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Hepatic cirrhosis: it is possible to avoid a liver transplant adopting good habits

Hepatic cirrhosis: it is possible to avoid a liver transplant adopting good habits

Liver cirrhosis occurs when the normal structure of the liver is replaced by fibrous tissue, resulting from chronic aggression healing, irreversible liver cell damage, and impaired liver function. It is the most frequent condition that leads to hepatic transplantation in adults and children, and is caused by chronic hepatitis B or C virus, alcohol, autoimmune hepatitis, non-alcoholic fatty liver disease, biliary tract diseases including primary biliary cirrhosis,

Many patients with liver diseases have normal liver function and do not require transplantation, and may never have an advanced disease where this procedure is required. But often a progressive worsening of the function occurs, leading to a failure or hepatic insufficiency, where the only form of treatment is the transplant. Since this progression is very variable, every patient should be accompanied by a gastroenterologist or hepatologist to determine the ideal time for inclusion in the liver transplant list of the Health Department of the State of São Paulo.

The diagnosis of some diseases of the liver at the initial stage and its treatment, as in the case of viral and autoimmune hepatitis can control the disease even in a stage of cirrhosis. Likewise, the identification of alcoholic liver injury and alcohol withdrawal may prevent the progression of the disease.

At this stage in which the patient has a still good condition, preserved or with a small reduction of his function, is very important to maintain good living conditions, such as:

  • Healthy eating habits
  • Weight control
  • Diabetes control
  • Cholesterol control
  • Triglyceride level control
  • Avoid alcoholic beverages
  • Preventing, identifying and treating complications of cirrhosis

Thus, the worsening of the disease can be reduced by avoiding or postponing a liver transplant.

The main advances in the treatment of cirrhosis are due to the recognition of its complications and the accomplishment of specific treatments, in order to prevent them from occurring or leading to worsening of liver function. of the most frequent complications of cirrhosis is ascites, which is the accumulation of fluid within the abdomen, which appears due to an increase in pressure within the veins that reach the liver due to organ fibrosis, associated with low levels of proteins by the reduction of Patients with cirrhosis should be seen regularly by a physician who will monitor it for the development or presence of complications of cirrhosis.

In order to avoid its formation or to treat when it has already appeared, it is necessary to have a a diet low in salt and high in protein, avoiding meat, restricting liquids and making use of diuretic medicines to help eliminate this liquid. An infection of the ascites fluid, ie, spontaneous bacterial peritonitis, which should be recognized and treated as soon as possible, may be an important cause of worsening of the patient's condition.

Another important complication, which can often lead the patient to death, is the hemorrhage resulting from esophageal varices. Esophageal varices are dilatations of the esophageal veins, resulting from increased pressure within the vessels that reach the liver due to liver fibrosis. All patients with chronic liver disease should undergo digestive endoscopy to identify varices of the esophagus and treatment when necessary, with sclerosis or elastic ligation of the vessels, to prevent the occurrence of hemorrhage. In addition, the use of specific medications, beta blockers, may help reduce variceal pressure, reducing the risk of bleeding.

Hepatic encephalopathy is another serious complication of cirrhosis, caused by the accumulation of toxic substances resulting from loss of liver function. It is characterized by a set of neurological changes, with tremors, sleep disturbance and alteration in the sleep-wake rhythm, that is, the patient becomes very sleepy during the day and more awake and agitated at night, being able to progress to coma in the cases. It may be associated with excessive meat intake, bleeding and potassium imbalances through the use of diuretics. Therefore, in order to avoid encephalopathy, it is important to avoid meat intake, care with the use of diuretics always with regular medical follow-up, avoid dehydration, infections and maintain a regular bowel movement, to avoid the accumulation of substances that can trigger encephalopathy. Patients with cirrhosis should be seen regularly by a physician who will monitor them for the development or presence of complications of cirrhosis. The control of these complications is fundamental for the preservation of hepatic function. The recurrent appearance of complications and the difficulty in controlling these causes progressive liver impairment, with a worse prognosis for the patient and the need for liver transplantation. Some symptoms may suggest worsening cirrhosis, such as severe tiredness, loss of appetite, weight loss, ascites and edema of the lower limbs, hepatic encephalopathy, bleeding and spontaneous ecchymosis, jaundice.

The candidate patient for liver transplantation is placed on a single waiting list, based on a disease severity index known as MELD (

Model for End-Stage Liver Disease

). This index corresponds to a numeric value ranging from 6 to 40 - the most severe patients present MELD higher and will have priority in performing the transplant.

For the calculation of MELD, a mathematical formula is used with the results of three laboratory tests : level of bilirubin, creatinine (a measure of renal function), and RNI (International Normalized Ratio), a measure of prothrombin activity, which measures the production of coagulation factors by the liver. Laboratory tests for MELD have a defined validity and need to be renewed with the following frequency: MELD up to 10: validity of 12 months, examination taken in the last 30

days

MELD from 11 to 18: validity of three months, last 14 days

  • MELD from 19 to 24: validity of one month, examination taken in the last seven days
  • MELD greater than 25: validity of seven days, examination taken in the last 48 hours
  • Generally the level of MELD for the patient to be col of the transplant list is 15.
  • Mortality is high on the waiting list, so it is very important to have regular medical follow-up for the prevention, identification and appropriate treatment of complications of cirrhosis, with the aim of preserving the quality of life until transplantation.

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