, in particular in liver failure. This is hepatopulmonary syndrome – it is based on dilatation of the precapillary and capillary beds and the formation of functional, with hepatopulmonary syndrome of the first type, and anatomical arteriovenous shunts. The clinical picture of its development occurs against the background of liver failure, dilatation of intrapulmonary vessels. The key symptoms are the appearance of platypnea and orthodeoxia.The treatment is liver transplantation.
Portopulmonary hypertension – the basis is spasm of arterioles, hypertrophy of the muscle layer and proliferation of endothelial cells. This syndrome is characterized by a combination of portal hypertension and pulmonary hypertension, followed by the addition of right heart failure and vascular vasospasm.
Acute respiratory distress syndrome – it is based on hyaline replacement of alveolocytes, violation of surfactant production. Clinically, it manifests itself as severe shortness of breath, diffuse bilateral infiltrates in the lungs, hypoxemia. The main methods are artificial ventilation of the lungs and prostaglandin E.
Dear colleagues, let me finish my message with this.
Stool color depending on the disease of the dog
Contents of article
Normal dog feces have a dense texture with a shade of light to dark brown. Any inconsistencies with this rule indicate an imbalance in the pet’s body – temporary or chronic.What deviations are in the excrement of dogs, and why it is imperative to show the pet to the doctor, we will consider further.
The green color of feces is due to the large secretion of bile or bile enzymes known as bilirubin, biliverdin. There can be several reasons for the appearance of such bowel movements:
- Inflammation of the gastrointestinal tract.
- Fungal infectious diseases, in which a fungal colony is able to multiply in the internal tissues and organs of the dog, disrupting their functions.
- Parasitic diseases caused by helminths, insect bites and other factors.
- Pathological abnormalities in the liver and bile ducts.
- Cholelithiasis. The formation of stones in the gallbladder or bile ducts leads to stagnation of bile and dangerous rupture of the gallbladder.
- External parasites. These include ticks, scabies itching, lice and other blood-sucking representatives.
- Errors in the composition of the diet.If the dog is prone to allergic reactions, manifestations of dysbiosis, or with an improperly selected diet, green stools can be a single symptom without causing pain in the animal. However, it is necessary to understand that a malfunction has occurred in the body’s work and in the absence of treatment, the pet’s condition will worsen significantly.
Often, green stools are accompanied by a liquid consistency, which can be an indicator of a putrefactive process in the dog’s intestines. This is an alarming and dangerous symptom of an illness that poses a threat to the pet’s life.
White color of feces, first of all, speaks of tumor formations in the liver, gallbladder or digestive organs. Such excrement may indicate the following abnormalities in the body:
- Malignant tumors of the liver or gallbladder interfere with the normal flow of bile.
- Inflammation of the pancreas (pancreatitis).
- Inflammation of the liver and bile ducts (cholangiohepatitis, cholangitis).
- Inflammatory process in the liver (infectious and toxic hepatitis).
- Liver failure with the threat of liver cirrhosis.
- Formation of cystic nodes in the liver and dysfunction of this important organ.
- Changes in the gallbladder – its deformation, decrease in size.
- Abundant consumption of food of high fat content (pork, sour cream) or other unusual foods. In the absence of other symptoms (vomiting, abdominal pain, apathy), it is allowed to control the dog’s stool for one day before going to the clinic, provided that the owner is sure of the origin of white feces due to an error in the diet.
The black color of the stool indicates the presence of blood in them. If the bright red color of the blood indicates the formation of bleeding in the large intestine or in the anal area, then the dark color of the secretions indicates that they are processed by enzymes and the cause of their occurrence is in the digestive tract or small intestine.
So, black feces may indicate the presence of serious health problems for the pet:
- Presence of helminths.Parasitizing the intestinal mucosa and destroying it, helminths gain access to the dog’s blood. Part of the blood enters the intestines, from where it is excreted.
- Infectious diseases – parvovirus enteritis. In case of infection with a dangerous infection, you need to know that the blood discharge does not come out in a homogeneous mass with the dog’s stool, but is contained in it in small clots.
- Stomach ulcer. This dangerous disease is associated with internal gastrointestinal bleeding, which explains the appearance of dark discharge in the dog’s feces.
- Hemorrhagic gastroenteritis occurs as a result of inflammation of the stomach and intestines. Complications after infectious diseases, stressful situations (for example, during the passage of medical therapy), circulatory disorders – all these are the causes of this dangerous disease.
- Damage to the walls of the gastrointestinal tract by a foreign object. It is dangerous if the pet has swallowed a hard and sharp object, which can damage tissues and provoke internal bleeding.
The appearance of loose, black stools indicates extensive internal bleeding and is extremely life-threatening.
The yellow color of the animal’s stool can indicate both a problematic state of health and be the result of the consumption of foods containing carotene.
Yellow faeces are characteristic of deviations such as:
- Liver dysfunction (cirrhosis, hepatitis, neoplasia).A yellowish tint of feces appears when the liver fails, it is intermediate and characterizes the transition to lightening the feces to white.
- The presence of helminths. The color may be yellowish due to the presence of worms and their larvae in the feces.
- Failure of the pancreas. Due to disturbances in the production of hormones, the body cannot cope with the processing of fats and the feces acquire an oily sheen and yellow color.
- Eating foods containing carotene (carrots, cereals and others).The body of the animal does not digest carotene and displays it intact.
Reasons for the formation of liquid yellow stools:
- intestinal infections;
- infection with a viral infection, for example salmonellosis, parvovirus;
- wrong diet.
Gray staining of excrement is a rare phenomenon and corresponds to abnormalities in the work of the pancreas or biliary system of the liver.
Gray feces may indicate the following abnormalities in the pet’s body:
- Alternating diarrhea and constipation. When the pancreas produces less secretion or the liver synthesizes less bile, the body stops processing lipids (fats), as a result of which food digestion is impaired, peristalsis suffers (diarrhea, constipation).
- Rapid development of opportunistic microflora (Escherichia coli and other types of bacteria). Due to the reduction in the amount of bile produced, which is a bactericidal compound, a favorable environment for the reproduction of harmful bacteria is created in the intestinal lumen.
- Deterioration of the general condition of the animal, loss of appetite, exhaustion.
Any deviation in a dog’s bowel movement is a dangerous symptom indicating the presence of an internal pathological process. In such cases, self-medication is extremely dangerous due to blurring of the diagnostic picture and a sharp deterioration in the health of the animal, when the only salvation can only be an operation.
The appearance of abnormalities in stool should be the reason for an urgent visit to the veterinary clinic, which will make it possible to diagnose the disease in time and help the animal to overcome the ailment.
Thyrotoxic hepatitis | Pikulev | Endocrinology Problems
The fundamental role of the liver in metabolic processes and its close connection with the organs of the endocrine system determine its defeat in the pathology of the thyroid gland. In most cases, liver damage in hyperthyroidism is limited to asymptomatic changes in laboratory parameters and much less often acquires a clinical embodiment. The incidence of biochemical abnormalities in patients with newly diagnosed hyperthyroidism reaches 45–90% , and the clarification of the thyroid status is recognized as justified with an increase in liver enzymes of unknown etiology [2, 3].Clinically significant cases of liver damage associated with hyperthyroidism are rare and are represented by single descriptions. One of the most substantial “collections” belongs to D. Mazo et al. , who summarized information about 8 cases, 2 of which were fatal, and one required liver transplantation.
Liver diseases in patients with hyperthyroidism can appear in three forms: drug hepatitis developing in response to thyreostatics, concomitant autoimmune liver diseases and, finally, hepatopathy as a direct manifestation of thyrotoxicosis [4-6].Hepatotoxicity of thyreostatics is manifested in less than 0.5% of cases  and is more often associated with the use of propylthiouracil than methimazole, which is mainly metabolized by the kidneys. Cases of toxic hepatitis have also been reported during treatment with radioactive iodine . The universal autoimmune nature of the pathological process explains the cases of the combination of Graves’ disease with autoimmune hepatitis [4, 5, 8] and primary biliary cirrhosis .
Of the three variants of liver damage in thyrotoxicosis, only the last one, obviously, can be considered in the context of the pathogenic effect of thyroid hormones.In the already mentioned article by D. Mazo et al.  out of 8 described cases, 2 were presented by autoimmune hepatitis, another 3 – by drug-induced hepatitis, induced by propylthiouracil, and only the remaining 3 cases were actually a reflection of thyrotoxicosis. The mechanism of development of thyrotoxic hepatitis is explained by the disproportion between blood supply and metabolic costs of the liver, which develops in conditions of increased cardiac output [6, 9]. Right ventricular heart failure caused by thyrogenic myocardial dystrophy can exacerbate liver damage [4, 9].The concept of the direct toxic effect of excess thyroid hormones on the liver has not been convincingly confirmed , although it is still being discussed .
Description of a clinical case
Patient M., 56 years old, was admitted to the city clinical hospital with complaints of jaundice, dark urine, weakness, shortness of breath with little physical exertion, swelling of the legs, abdominal enlargement, weight loss. From the anamnesis it became clear that for the last 5 years the patient has had a constant form of atrial fibrillation (attempts to restore the sinus rhythm have not been made), and 6 months ago he was diagnosed with liver cirrhosis.The patient’s state of health worsened during the last 2 months, when the above complaints appeared and intensified.
On admission, the condition was assessed as severe. The patient is emaciated (after elimination of edema: height 176 cm, body weight 52 kg, body mass index 16.8 kg / m2), the skin and sclera are intensely icteric. The borders of the heart are expanded to the left, tones are arrhythmic 98 per minute, at the apex of the heart and at the base of the xiphoid process there is a systolic murmur. The abdomen is evenly enlarged due to ascites. The liver is dense, with a smooth surface, sensitive to palpation, protrudes from under the edge of the costal arch by 5 cm.
Complete blood count documented mild anemia (hemoglobin 108 g / l, erythrocytes 3.5 × 1012 / l), which was accompanied by a reduced iron level (8.6 μmol / l) and a fairly high level of ferritin (230 μg / l). Hyperbilirubinemia was noted (total bilirubin 279.2 μmol / L, direct bilirubin 224.6 μmol / L, indirect bilirubin 54.6 μmol / L), an increase in the level of transaminases (AST 101.4 U / L, ALT 58 U / L), low values of fibrinogen (1. 02 g / l) and total cholesterol (1.87 g / l), dysproteinemia (albumin 40.7%, γ-globulin 33.1%), urobilinuria.Markers of viral hepatitis B and C were negative.
ultrasound revealed increased liver echogenicity and moderate hepatomegaly – a skew-vertical size of 167 mm (the norm is up to 150 mm). An increase in the diameter of the portal vein – 13.5 mm (the norm is up to 12 mm) and the inferior vena cava – 21 mm (the norm is up to 15-16 mm). The diameters of the bile ducts, the size of the spleen is within normal limits. A significant amount of fluid in the abdominal cavity has been confirmed.
Esophagogastroduodenoscopy did not reveal significant changes.
ECG confirmed the presence of atrial fibrillation with a frequency of ventricular activation of 78-136 per minute, signs of left ventricular hypertrophy.
Thus, the disease was represented by jaundice, hepatomegaly, arrhythmias like atrial fibrillation, heart failure, edematous-ascitic syndrome. Deviations of laboratory parameters fit into cytolytic, mesenchymal-inflammatory and hepatodepressive (hypoalbuminemia, hypofibrinogenemia, hypocholesterolemia) syndromes. Taking into account the revealed diffuse liver damage and unchanged bile ducts, the most probable assumption was the hepatic nature of jaundice. Standard treatment of heart failure (angiotensin-converting enzyme inhibitors, diuretics, β-blockers, cardiac glycosides) in combination with ursodeoxycholic acid drug led to a rapid elimination of edema and ascites, a significant decrease in shortness of breath; jaundice nevertheless persisted.
Performed to clarify the diagnosis, magnetic resonance imaging stated the absence of changes in the shape, size, structure and density of the liver and spleen, the lumen of the intrahepatic ducts, lymph nodes of the abdominal cavity and retroperitoneal space; the diameters of the portal and inferior vena cava during the treatment acquired normal values, there was no free fluid in the abdominal cavity.
Negative markers of viral hepatitis, the absence of choledochoectasia and structural changes in the liver tissue did not give grounds to speak of primary damage to the liver and biliary system. Atrial fibrillation, total heart failure, cardiomegaly in combination with systolic murmur indicated a possible heart defect. In such circumstances, jaundice and hepatomegaly could be considered as a manifestation of cardiac fibrosis of the liver, but this version did not fit the high and persistent level of bilirubin and pronounced laboratory signs of hepatodepression.
The performed echocardiography revealed signs of pulmonary hypertension and cor pulmonale: dilatation of the atrial cavities (left 4.3 cm, right 6.9 × 5.0 cm) and right ventricle (3.0 cm), increase in the diameter of the pulmonary artery 2.8 cm, tricuspid regurgitation of the II degree. The valve cusps were intact, there were no violations of local myocardial contractility, and the ejection fraction was 65%.
With the so-called “cardiogenic liver”, the liver tissue is damaged due to an increase in central venous pressure and insufficient arterial perfusion.In the clinical picture, hepatomegaly comes to the fore, while jaundice is usually insignificant. Against the background of right ventricular failure, hyperbilirubinemic crises may develop with a significant rise in bilirubin, mainly its direct fraction. Most often, cardiac cirrhosis of the liver develops with defects of the tricuspid valve or constrictive pericarditis and in most cases proceeds latently, without pronounced exacerbations. Thus, the patient’s right ventricular failure could undoubtedly lead to congestion in the liver, but it remained unexplained that the complete elimination of edematous-ascitic syndrome (against the background of standard treatment of heart failure), the disappearance of signs of portal hypertension, normalization of liver size did not restore the functional the state of the latter.
The range of diseases with simultaneous involvement of the heart with the development of atrial and liver fibrillation includes lesions of the thyroid gland, occurring with symptoms of hyperthyroidism. A targeted examination of the patient revealed positive eye symptoms of Delrimple and Stelvag, pronounced glitter of the eyes, tremors of the body and limbs, exophthalmos. Ultrasound examination revealed reduced echogenicity and an increase in the volume of the thyroid gland up to 26.2 cm3. Signs of manifest thyrotoxicosis were documented by the level of hormones: free T4 45.0 pmol / l (normal 10.0-23.2 pmol / l), total T4 37.0 nmol / l (normal 52-155 nmol / l), T3 0 , 4 ng / ml (norm 0.8-2.8 ng / ml), TSH 0 μIU / ml (norm 0.23-3.4 μIU / ml).
Laboratory and clinical signs of thyrotoxicosis gave rise to the appointment of thiamazole, which led to a decrease in jaundice and a rapid positive dynamics of laboratory parameters. A control laboratory study showed a significant decrease in hyperbilirubinemia and normalization of the level of transaminases: total bilirubin 55.6 μmol / L, direct bilirubin 50.9 μmol / L, AST 35.4 U / L, ALT 35.1 U / L. The level of thyroid hormones was: T4 free 19.6 pmol / l; T4 total 58.0 nmol / L, T3 0.99 ng / ml, TSH 0.1 μIU / ml.
Final diagnosis: diffuse toxic goiter I degree (according to WHO), severe thyrotoxicosis. Thyroid myocardial dystrophy, cardiomegaly, permanent form of atrial fibrillation, stage IIB HF. Severe thyrotoxic hepatitis, hyperbilirubinemic crisis, edematous-ascitic syndrome. Anemia of chronic diseases of mild degree. Malnutrition of the II degree.
Intense jaundice in severe thyrotoxicosis was described in publications dating back to the 20s-40s of the last century.However, it is erroneous to believe that at the present time, with the modern level of diagnosis and treatment, the problem of liver damage in diseases of the thyroid gland has ceased to be relevant.
The variety of etiological factors of liver involvement in hyperthyroidism, the versatility of the clinic and the absence of specific histological markers of hepatic lesions make it difficult to establish the correct diagnosis. Liver dysfunctions in patients with hyperthyroidism include drug-induced lesions, concomitant autoimmune diseases, and thyrotoxic hepatitis itself.We have described a clinical case of thyrotoxic hepatitis, which developed against the background of Graves’ disease and complicated by edematous-ascitic syndrome and hyperbilirubinemic crisis. Concomitant thyrogenic myocardial dystrophy with cardiomegaly and atrial fibrillation complicated the diagnosis and required the exclusion of the “cardiogenic liver”.
Commenting on the above case, I would like to draw attention to an isolated increase in the concentration of free T4 at the initially lowered levels of total T4 and T3.Obviously, a pronounced decrease in protein-synthetic function (the fact of hepatodepression was confirmed by laboratory) led to a decrease in the synthesis of proteins-carriers of thyroid hormones, and only the level of free (not bound to proteins) T4 turned out to be informative. It is indicative that, against the background of treatment, the concentration of total T4 and T3 increased, which indirectly testified to the normalization of liver function.
In conclusion, we refer to D. Mazo et al.  an algorithm for managing a patient with liver damage associated with hyperthyroidism (see.drawing).
Algorithm for the management of patients with liver damage on the background of hyperthyroidism .
Funding information and conflicts of interest
The authors declare no obvious and potential conflicts of interest related to the publication of this article.
The search and analytical work on the preparation of the manuscript was carried out at the personal expense of the members of the group of authors.
Medical information about the patient is published with his written consent.
Contribution of authors : concept and design of the study – D.V. Pikulev, A.V. Klemenov; collection and processing of materials – D.V. Pikulev, A.V. Klemenov; analysis of the data obtained, writing the text – A.V. Klemenov, D.V. Pikulev; text editing – A.V. Klemenov.
90,000 Life after transplantation – Liver Transplantation Center, N.V. Sklifosovsky
The anti-rejection drugs you will take reach
effect due to interaction with the cells of your immune system.This is
can lead to a decrease in the body’s resistance to certain infections,
especially viral. After leaving the hospital, try to avoid
contact with patients with colds, cough, increased
body temperature or intestinal disorders. Feel free to wear
mask during the first year after transplantation in places of large
crowds of people. If possible, try not to use
public transport, especially during epidemics. Coming home with
streets, always wash your hands and nose thoroughly.
Be sure to see a doctor if you develop symptoms of infection:
- body temperature above 37.5 ° C
- persistent cough with phlegm
- sore throat or mouth
- nausea, vomiting or diarrhea
- pain or burning when urinating, cloudy urine or frequent urge to urinate
- redness or swelling in the incisional wound
The risk of developing tumors
Immunosuppressive drugs that you have been taking after many years
may slightly increase the risk of developing cancer, since
reduce, among other things, and antitumor immunity.It is important to know about it
in order to reduce this risk.
What tumors can develop after transplantation?
The most common after transplantation tumors of the skin and lips associated with
prolonged exposure to the sun. Lymphomas may also develop, which
associated with the activation of infection with the Epstein-Barr virus (EBV) in the background
immunosuppressive therapy. We should not forget about other tumors,
widespread in the population – cervical cancer, breast cancer
gland, colon cancer.
What symptoms may indicate the presence of a tumor?
Identification of a node, a lump in the mammary gland, not associated with
menstrual cycle or feeding, any other skin changes,
|Cancer of the cervix or body of the uterus||Bleeding outside the menstrual cycle, pain|
|Colon cancer||Bleeding from the anus, blood in the stool, impaired bowel function (constipation or diarrhea)|
|Lymphoma||Swollen and thickened lymph nodes, unexplained fever or weight loss, nocturnal chills|
|Prostate cancer||Weak or intermittent urine stream when urinating, back pain, pelvic pain|
|Skin cancer||Permanent wound on the skin, with undermined edges, not healing, with bleeding, discoloration of the skin|
How to prevent the development of tumors?
Visit your doctor and perform the screening tests prescribed
them, on time. Key activities to reduce the risk of developing tumors
after kidney transplant:
- Avoid prolonged exposure to the sun. Even on a cloudy day
use sunscreens (SPF> 30) that block
ultraviolet waves of the spectrum A and B (UVA, UVB). Dress
appropriate clothing, including sunglasses, sun hat.
Avoid the midday sun.
- Stop smoking. A kidney transplant is a good enough reason to quit smoking
- Eat healthy, quality foods.Your Calorie Diet
should match you exactly. The diet should include a lot of fruits and
- Lead an active lifestyle. Perhaps you need an additional exercise program. Discuss this with your doctor.
- Tell your doctor about any additional medications you take, including vitamins, dietary supplements.
- Tell your doctor about all members of your family who have been diagnosed with tumors
treatment of CMV infection) reduces the risk of developing tumors in a timely manner
get treatment with antiviral drugs (such as valcyte,
cymeven).Discuss this with your doctor
What tests do I need to undergo?
|Cancer of the skin, lips||
|Cancer of the cervix, body of the uterus||
Examination by a gynecologist
Self-palpation of the mammary glands
All women once a cycle (or once a month in menopause), immediately after menstruation.Mammography
Annually for women over 45
|Prostate cancer||Digital rectal examination, PSA (prostate specific antigen) test||Annually for men over 50|
Feces for occult blood
Annually for patients over 50 years of age
Once every 1-5 years, depending on the presence of risk factors
What happens if a tumor is found?
All of the listed tumors are excellent if detected early.
give in to modern treatment.In case of detection of tumor growth
treatment tactics will be determined by experienced oncologists and members
We hope that these problems will never affect you, and that
therefore, we ask you to be on the alert and monitor the state of your
See your doctor immediately if you develop any of the following conditions.
- Fever. An increase in body temperature above 37.5 ° C can be
a sign of infection or acute rejection.If you have a promotion
temperatures less than 37.5 ° C, but longer than 24 days, still contact
transplant center. Do not take any antipyretic without asking
- Pain in the wound or discharge. Postoperative redness
wounds, swelling, local warming, or other changes
- Liquid retention. If you have added 1 kg per day, you have swelling on the ankles and face, you need to consult a doctor.
- Decreased urine output. This may indicate an episode of rejection, dehydration, or impaired urine flow.
- Symptoms resembling a cold. Fever, muscle pain, weakness, headache, nausea and vomiting.
- Symptoms associated with urination – pain and burning when urinating, dullness and an unpleasant odor when urinating.
- Breathing problems – shortness of breath, cough with or without phlegm, pain in
chest, sore throat. Chest pain and shortness of breath may be signs
cytomegalovirus pneumonia, a formidable complication that requires
- Pathology of the gastrointestinal tract. Nausea, vomiting, diarrhea last longer
days require special treatment. Drink plenty of fluids to keep you
did not develop dehydration, which is dangerous after the transplant, as soon as possible
contact the transplant center.
- Unusual change in blood pressure. Sudden rise
blood pressure may indicate an episode of acute
rejection, lowering – about dehydration.
- Blood in urine or stool.
If one of the listed conditions develops, consult a doctor immediately
Exercise is important for your health and well-being in
postoperative period.Best Exercise After Transplant
is walking. Gradually increasing physical activity, walk under
under the supervision of your doctor. Within 6 weeks after surgery
Limit squats and lifting weights over 5 kg. Anyway,
discuss your physical activity with your doctor.
After a liver transplant, nutrition is of great importance. If before that
You had to adhere to dietary table # 5, meals after
transplantation becomes more free.
- Drinking alcohol after liver transplant is strictly prohibited
in any form and in any quantity. Resistance of the transplanted liver to
alcohol differs from that of healthy. Don’t ruin yourself, organ from
another person and our work.
- It is very important that your nutrition after transplantation is
varied, high quality and well balanced. Natural food,
cooked at home, you need to give preference to
semi-finished products. Increase the amount of vegetables, fruits, cereals.If you not
get enough vitamins from food, you will have to
take multivitamin preparations.
- All food you will eat must be fresh and
high quality. For this reason, one must beware of eating on the street, in
fast food, eating stale food. Undoubtedly, when cooking,
table setting should methodically observe all hygienic
requirements as if you were feeding a small child. Everything, that
being cooked, must be properly cooked and cooked.Raw
must be thoroughly washed and thoroughly cleaned.
- In the early postoperative period, you will need more food
squirrel. It is necessary for the body to recover normally after
operations. In addition, a tendency towards lower protein levels may appear in
You on the background of the medications you are taking. Lean meat (beef, chicken
meat without skin), the fish will be optimal for this.
- Avoid eating pickles, salted and dried fish, canned food,
hot sauces and other foods that contain too much salt, as
they lead to the accumulation of salt and water in the tissues.
- Try to limit carbohydrates in food – sugar and sweets,
especially if you are taking prednisone. Prednisone increases appetite and
retains fluid in tissues, leading to weight gain. remember, that
a lot of sugar is found in carbonated sugary drinks, from
the use of which is better to abstain. If you like sweet drinks,
buy sugar-free versions of them. If you like sweets, you should
buy them in the departments for patients with diabetes. Sugar in food is good
replace it with fructose, which is sold in dietary stores.
- Cholesterol levels may rise after transplant. For his
You and the entire transplant team will monitor the level. For that,
to prevent cholesterol levels from increasing, you should limit it
intake in food. This applies primarily to animal fat – lard,
fatty meat, chicken skin, butter, sour cream, mayonnaise.
Egg yolk also contains a large amount of cholesterol.
Eat lean meat, cook skinless poultry, replace oil with
margarine, fry not in butter, but in olive.Try to
eat seafood, fish.
- Problems with calcium-phosphorus metabolism prior to transplantation,
some time can be saved with you. Unless given otherwise by your doctor
recommendations, twice a day you will need food rich in calcium –
milk, cottage cheese, low-fat cheese.
- We ask you to limit the use of citrus fruits, especially
grapefruit, as they contain substances that change the action
If your blood sugar rises or
there will be a significant increase in cholesterol levels, decreased function
graft, the attending physician will make additional changes to your
Return to work or school
If you worked or studied before your transplant, you can return to
these activities. We usually recommend doing this after 3
months after transplantation, when repeated
hospitalization. Many patients who could not work before
transplantation, begin to work after it. If your work is related to
lifting significant weights, hypothermia, long trips to
remote places, contact with infectious patients, animals,
discuss the prospects for changing her character with your doctors.
Primary health care
You will need to establish contact with doctors after transplantation
primary health care – general practitioner, head
GP department, district surgeon, hepatologist, center personnel,
responsible for the dispensing of medicinal products. Write them down and keep them
phones. Let them also write down your phone number and coordinates. Do not forget
timely send copies of all extracts and all
documents related to your health.
The safety of medical documents after transplantation is especially important.
We advise you to scan or photocopy All your statements, data
additional research. To avoid loss of even medical
try to give employees only copies of documents, leaving
originals at home.
The use of prednisolone makes the skin more sensitive to the sun
light, sunburn becomes much easier.Try to avoid
direct sunlight, do not sunbathe, use umbrellas from
sun, tanning products. If any changes appear on the skin
Suddenly see a doctor.
We recommend that you visit the dentist every 6 months. Necessary
carefully follow the rules of oral hygiene after transplantation. Clean
teeth twice a day, not less than 2 minutes, if necessary
use dental floss. Change your toothbrush as often as possible,
use quality toothpaste.While taking cyclosporine
overgrowth of the mucous membrane of the gums is possible. You may need to refer to
dentist about this. Often, treatment with a dentist after
transplantation should take place while taking antibiotics.
Check with your doctor about this.
Women’s health issues
General recommendations for patients
- We recommend an annual gynecological examination with genital tract smear for all women.
- You should not self-palpate the mammary glands.
less than 1 time per month (1 growth per cycle).Self-palpation is performed immediately
after the cessation of menstruation, in front of a mirror, in lying and sitting positions.
We feel the tissues of the mammary glands between the fingers of two hands, methodically, according to
spirals, from the nipple to the periphery. Be sure to feel the fiber for
the outer edges of the pectoralis major muscles. If you have questions,
associated with self-palpation, be sure to consult a doctor
- Women over 40 require an annual mammography x-ray.
You can return to sex life as soon as you feel
better.Usually, the sex life of patients after transplantation improves.
However, it is necessary to remember the risk of contracting diseases,
sexually transmitted diseases that are dangerous for the transplant. For this reason
casual relationships should be avoided.
Pregnancy in women with cirrhosis of the liver usually develops
rarely. This is due to severe dysfunction of hormonal mechanisms,
responsible for fertility. On the contrary, after liver transplantation
in many women, menstrual function is restored.It may
lead to pregnancy.
Pregnancy after transplantation should not be accidental. This is –
a very important decision, which must be made by the whole
transplant team. Therefore, if the active
sexual life and the inability to currently plan
pregnancy, for medical reasons you will need
The method of choice after transplantation is the barrier
contraception. Taking oral contraceptives after a transplant is extremely
undesirable, as it leads to an increase in pressure, increases the risk
thrombosis, affects the concentration of tacrolimus in the blood.Intrauterine
spiral after transplantation is a high risk factor in the development of infections, its
installation is also contraindicated.
If you suspect that you are pregnant, immediately contact
transplant center. Abortion after liver transplantation is undesirable.
Therefore, in the absence of contraindications in the case when pregnancy
has come, it is worth saving.
Pregnancy and childbirth after transplantation
Modern immunosuppressive drugs used after
transplantation, do not have a significant effect on the fetus.therefore
a woman after a transplant may well be planning a pregnancy.
It should be remembered that in this case, you need a particularly responsible
attitude towards planning and managing such a pregnancy. Decision to start
the patient accepts the child only together with the doctors of the transplant
teams. Despite the possibility of giving birth through a natural birth canal,
delivery is optimal in women after liver transplantation
by caesarean section. Since re-birth after transplant
risky, you may be offered to ligate the fallopian tubes during this
operations.Due to the fact that immunosuppressants enter the maternal
milk, breastfeeding will not be possible. Children born to mothers with
transplanted liver, according to statistics, do not have deviations from the norm
compared to other children. They are characterized by a slightly lower body weight,
they have a slightly higher risk of infectious complications, which, however, quickly
Do not plan any travel for at least 3 months after
transplantation, since in this period it may be necessary
unplanned hospitalization.Discuss your travel plans with
By your doctors. When traveling abroad, do not drink iced drinks. Drink
only bottled water. Use it when brushing your teeth.
Immunosuppressive drugs that you are drinking should be with
for the entire period of stay abroad in excess, in case
unexpected delays. Never check them in your luggage on the plane, and
carry only in carry-on baggage. Necessary to confirm this
you should prepare medical documents in advance. Everything you need for
the country of destination must be fully vaccinated.
The issue of vaccinations will be decided on an individual basis with
By your doctor. We often recommend getting vaccinated annually against
flu in the fall. After some vaccinations with
mucous membranes in children can release live viruses. This is normal and
safe for children, but may come with a potential risk to
patient after transplantation. If you have a child and his pediatrician
told you that he is being vaccinated with a live virus (for example, against
polio), you may need to wear a mask to avoid
contact with the virus.
An optometrist should examine you at least once a year. On the background
therapy with prednisolone, it is rarely possible to develop cataracts and other
If you have a pet at home, it must be well cared for. The place where he lives must be clean. The patient after organ transplantation should not be in contact with animal excrement. Do not allow the animal to lick the face or wound area.A cat or dog’s toilet should be cleaned by someone else. The toilet must be disinfected at least once a month. If an animal has bitten or scratched you, treat the wound with antiseptic solutions. Call your doctor right away. Some animals carry diseases that can be transmitted to humans. Beware of contact with exotic animals, wild animals and monkeys.
It is well known that smoking leads to the development of chronic
lung diseases and even cancer.Post-transplant smoking increases
the risk of developing lung cancer. In addition, smokers have a higher risk of developing
bronchitis, which, against the background of ongoing immunosuppressive therapy, can
be life threatening. Transplantation is a good enough reason,
to quit smoking.
We prohibit alcohol intake for our patients after liver transplantation
After transplantation, you will need to come for control
research.The frequency and schedule of their implementation will be established by the doctor, who
will watch you. Currently for every consultation
a referral from the clinic is required.
90,000 15 foods for a healthy liver
The liver is considered the largest gland in the human body. The mass of this organ can reach 1800 grams. The liver is located under the rib and occupies a significant part of the right abdominal cavity. Among the most important functions of the liver are metabolism (glucose processing, cholesterol synthesis, etc.)protection from bacteria and toxins, production of bile necessary for digestion, production of certain hormones.
Also, the liver acts as a natural filter that protects the body from the effects of many harmful substances. But in modern conditions, this organ is heavily burdened. Often, he cannot cope with such a massive blow. The functioning is affected by an improper diet with an abundance of fast food, stress, uncontrolled intake of drugs, and a passion for alcoholic beverages.And among liver diseases, there are both functional disorders and formidable ailments – hepatitis, cirrhosis, venous thrombosis, cholangitis and oncology.
What is bilirubin and why does it rise
An increase in bilirubin can indicate various diseases.
Bilirubin is the name of the bile pigment, which is one of the most important components of bile. It is formed as a result of the breakdown of various proteins (including hemoglobin). In the blood of a healthy person, bilirubin can be found in small amounts.For total bilirubin, normal values are 5.1-17 mmol / L.
It should be understood that bilirubin is a toxic substance and very harmful to the human nervous system. Therefore, the normal functioning of the liver is aimed, among other things, at the excretion of bilirubin with bile or urine. And the excess of the indicators can indicate a variety of diseases of an important organ, blockage of the biliary tract and even about the active destruction of red blood cells in the blood.
Primary cirrhosis, cholelithiasis, the development of parasites in the body, cholestasis and some other conditions are called among the causes of increased bilirubin.
Diet with increased bilirubin
Of course, in the case of increased rates, it is imperative to consult a doctor to clarify the diagnosis and prescribe adequate treatment. But it is also important to adjust your diet, which will help to unload the liver as much as possible, stimulate the activity of metabolic processes and make the outflow of bile more efficient.
Allowed foods on this diet include lean meats (beef, rabbit, chicken).It is recommended to boil such meat first, and then bake it a little. You can also eat lean fish. Shown to people with elevated bilirubin light soups on vegetable broths without dressing in the form of fried vegetables. Milk should be limited, but the amount of low-fat fermented milk products, on the contrary, should be increased. There are great restrictions on bread – it must necessarily be salt-free. If you cannot find one on sale, then it is better to bake it yourself. In addition, you cannot eat fresh bread, you can only eat yesterday’s.Almost any vegetables are allowed, with the exception of fresh onions, sorrel, spinach, radishes, radishes, and garlic. You also need to exclude mushrooms, sour berries and fruits. It is not recommended to eat any fried foods.
With elevated bilirubin, only low-fat and unsalted foods should be included in the menu.
Diet rules for high bilirubin
- Do not eat cold food. Food temperature should not be lower than 45 degrees.
- Sufficient drinking regime – not less than 2 liters of liquid per day, but not more than 2.5 liters.Water should be without gas.
- Regular meals with frequent meals (about 5-6 per day). In this case, the portion should not be more than 300 grams.
- All meals and products may only be eaten unsalted.
Top 15 Foods for a Healthy Liver
Experts say that the best prevention of liver diseases is the correct diet. It should contain a lot of fresh vegetables and fruits, vegetable oils, easily digestible proteins, low-fat dairy products.But the number of refined foods, fatty meat dishes, semi-finished products and high-calorie sweets on the menu should be limited. Regular meals, lack of overeating, and adequate physical activity are also important.
Chinese scientists have noted that many plants have hepatoprotective properties. Among them are cruciferous vegetables, citrus fruits and many others. Also, these herbal remedies are a good source of antioxidants for the whole body.
1.Pumpkin and pumpkin seed oil
Pumpkin has a mild choleretic effect and helps to remove harmful substances.
Pumpkin contains a large amount of substances that accelerate the regeneration of hepatocyte membranes. These include pectins, riboflavin, beta-carotene, and niacin. Often, pumpkin dishes are included in the menu of patients suffering from chronic liver diseases. It is also known that pumpkin has a mild choleretic effect, helps to remove harmful substances, and increases the acidity of gastric juice.
Both the fruit itself and the oil from it are useful. A 2015 study showed that replacing saturated fat with pumpkin seed oil in the diet weakened the development of non-alcoholic fatty liver disease and atherosclerosis, and had an additional anti-inflammatory effect.
You can read more about the benefits and types of pumpkin here. Also in the article you can find tips for choosing this wonderful vegetable.
Boiled beets are indicated for many liver diseases.
Beetroot is a very useful root vegetable. It contains a lot of useful fiber that is resistant to prolonged heat treatment. Eating dishes with beets allows you to reduce harmful cholesterol in the blood, accelerate the regeneration of hepatocytes, and normalize the biochemical composition of bile. Therefore, regular consumption of boiled beets is good for the liver.
A study published in the journal Nutrients has shown that eating beet greens can also help reduce liver damage from a high-fat diet and improve metabolic parameters.
Another 2007 study confirmed that eating beetroot can significantly reduce the risk of liver ischemia.
You can read more about the different varieties of beets and their general health benefits here.
Carrots help prevent liver congestion.
Carrots can be called one of the largest plant sources of vitamin A. It also contains a lot of vitamins B2 and B6. The use of this root vegetable stimulates the functioning of the gallbladder, helps to eliminate the blockage of the bile ducts, prevent stagnation, improve the outflow of bile, and has a beneficial effect on the synthesis of unsaturated fatty acids and fat metabolism.
The use of carrot juice is recognized as especially useful. It is recommended to dilute it a little with water and drink in small portions. This will significantly improve the metabolic processes in the liver.
Melon helps liver cells to regenerate.
Melon is not only tasty, but also healthy fruit. It has a mild choleretic effect, inhibits the development of fatty hepatosis, prevents the formation of calculi in the gallbladder, and helps liver cells to recover.But, since there is a lot of sugar in it, you cannot abuse the melon. You also need to remember that it increases the acidity of the gastric juice. And this is not useful for gastritis and peptic ulcer disease.
Lemon juice has good antioxidant properties.
Vitamin C is one of the main elements that prevent fatty hepatosis. Therefore, all citrus fruits and lemon, including, are very beneficial for the liver.Lemon juice stimulates the outflow of bile, removes excess bad cholesterol, helps to cope with calculi in the gallbladder. But, of course, lemon juice should not be overused so as not to cause gastritis and other ailments.
Scientists have also found that lemon juice has good antioxidant properties and can have a protective effect on the liver against significant damage caused by alcohol consumption.
You can read about other useful properties of lemon here.
Grapefruit may be active in liver cell regeneration.
Like lemon, grapefruit is high in vitamin C and many other elements. Long-term studies have shown that grapefruit can be active in cell regeneration and the detoxification process, significantly reduces cholesterol levels, helps with rheumatoid arthritis, and is a good way to prevent cancer. Red and pink varieties are high in beta-carotene and lycopene.Also in grapefruit contains a very useful flavonoid naringin. This substance is able to mitigate the adverse effects of ethanol on liver cells and helps to strengthen the antioxidant defense system of this organ.
Grapefruit can be eaten fresh, but it can also be used to make juice, tea, salad. Read more about options for using grapefruit here.
Apples help prevent fatty liver disease.
As you know, apples are also rich in vitamin C and iron.Therefore, apples are good for the liver as well. They help prevent fatty hepatosis, accelerate the excretion of cholesterol, prevent bile stagnation, and help to cope with the adverse effects of drugs. Doctors recommend eating baked apples in the presence of various disorders in the work of the stomach and liver. So the fiber will be better absorbed, and various acids will not harm the inflamed mucous membranes.
A complete guide to apple varieties can be viewed here.
The use of grapes and grape juice helps protect the liver from the effects of carcinogens.
Fresh grapes and grape juice, as well as grape seed extract, are very beneficial for the liver. These foods are high in resveratrol, epicatechins, anthocyanidins, proanthocyanidins, and other beneficial flavonoids.
The “Review of natural products with hepatoprotective action” states that the use of grapes and grape juice helps to protect the liver from the effects of certain chemical carcinogens and from oxidative damage, helps to control chronic liver intoxication with ethanol, and to restore cells of many organs.
Cranberry removes excess cholesterol and improves lipid profile.
Cranberry is a very healthy berry. It also possesses hepatoprotective properties. This berry improves the lipid profile, prevents the degeneration of liver cells into adipose and connective tissue. But you need to remember that cranberries should be limited during exacerbation of various inflammatory processes. In the “Review of natural products with a hepatoprotective effect” it was also found that the introduction of cranberries into the diet reduces the toxic effect, normalizes bilirubin levels, and prevents the accumulation of lipid oxidation products in the liver membranes.
You can read about other useful properties of cranberries here.
9. Fatty fish
Fish, due to the content of omega-3 acids, slows down the course of fatty liver disease.
Fatty fish are rich in omega-3 fatty acids. Therefore, they are very beneficial for liver health. In a meta-analysis from Chinese scientists, it was confirmed that omega-3 acids have a beneficial effect on the optimization of liver fat, liver enzymes and blood lipids. And in patients with non-alcoholic fatty liver disease, these acids slow down the progression of the disease.
But in case of some other diseases, for example, hepatosis, it is better to replace fatty fish with lean fish – trout, pollock, cod, flounder, etc.
And, of course, all types of fish must be prepared in the healthiest way possible – boil, steam or bake.
Nuts help reduce inflammation in the liver.
The benefits of including a small amount of nuts in the daily diet have recently been proven by many experts.Nuts are also considered one of the easiest ways to maintain liver health. They, like fish, contain unsaturated acids, vitamin E and many antioxidant substances.
In a 2015 study, scientists demonstrated that nuts have great therapeutic potential in patients with non-alcoholic fatty liver disease by improving lipid profiles, hepatic steatosis and reducing inflammation.
Walnuts and almonds are recognized as the most useful in this regard.To improve the condition, it is enough to eat just a handful of these nuts a day.
And the rating of the healthiest nuts can be studied here.
11. Olive oil
Olive oil helps reduce oxidative stress.
Fatty foods are generally known to be harmful to the liver. But this does not apply to cold-pressed vegetable oils. Olive oil has been found to be particularly beneficial for liver health. A 2015 study found that adding enough olive oil to the diet can help reduce oxidative stress, improve liver function, and help with certain metabolic disorders.
Another study published in the Journal of Nutrition showed that a Mediterranean diet rich in extra virgin olive oil reduced the incidence of non-alcoholic fatty liver disease and hepatic steatosis. This effect is especially noticeable in the elderly with diseases of the heart and blood vessels.
About which oil is healthier – olive or sunflower, read here.
Turmeric helps break down bilirubin.
Many spices are beneficial for liver health, but curcumin is one of the most beneficial substances that help with oxidative stress in the tissues of the organ.Iranian scientists made a systematic review of cellular mechanisms and found that curcumin induces the expression of heme oxygenase and helps to break down bilirubin, inhibits the activation and proliferation of certain enzymes, and protects the liver from fibrogenesis. According to scientists, consuming significant amounts of curcumin on a daily basis or as a dietary supplement, along with limited therapeutic options, may provide ideal prevention and treatment of liver disease.
For information on which diseases turmeric can be used for, read here.
13. Whole grain cereals
Whole grains protect the liver from inflammation.
The main benefit of meals with whole grains is that they allow overweight people to successfully lose weight. And control over body weight is one of the main factors in the prevention of various liver diseases. There are other beneficial effects on the liver when you include significant amounts of whole grains in your diet. A 2013 study found that people who eat a diet rich in whole grains tend to have a lower risk of many of the comorbidities associated with non-alcoholic fatty liver disease.These foods also help to reduce the number of fat cells in the liver and protect it from inflammation. Also, experts recommend replacing processed grain with whole grain for the preparation of most dishes.
14. Green tea
Green tea is beneficial for liver diseases.
It is known that green tea is very useful for the heart and blood vessels, but this drink can also bring many benefits to the liver. In 2016, a randomized clinical trial was conducted. Within its framework, 80 patients underwent ultrasound of fatty degeneration of the liver.Research has shown that green tea extract can be used as a therapeutic agent to increase serum liver enzymes in patients with non-alcoholic fatty liver disease. And to enhance this effect allows weight loss.
All useful properties of green, as well as black, white, yellow and other types of tea can be studied here.
Caffeine reduces the growth factor of fibrogenesis.
Some experts call coffee a magic drink for liver diseases.With regular coffee consumption, there is a decrease in the rate of development of cirrhosis, the risk of neoplasms in the liver decreases, and the outflow of bile increases.
A 2017 study confirmed that caffeine reduces growth factor fibrogenesis. It is noted that coffee, in general, has a beneficial effect on the condition of people with chronic liver disease. Experts pointed out that more research is needed to elucidate the mechanism of action of coffee, but it is already clear that patients with chronic liver disease can safely enjoy their favorite drink.