ALCOHOLIC CIRRHOSIS

	A
	ALCOHOLIC CIRRHOSIS
	*ALCOHOLIC CIRRHOSIS*

ALCOHOLIC CIRRHOSIS

Alcoholic cirrhosis

Introduction

Digestive Apparatus

The digestive apparatus must like function assure the digestion or assimilation different foods.

The digestion consists of reducing all foods in elementary substances simpler, able to happen to the blood to be used by the organism:

• Is like a power plant (power paper),

• Is for forming the necessary materials for the construction of the cellular architecture (plastic paper).

PHYSIOLOGY

As we already know, the function of the digestive apparatus is to assure the digestion. The assimilation of different foods is obtained by its degradation in simple elements: fatty acid lipids, glúcidos in simple sugars (bears), prótidos in amino acids.

The set of these transformations needs combined mechanical and chemical actions. The mechanical actions consist of movements of mixed (stomach) and peristálticos (internal). The chemical actions require to digestive enzymes (also called diastasas). Lipasas degrades lipids, glucidasas glúcidos and the proteases the proteins.

The digestion begins in the mouth. By the mastication, the teeth crush and divide - mechanical action the foods, facilitating the contact with the enzyme to salivar, the ptialina (glucidasa) - chemical action -. Therefore, the saliva (1 l to 1.5 ls per day) attacks sugars and dampens the mucosa. It transforms foods into a doughy nourishing skittle.

The esophagus is a simple one via of step. The liquids descend by the effect of their own weight. The solid foods are impelled by the peristálticos movements, towards the stomach, tensile cavity that performs 3 functions simultaneously:

• gastric Motilidad, assuring the mixed one the foods that gives rise to the formation of quimo. This mechanical action is under the dependency of the parasimpático nervous system.

• Degradation of foods, being responsible the gastric juice that forms from:

• Acid hydrochlorate,

• protective Mucus of the mucosa and

• Pepsina, proteolytic enzyme.

The secret stomach 2 ls of gastric juice per day. The secretion is regulated by the nerves vague (order nervous) and by the gastrina (hormonal order).

• Storage of foods:

The stomach stores foods and releases quimo very progressively. The gastric evacuating becomes through píloro, in small amounts. This progressive liberation in the duodeno allows to the intestine an optimal yield. The gastric evacuation needs a total of 5 to 6 hours, depending on the composition of the food.

The essential of the digestion takes place in the duodeno and the rest of the intestine. The duodeno simultaneously receives the pancreáticos bile and enzymes. Let us see the paper of each one of them.

Intestinal Digestiòn

• the bile is secretada by the hepatocitos, it is stored in the biliary vesicle and it is excreted when the food ingestion takes place. It is constituted essentially by biliary salts and cholesterol. Its paper is the one of emulsionar greasy, transforming them into micro-drops that are more easily degradables by lipasas pancreáticas and intestinal. The bile prepares, this way, the digestion of the greasy bodies.

• On the other hand alkaline his pH neutralizes the acidity of quimo gastric.

• the pancreático juice.

The páncreas are the main source of enzymes of the digestion as they are lipasas, colesterolesterasas, glucidasas (amylase) and several proteases: tripsina, quimotripsina carboxipeptidasas, elastasa.

The pancreático juice allows the degradation of the glúcidos ones and the prótidos ones. He is only the able one to degrade fats.

• the intestinal juice.

The enterocitos also synthesize enzymes of degradation like glucidasas, proteases and perhaps lipasas.

Let us remember that they produce secretina that triggers the pancreática secretion.

With the digestion one has obtained that the complex foods can be absorbed and be assimilated.

Intestinal absorption

How takes place this absorption or assimilation?

• the intestinal vellosidades.

By its system of you fold covered by a carpet of intestinal vellosidades, the organism increases of considerable way the faying surface of the intestinal mucosa with the food. The set of vellosidades - that constitute the absorption organ represents a surface of 250 m2. He is widely vascularizado and the cells of coating - enterocitos- is specialized in the absorption function.

• the absorption.

The nutrients cross the enterocitos. Amino acids and bears are absorbed by the capillaries and follow the route sanguineous (vein carries towards the liver).

Fatty acids and glicerol are absorbed, and once in the enterocito they become to recombine forming triglicéridos; these surrounded by proteins form then microscopic drops or quilomicrones that through the lymphatic route reaches the veins and the heart, without happening through the liver.

The heavy intestine

Five to six hours after to have produced the ingestion of the food, quimo intestinal reaches the heavy intestine. The cólico transit lasts 24 hours approximately.

The nonsecret colon no digestive enzyme nevertheless, has an important paper in the reabsorción of water and mineral salts. The dehydration of quimo produces a more consistent intestinal content. The hardness of lees depends on the duration of the cólico transit.

The heavy intestine is colonized by an important saprófita bacterial flora that it acts on the glucídicos remainders of the digestion causing reactions of fermentation and on the protídicos remainders causing reactions of rotting. Both reactions are accompanied by a gas liberation.

Defecación

It is triggered when the rectal blister is full. The defecación needs the liberation the anal sphincter, constituted partly by fluted muscular fibers. It is the only element of the alimentary canal that has a voluntary operation.

The fecal skittle, is compound of food remainders nondigested.

Definition

The cirrhosis, originated by prolonged injuries of the hepatocitos, characterizes by fibrosis and nodules of regeneration. Therefore, its definition is histológica. Although the origin is generally alcoholic, also can be originated by a hepatitis.

The risk of alcoholic cirrhosis depends, evidently, of the alcohol mean consumption, beginning to be dangerous from 60 g for the man and of 40 g for the woman. The nature of the alcohol does not influence in the risk, but the ingested amount. Nevertheless, important particular differences exist. The alcoholism is responsible for 90% of the cases of cirrhosis in the man and of 75% in the woman.

Clinical signs

• the cirrhosis can remain asintomática during many years: in these cases, usually it is discovered of fortuitous form during a clinical examination in hepáticos biological examinations.

• Generally, is discovered the presence of a cirrhosis after the appearance of some of the following symptoms: asthenia, thinning, or complication: digestive, ictericia hemorrhage.

• In the clinical examination is registered:

• an increase of the volume of the liver (hepatomegalia), preséntando sometimes one even atrophies severe or to nodular.

• Signs of hypertension: esplenomegalia, ascitis, edema, collateral circulation.

• stellar Angiomas.

• Sometimes, can even have a neurological reach: polineuritis, upheavals of the bucket I lie.

The doctor will make the following tests:

Biochemistry

• Analysis of the hepática insufficiency: generally, gamma-glutamil-transferasa (gamma G.T.) it increases.

• Electroforesis of proteins to show the protídicos disorders.

Abdominal Ecografía

It must be systematic. It shows to the volume and the aspect of the liver.

Hepática biopsy

He is indispensable to confirm the diagnosis.

Treatment

1. Hygienic-dietetic treatment

One advises a healthy nourishing regime, protein balance, sufficiently rich.

The true treatment for the compensated cirrhosis consists of leaving the alcohol totally.

In order to control the abandonment of its consumption, it can resort to a measurement of gamma G.T.

2. Bases for the tratamento

In many occasions the doctor reduces to the minimum the chemical medicine advice, because the liver finds a great difficulty in metabolizar them and eliminating them.

In order to protect the nervous system, usually one resorts to a vitaminoterapia B.

3. Fitoterapia

Medicinal plants that can be used in the treatment of the alcoholic cirrhosis

Two hepatoprotectoras plants could be proposed: Thistle Maria and Alcahofa.

Plants adapted for this disease

Thistle Maria

Artichoke

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