评论:肝硬化：不再是一个自动判处死刑

StephenW

Cirrhosis: no longer an automatic death sentence
DR TEERHA PIRATVISUTH and DrR PITULAK ASWAKUL
Special to The Nation October 22, 2013 1:00 am
In our last column, we looked at the causes and symptoms of chronic hepatitis B and its effects on the liver. Today, we examine cirrhosis, a condition found in patients in the end stages of chronic liver disease.
Cirrhosis is caused by the tissues of the liver being increasingly damaged and replaced by fibrosis, changing the structure and the shape of the liver. The surface of the liver becomes rugged and the fibrosis increasingly accumulates in the liver, which becomes even stiffer. In addition, the increasing loss of liver tissue gravely affects the functions of the liver.

The most common causes of cirrhosis in Thailand are alcohol abuse, chronic inflammatory liver disease which can be divided into hepatitis B and C, fatty liver which commonly found in patients with diabetes and chronic inflammatory liver disease which is caused by, for example, autoimmune disease, and chronic biliary atresia. Certain types of medicines can also produce fibrosis over a prolonged period. However, the exact cause is unknown in 10-15% of cirrhosis patients.

In the past, the condition of a patient inflicted with cirrhosis would gradually deteriorate with death the most likely outcome. Today, thanks to the latest medical advances, doctors can find the causes of cirrhosis and successfully remove them. This can partially improve the condition with regard to the function and pathological conditions of the liver. According to some studies, if patients with chronic cirrhosis from chronic hepatitis B and C receive treatment on time, the production of fibrosis in their liver noticeably decreases. Furthermore, the liver in cirrhosis patients who were heavy drinkers but who now abstain from alcohol consumption will improve and be able to function well.

Patients who are in the early stages of cirrhosis do not display any symptoms. In certain cases, they will only experience tiredness and loss of appetite. The commonly known symptoms such as jaundice and swellings in the legs and abdomen occur at a later stage when the liver is no longer able to function effectively. It is thus vital to monitor the development of cirrhosis closely in those who are at risk.

The diagnosis of cirrhosis involves a set of examinations. A blood test can evaluate the function of the liver. Additionally, radiology tests, including ultrasound, computer X-ray, and magnetic resonance imagining, are able to evaluate the general condition of the liver. In some patients liver biopsy will be necessary. A new technological development called a fibroscan can be employed to evaluate the stiffness of the liver by using ultrasound waves. A recent breakthrough, fibroscan is proving effective in diagnosing fibrosis in the liver and cirrhosis and its use has markedly reduced the number of patients requiring a biopsy.

Once a patient has been diagnosed with cirrhosis, additional testing must be carried out to find its cause so that effective treatment can be planned and proper care administered in order to prevent complications.

Patients with cirrhosis can be divided into two groups based on liver function. The first group, patients at the early stage of cirrhosis (compensated cirrhosis) , usually show no symptoms. The second group, patients in the later stages of cirrhosis (decompensated cirrhosis), suffer such symptoms as high pressure in the hepatic portal venous system, leading to fluid build-up in the abdomen, swelling in the legs, swelling in the blood vessels of the oesophagus and the stomach, and upper gastrointestinal bleeding.

A patient with compensated cirrhosis can expect to see his/her condition deteriorating by 8 to 12 per cent a year. Cirrhosis patients are also more likely to suffer from liver cancer, although the likelihood of each patient developing liver cancer varies, depending on the cause of the cirrhosis, with patients who develop cirrhosis from hepatitis B most at risk.

DR TEERHA PIRATVISUTH and Dr Pitulak Aswakul are specialists in gastroenterology and hepatology at Samitivej Sukhumvit Hospital. |Call (02) 711 8822-4.

StephenW

肝硬化：不再是一个自动判处死刑
DR TEERHA PIRATVISUTH和DRR PITULAK的ASWAKUL的
特向全国2013年10月22日上午01点00
在我们的最后一栏，我们看着慢性乙型肝炎及其对肝的原因和症状。今天，我们研究肝硬化，这种情况在结束阶段的慢性肝病患者中发现。
肝硬化是由正越来越多地损坏和更换纤维化改变的结构和形状，肝脏的肝组织。肝脏的表面变得凹凸不平，越来越多地在肝脏中积聚，甚至变得更硬和纤维化。此外，肝组织的损失增加严重影响肝功能。

肝硬化在泰国的最常见的原因是酗酒，慢性炎症性肝病可分为乙型和丙型肝炎，脂肪肝，这是引起糖尿病和慢性炎症性肝病的患者中常见的，例如，自身免疫性疾病和慢性胆道闭锁。某些类型的药物，也可以在长时间内产生纤维化。然而，确切病因不明的肝硬化患者在10-15％ 。

在过去会造成肝硬化的病人，病情逐渐恶化，死亡最可能的结果。今天，得益于最新的医学进步，医生发现肝硬化的原因，并成功地删除它们。这可以部分改善的条件方面的功能和病理条件下的肝脏。据一些研究，如慢性肝硬化，慢性乙型和丙型肝炎患者接受治疗的时间，在其肝脏纤维化的生产明显下降。此外，肝硬化患者的肝脏重度饮酒者，但现在谁放弃酒精消费将提高，并能够运作良好。

谁是病人在早期肝硬化阶段，不显示任何症状。在某些情况下，他们只会遇到疲劳和食欲不振。俗称症状，如黄疸，并在腿和腹部肿胀发生在稍后阶段，当肝脏不再能有效地发挥作用。因此，这是至关重要的那些谁是危险的肝硬化密切监察事态发展。

肝硬化的诊断涉及的一组检查。血液检查可以评估肝脏的功能。此外，放射学检查，包括超声，计算机X射线和磁共振想象，能够评估肝脏的一般状况。在一些患者中，肝活检是必要的。一个新的技术的发展称为肝纤维化可以通过使用超声波来评估肝脏的刚度。 Fibroscan的最近的一个突破，被证明是有效的诊断肝纤维化和肝硬化，其使用需要活检的患者数量明显减少。

病人一旦被确诊患有肝硬化，必须进行额外的测试，找到其原因，这样可以有效的治疗计划，并给予适当的照顾，以防止并发症。

肝硬化患者可根据肝功能分为两组。第一组中，患者在早期阶段的肝硬化（代偿性肝硬化） ，通常没有任何症状。第二组，在后期肝硬化（肝硬化失代偿期）患者，患有肝门静脉系统高压等症状，导致液体积聚在腹部，腿部肿胀，肿胀的血管食道和胃，和上消化道出血。

咬牙硬挺

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