THE ATO PUGLIA IN FIRST LINE FOR L' INFORMATION

 

 

 

 

THE LIVER ILLNESSES: Hepatitis, Cirrhosis and Tumor to the Liver.   

  
The Liver: what it is and to thing it serves. 
The liver is an organ set in the abdomen of the hung of 1.200 - 1.500 grams. 
Being to the center of the metabolism as well as appointed to "to detoxify" the organism, is exposed to one big varieties of attacks and therefore it is more frequently one of the organs of the body damaged. 
The inflammation and the necrosis (death) of the cells you/he/she can be caused by infections (above all viral), from toxic causes (inclusive medicines and alcohol) and from reactions autoimmunitarie. 

The more problems typical of the liver. 
All the inflammations that characterize the liver, can last in the time (chronic hepatitises) and to evolve in various percentage toward the cirrhosis of the liver. 
Every year in the 34% of the cirrhoses can appear a liver tumor, generally carcinoma epatocel, lulare. 
The more problems typical of the liver they are tied up to the lack of essential elements in the cellular metabolism, to an inflammatory picture, generically defined hepatitis, or to the compromissione of the it systematizes of excretion of the bile. 


The hepatitis is the most frequent condition among the pathologies of the liver, in partnership to an acute or chronic inflammatory picture. 
Among the causes of hepatitis they distinguish him: toxic forms (for instance from medicines or toxins), forms dismetaboliche, that is tied up to dysfunctions of the metabolism (how Vaccumulo of fats in the liver, tied up to the abuse of alcohol, to the obesity or to the diabetes), forms colestatiche, tied up to the defect of excretion of the bile and viral forms. 

Numerous they are the defined viruses epatitici (Á., B, C, D and And). They results a great deal dangerous for the health of the liver. 
Among these the viruses Á. and And they exclusively manifest him in acute form, while the viruses B, C and D can persist, in a percentage of cases, in chronic form evolving himself/herself/itself in cirrhosis. 

The cirrhosis of the liver, 
it is a chronic illness characterized by alterations of the structure and the functions of the liver. The normal liver cells are damaged and replaced by fabric cicatriziale (fibrosis). You cirrhosis of the liver constitutes the principal condition predisponente the tumor of the liver (epatocarcinoma). 


The causes of cirrhoses of the liver are so many, 
but often the result is similar. There am hundreds of million of people cirrhosis of the liver affette in the world.

The principal causes are: the chronic hepatitis B, C and D, the Epatopatia alcoholic and the hepatitis autoimmune. 

The malignant Tumors of the liver are brought by the degeneration of the cases of cirrhosis. 
The tumors can be divided in benign and malignant. 
The most frequent of the benign tumors is the angioma, that doesn't have meaningful clinical relief. He generally finds by chance, when an ecografia or a TAC of the thick abdomen it is performed for non liver pathologies. 
The most frequent among the malignant tumors of the liver is the carcinoma epatocelluiare that is, to world level, among the most frequent. 

Malignant Neoplasie. 
In Italy her totality of these tumors almost rises up in patient with cirrhoses of the liver. The screening of the cirroticis and the actual methodic diagnostic they often allow to formulate a diagnosis when he/she anchors the tumor it is of small dimensions, allowing the choice among numerous therapeutic options, among which the transplantation, the liver surgical resection and the techniques of local dwelling. 

THE HEPATITIS 
The epidemiological importance of the illnesses of liver in Italy is notevole:  
they esteem him around 1 million people with virus infection B and around 1 million and a half of subjects with virus infection C. 
To these the subjects affections are associated by alcoholic epatopatia, the forms dismetaboliche, that is tied up to metabolic dysfunctions, in rapids growth in relationship to the increase of the tied up problem list to the obesity. 

In USA, where the percentage of obese patients is strongly meaningful you/he/she has been in relief, on a champion of 900.000 people, an increase of the I risk related to the tumor to the liver of 2 times in the averages obesity and of 4 times in the serious ones and, an analogous tendency, seems to also stand out himself/herself/themselves in other areas of the I husk western. 
In Italy, gives 2000 ISTAT, they point out more than 21.000 annual deaths because of cirrhosis or tumor of the liver. Particularly while in the last years the mortality for cirrhosis appears in decrement, in relationship to the therapeutic and preventive progress, the mortality for tumor of the liver continues to increase and in some regions it is positioned to the third place as cause of mortality among the illnesses oncologiche. 

Our Country introduces values of mortality for cirrhoses of the liver among the most elevated in western Europe (second only in Germany) that they are attested on a middle figure of 20 deaths every centomila inhabitants, around 55 deaths a day. 

And' interesting to notice that this datum opposes with that on the general mortality that is, in Italy, among the more lower part among the principal Countries industrialized of the I husk. Besides, if mortality is compared a great deal for cirrhosis with the rate of lethality of other diffused chronic illnesses, as those cardiovascular, metabolic, pulmonary or renal, discover that the cirrhosis of the liver in Italy engraves especially in the band of age giovanile/adulta, thing that involves enormous social, direct and indirect costs (loss of days of job, therapeutic interventions super/specialistici, transplantation, etc). 

An illness asintomatica 
In the large majority of the cases, the acute liver illnesses and, particularly, the chronic forms can elapse in form of the all silent and nearly asintomatica. These last ones can evolve within periods very prolonged, decennial pluri, esteems often him, in fact, that in the majority of the subjects a superior temporal period is necessary a 20/30 years before the clinical complicanzes of the cirrhosis are manifested. 

The causes of contagion and the formalities of trasmíssione.   
In the case of the hepatitises they are different the formalities of transmission of the viruses. 
For the viruses Á. and E. not cronicizzati, the contagion happens in form oro/fecale through foods you infect (fruits of sea, vegetables, water) while for the forms with potential of cronicizzazione (13, C and D) the principal source of infection is represented by the contagion parenterale, that is with contact among the blood of an infected subject and the blood of an element not statement previously to the virus and, therefore, not protected from the memory immunitaria. 

The Epidemiological observatory of the institute of Health, 
it points out among the most greater formalities day transmission the sexual promiscuity, the toxic-dependence with I exchange him/it infected syringes and practices as piercing and tattoos effected with tools non'adeguatamente remarkable sterilizzati.Meno, but not of the all negligible, the tied up risk to surgical operations appears, while the sexual contagion in monogamous couples appears exceptional in the case of the hepatitis C and more remarkable for the virus B. 

The young people and the hepatitis. 
The juvenile band is recognized by the experts as the most greater to risk of contagion for practices to risk, what the drug addiction, the píercing or the tattoos effected with infected tools and the beginning of the sexual activity. Not to neglect, in the juvenile band, the increasing use of alcoholic. 
This imposes a careful and thick senses bi lizzazione respect the prevention. 
The young people must be sensitized besides in comparison to the risk of toxic hepatitises, independent from the viral contagion, tied up to the different chemical amazing substances and the alcoholic abuse. 

The adults and the hepatitis. 
The frequent asintomaticità and the elapsed pluri/decennale of a lot of chronic epatopaties it imposes, also in this case, the necessity of ample sensitization both I concern the screening (kind for the subjects with familiarity or coming from endemic areas for liver illnesses) both I concern the control of the practices to risk (sexual promiscuity, alcoholic abuse and to feed, obesity). This both to preventive purpose is of precocious therapy of the chronic forms. 

  
THE PREVENTION 

In the case of the viral forms to oral contagion (Á. and And) the principal mechanism of prevention resides in the hygienic control. In the case of the hepatitis Á. is available besides a specific vaccine, whose use appears desirable on the occasion of trips in exotic Countries, kind in the subjects affections from liver illnesses. 
A specific vaccine is also available for the hepatitis B. In this pathology the control of the pregnant women and the use of the vaccine during the I depart they allow to check the infection of the newborns. In the case of the viruses B, besides, the activation of the country must be remembered vaccinate her, obligatory in Italy from 1991. 
To such respect our country has been among the first ones in the western world to activate the obligatory vaccination of his/her/their children (to today around 150 countries in the world they apply this strategy but not the England, Holland or Sweden). 
This is due to the particular diffusion of the viruses B in Italy, kind in the regions of the South. 
The recent attainment of the protection immunology in all the subjects actually a 15 years it assumes particular importance, in how much it protects the band of age (among 1 15 and the 25 years) recognized as to greater risk of contagion for practices to risk, what the drug addiction, the piercing or the tattoos effected with infected tools the beginning of the activity plotted her. 
If in the case of the hepatitis B the availability of the vaccine allows a good protection of the Italian population, in the case of the hepatitis C the information on the practices to risk constitutes the principal tool of prevention. 
In the case of the tied up forms to the alcohol and the obesity the control of the voluptuary habits, of the feeding and of the hung, beginning from the infancy, they constitute the principal mechanism of prevention of the cirrhosis and the tumor of the fegato.ùs 


Control's examinations. 
A simple control of the liver enzymes in progress of controls of routine, allows to individualize the picture of inflammation of the liver. 
The control of the viral markers of the viruses epatitici is to reserve to the subjects with alteration of the liver enzymes and, within the prevention, to the donors of blood or organs, to the pregnant women and to patient to submit immunosoppressive to therapies. 
He/she remains instead he/she anchors debated the necessity of the I check in the population, kind for the virus C, in subjects with persistent normalcy of the liver indexes, out of the aforesaid conditions. 

The styles day life recommended. 
The control of the hung, a least alcoholic income (not superior to 1 meal glass, to subsequently reduce in the case of particular metabolic conditions), the absolute abstention from important occasional alcoholic abuses also, the control of the diabetes, the abstention from the assumption of chemical amazing substances and from practices to risk of transmission parenterale (use of syringes in common in case of drug addiction, piercing and tattoos with tools not sterilized, sexual relations to risk non protected, use in common of edges in case of cohabitants chronic carriers of virus epatitici) they allow the prevention of the principal forms chronic epatitiche. 

In the case of the hepatitis B, is besides to consider himself/herself/themselves essential the screening of the women in pregnancy, for the possible prevention of the health of the neonato. s 
Besides, for his/her/their children it is important the adhesion to the program of obligatory vaccination activated to national level in 1991. 


In the case of the hepatitises to oral contagion (virus Á. and And) the respect of the common norms is advisable igieniche,  
kind in case of permanence in endemic areas and the use of the vaccination against the virus Á. in case of missed spontaneous immunization, kind in frequent and subject travellers epatopatici. 
The sensitization and the screening of first level allow the precocious índividuazione of the subjects with chronic hepatitis and the activation of the effective available therapies today. 
Finally the monitoraggio biochemical and instrumental periodical of the liver allows, in case of cirrhosis, the prevention of the tumor of the liver, towards which different therapeutic possibilities exist, today kind in the precocious phases.