Lviv clinical bulletin 2013, 2(2): 37-45

Treatment of the Liver Cirrhosis: Modern Principles, Considering Syntropic Co- and Multimorbid Lesions of other Organs and Systems of Organs

M. Abrahamovych, M. Farmaha

Danylo Halytsky Lviv National Medical University

Introduction. Cirrhosis of the liver is a frequent chronic polyethyologic disease of the internal organs with polymorphous syntropic lesions, which often causes early disability and death of patients – that is why it is necessary to improve the principles of complex differentiated treatment taking into account extrahepatic manifestations of the disease.

Aim. To improve the algorithm and to improve the efficiency of treatment of patients with cirrhosis of the liver by taking into account detected extrahepatic co- and polymorbid syntropic lesions of other organs and systems.

Materials and methods. The study included 1713 patients with cirrhosis (75.7% of men, 24.3% of women, age 18-86), who performed a comprehensive examination of all organs and systems in accordance with the requirements of modern medicine. Subsequently, patients were divided according to the criteria for classification of C. G. Child – R. N. Pugh by severity at A (38.1%), B (52.3%) and C (9.6%) classes, and a comprehensive differential treatment was performed for 4-6 weeks. The control group consisted of 302 patients, representative of gender, age and severity of liver cirrhosis, which were treated according to the generally accepted method.

Results. Among patients with cirrhosis of the liver, 74.3% had varicose veins of the esophagus, 61.3% had gastropathy, 48.2% had varicose hemorrhoidal veins, 19.2% had arterial hypertension, 56.4% arterial hypotension, 57,3% – secondary cardiomyopathy, 27.5% – rhythm disorders, 65,3% – disorders of conduction, 82,9% – signs of hepatopulmonary syndrome, 8,9% – portopulmonal hypertension, 0.8% – signs of hepatolateral syndrome type І, and 3.3% – type II, 56.0% – secondary encephalopathy, 73.1% – signs of the disorders of the autonomic nervous system, 60.5% – osteopenia and 39.5% – osteoporosis, 42.3% – anemia, 29.8% – coagulopathy and 94.2% – signs of skin lesions.

In 64.2% of the patients treated using the system we had modified, good results were obtained, in 28.7% the results were satisfactory and 7.1% – were not satisfactory. 73.1% had a good result in patients with class A of liver cirrhosis, 63.9% – class B and 61.8% – class C. The number of patients with satisfactory results was roughly the same in all groups (26.5% -30.4%). In group A, there were no patients with poor treatment outcomes, in group B – 5.7%, and in group C they were 11.7%. The presented actual material allows us to assert that the complex treatment we have modified is effective in 92.9% of the patients with liver cirrhosis. In the significantly lower number of patients treated using the usual method compared to the experimental group (47.4%), good results were obtained, and this was due to a significant increase in the number of patients with only a satisfactory result of treatment (46.7%). In 5.6% of the patients, the results of treatment were not satisfactory, and 0.3% the results were poor. 51.3% of the patients with a good result were patients of class A of liver cirrhosis, 49.4% – class B and 20.7% – class C. The number of patients with satisfactory results, as in the experimental group, was approximately identical in quantity in groups A, B and C (from 46.2% to 48.3%). In group A, 1.7% of the patients had a poor outcome, in group B they were 4.4%, and in group C – 27.6%. Consequently, the generally accepted comprehensive treatment is effective in 94.1% of patients with liver cirrhosis, but for qualitative indices, it is significantly lower than the medical complex we have modified.

Conclusions. Modified by the authors, the complex differential treatment of patients with liver cirrhosis, taking into account the presence of polymorbid syntropic lesions, as well as the traditional one gives a positive result, but the effectiveness of conventional treatment is lower compared to the complex we modified.


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