Pulmonary cirrhosis

Cirrhosis of the lungs is a pathological disease in which irreversible changes occur in the cells and tissues of the organ. Let's consider the main causes of the disease, symptoms, signs, diagnostic and treatment methods.

Cirrhosis is the growth of tissue in organs such as the lungs, kidneys, liver and others, accompanied by partial or absolute changes in their structure, some compaction and various deformations.

The disease is an overgrowth of connective tissue in the lungs. Cirrhosis is the extreme and most severe stage of pulmonary tuberculosis. With this disease, the vessels, bronchi and alveoli are completely replaced by connective tissue and collagen, gas exchange functions are disrupted and the pleura thickens. Cirrhosis entails the process of fibrous degeneration and sclerosis of the bronchi, which are deformed, narrowed, that is, change their physiological characteristics. It is this factor that allows this disease to be recognized using X-ray examination.

Cirrhosis of the lungs is characterized by a long course. The pathology can be either unilateral or bilateral. But in both cases, sclerotic changes in the lung tissue are formed. Not only the bronchi are subject to deformation, but also the vessels, the organs of the mediastinum are displaced, and emphysema appears in areas adjacent to the lungs.

There is a certain classification of pulmonary cirrhosis, that is, cirrhotic tuberculosis:

• Cirrhosis with local damage to lung tissue – most often, the upper segments of the organ are subject to deformation. Patients with this diagnosis feel normal, since the disease may not give clinical manifestations for decades. Such patients are dangerous, since they excrete mycobacteria in small quantities. But stress, acute respiratory diseases and a number of other diseases can provoke a relapse of cirrhosis of the lungs.
• Cirrhosis with frequent relapses - the patient suffers from subfebrile fever, intoxication of the body and dehydration. Fibrous tissue grows and can capture the entire lung. Bilateral damage due to bronchogenic seeding is very common.
• Cirrhosis of the lungs with bronchiectasis - the condition of patients is severe, there is abundant bacterial excretion of sputum. Bronchiectasis is quite extensive, difficult to treat and becomes secondarily infected. With this form of the disease, surgical treatment is impossible, such patients have a poor prognosis.
• Cirrhosis of the lungs, causing destruction of organ tissue. In the process of long-term progression against the background of pulmonary-cardiac insufficiency, fibrous tissue develops. Patients constantly have a fever, the body is in a state of dehydration. Infusion therapy is used for therapy.

[ 1 ], [ 2 ], [ 3 ], [ 4 ]

Causes of pulmonary cirrhosis

The causes of pulmonary cirrhosis are varied; the disease may arise against the background of advanced tuberculosis and other pathologies of the body. In recent years, doctors have noted that long-term treatment with antibiotics contributes to the formation of cirrhosis. But most often, the disease develops against the background of chronic fibrous-cavernous and hematogenous-disseminated tuberculosis. Pleurisy and tuberculous lobititis can also be a source of pathology.

Since the main cause of cirrhosis is tuberculosis, it is worth knowing that it is provoked by acid-resistant bacteria of the genus Mycobacterium. Cirrhotic tuberculosis develops over a long period of time, often the disease progresses for years or even decades. But in some cases, the disease develops rapidly. In this case, age-related features of the body are of great importance. Since in the aging process, the elastic fibers of the lungs are gradually replaced by connective tissue, which leads to the formation of emphysema.

But people of middle age, young age and even childhood are susceptible to the development of cirrhosis of the lungs. The development of the disease is influenced by various complications, for example, damage to the cardiovascular system and lungs, sclerosis in the lymph nodes and tuberculous foci. A limited form of cirrhosis can occur against the background of focal tuberculosis due to disruption of the ventilation of the lungs and damage to the small bronchi. In the affected area, not only sclerosis is formed, but also grape-like swellings.

Cirrhosis can develop after surgery, for example, after lung resection. Empyema of the pleura and bronchial fistula are also risk factors for the development of cirrhosis. Long-term inhalation of organic and inorganic dust provokes lung damage, which leads to fibrosis. Pathologies of connective tissue, pneumonia, inflammation of the walls of blood vessels and many other diseases can cause cirrhosis.

[ 5 ], [ 6 ], [ 7 ], [ 8 ]

Symptoms of pulmonary cirrhosis

Symptoms of pulmonary cirrhosis are wave-like and may not manifest themselves for a long period of time. Thus, periods of normal condition are replaced by exacerbations with signs of intoxication. The patient's cough and sputum production increase, hemoptysis and pulmonary hemorrhage appear. Against the background of these symptoms, new foci of inflammation are formed in different parts of the lungs due to seeding with mycobacteria. As the disease progresses, a disorder of all body systems and damage to various organs develops.

Patients complain of shortness of breath, frequent asthma attacks, and foul-smelling sputum. As cirrhosis develops, the cardiovascular system becomes dysfunctional, fluid accumulates in the peritoneal cavity, and the liver increases in size. In some cases, cirrhosis is accompanied by amyloidosis, i.e., non-tuberculous damage to the kidneys and liver.

The course of cirrhosis is very slow, it can last for years, as it takes a chronic form. The patient can often suffer from chronic bronchitis, against which bronchiectasis is formed and mucopurulent sputum accumulates. If the disease develops from hematogenous-disseminated tuberculosis, then the predominant symptom of pulmonary cirrhosis is diffuse emphysema.

Diagnosis of pulmonary cirrhosis

Diagnosis of pulmonary cirrhosis presents a number of difficulties, since the clinical symptoms of the disease are difficult to differentiate from a number of other pathologies of the respiratory organs. But, despite this, the following methods are used to determine cirrhosis:

• Collection of anamnesis, i.e. analysis of complaints of the disease (shortness of breath, general weakness, cough, intoxication). The doctor asks the patient about when the first symptoms of the pathology appeared, about past and existing diseases, working and living conditions.
• At the next stage, the doctor listens to the lungs and determines the degree of damage (unilateral or bilateral). In addition, percussion is performed, that is, tapping the lungs. Also, the patient will undergo spirography to determine respiratory function disorders and the volume of the respiratory organs.
• After this, the patient undergoes a chest X-ray, which can be used to identify changes in the lungs, i.e. their deformation. Computer and magnetic resonance imaging are used as additional diagnostic methods. These methods allow for a more accurate determination of the degree of pathological changes in the lungs.
• A biopsy, i.e. a study of lung tissue obtained using bronchial endoscopy, would not be superfluous. Such a study reveals the growth of connective tissue in the lungs at a microscopic level.

In addition to the above methods, the patient must undergo a number of tests. First of all, this is a general and detailed blood test, and an analysis of the secreted sputum. This will provide information about the course of the inflammatory process and the level of intoxication of the body. Sputum is examined for the presence of mycobacteria and increased sensitivity to antibiotics. The data obtained is used to draw up a treatment plan.

[ 9 ], [ 10 ]

Treatment of pulmonary cirrhosis

Treatment of pulmonary cirrhosis is symptomatic therapy, which is aimed at reducing oxygen starvation and maintaining cardiac activity. In some cases, surgical treatment is performed, for example, in case of unilateral cirrhosis. The patient is hospitalized and undergoes conservative therapy, after which surgical intervention is possible. In addition, it is necessary to constantly conduct control studies to assess the correctness and effectiveness of the chosen treatment method.

Antibacterial treatment consists of two phases:

• In the intensive phase, the patient is given combinations of antibiotics to suppress the intensive reproduction of mycobacteria and to prevent the development of drug resistance.
• In the phase of ongoing therapy, the effect is directed at dormant and intracellular forms of mycobacteria. The patient is prescribed drugs to stimulate regenerative processes and prevent the proliferation of bacterial microorganisms.

The patient's diet is of particular importance. Doctors recommend a special diet with the use of food rich in proteins. This allows to correct metabolic disorders. Surgical treatment of pulmonary cirrhosis is carried out in the presence of tuberculomas, single cavities, cavernous changes within several or one lobe of one lung. Resection of the lung areas affected by cirrhosis is prohibited in severe degrees of cardiac and respiratory failure.

Particular attention is paid to collapse therapy. This method is used only when no signs of sclerosis are detected, but there are already cavities and pulmonary hemorrhage. The essence of the treatment is to create an artificial pneumothorax to compress the lungs. Due to this, the cavities of decay collapse, the risk of infection dissemination is significantly reduced, and reparative processes are improved. As a rule, this method is used for cirrhosis localized in the lower lobes of the lungs.

Prevention of pulmonary cirrhosis

Prevention of pulmonary cirrhosis is aimed at preventing the development of diseases that cause pathological damage to the respiratory organs. To do this, it is necessary to promptly treat any inflammatory diseases of the lungs. Vaccination (BCG), that is, the introduction of a weakened strain of mycobacterium tuberculosis to develop immunity, will not be superfluous. This preventive method is included in the calendar of routine vaccinations for children and remains effective for five years. According to doctors' indications, vaccination can be carried out every five years until reaching 30 years.

Do not forget about chemoprophylaxis, i.e. taking antibiotics. This method can be used in case of primary infection with mycobacteria or secondary, i.e. for patients who have had mild forms of pulmonary tuberculosis. The main indications for such prophylaxis are professional or household contacts with patients with open tuberculosis. Such a method is necessary for patients with tuberculosis changes in the respiratory organs, taking immunomodulators or steroid hormones.

Particular attention should be paid to taking medications that can lead to the development of pulmonary fibrosis. Do not forget about quitting smoking and annual fluorography. This screening study allows you to identify not only cirrhosis of the lungs, but also other non-specific lesions of the respiratory organs and even tumors of the chest organs.

Prognosis of pulmonary cirrhosis

The prognosis for cirrhosis of the lung is favorable for life, even if the therapy is supportive and lasts for a very long time. But cirrhosis can cause a number of complications, such as chronic pulmonary heart disease, pulmonary hypertension, respiratory failure, or secondary infection.

Cirrhosis of the lungs is accompanied by a strong cough with blood and sputum. These symptoms should be the reason to seek medical help, undergo a series of examinations and begin treating respiratory damage. The earlier cirrhosis of the lungs is detected, the greater the chances of avoiding serious complications that negatively affect the functioning of the entire body.