The diagnosis and treatment of chronic diffuse liver diseases

Diagnosis and treatment of chronic diffuse liver diseases represent one of the current interests of modern hepatology due to their high prevalence, significant deterioration of patients’ quality of life and increase in mortality from complications. According to the statistics of the World Health Organization (WHO), mortality from cirrhosis and liver cancer has increased in the world in recent years: in 2000, the cause of death from cirrhosis was in 13th place, in 2017 – at 11- it; mortality from liver cancer in 2000-20th place, in 2017-16th place..

The appearance of liver fibrosis is key to the development of the pathological process in the liver tissue, the result of chronic damage to the liver tissue and excessive accumulation of extracellular proteins, under the influence of various etiological factors: viral and autoimmune hepatitis, toxic effects, metabolic disorders (fat disease, amyloidosis, hemochromatosis), congenital and acquired immunodeficiency conditions, hematological diseases, chronic heart failure. The prognosis and treatment of patients with chronic liver diseases of any etiology is largely determined by the severity and duration of fibrosis, which is a kind of measure of the activity, spread and duration of pathological changes in the liver.

The main way in which chronic diffuse liver diseases progress is through the development of successive stages of fibrosis with the eventual formation of cirrhosis and an increased risk of developing hepatocellular carcinoma. Liver fibrosis is asymptomatic for a long time, and often patients seek medical help only with the development of cirrhosis and its complications. Liver fibrosis is asymptomatic for a long time, and often patients seek medical help only with the development of cirrhosis and its complications.

Diagnosing fibrosis at an early stage allows: 1. the initiation of timely therapy; 2. stopping or slowing down the progression of fibrosis to the final stage of decompensated cirrhosis.

In this regard, various methods for non-invasive diagnosis of liver fibrosis have been introduced in medical practice, which do not have contraindications and complications, such as liver biopsy, which is an accurate but risky examination in the diagnosis of fibrosis.

In recent decades, diagnostic methods have appeared that allow visualization of fibrosis – elastography and elastometric methods – the development of “ultrasound palpation”.

Liver stiffness correlates with the degree of fibrosis and indirectly with portal hypertension, i.e. with fibrous changes in the liver, the stiffness of its tissue diffusely increases (elasticity decreases). Elastographic assessment of liver stiffness is a surrogate marker of liver fibrosis that has become increasingly relevant in recent years for non-invasive assessment and staging of fibrosis in patients with chronic liver diseases. Elastographic assessment of liver stiffness is a surrogate marker of liver fibrosis that has become increasingly relevant in recent years for non-invasive assessment and staging of fibrosis in patients with chronic liver diseases.

When conducting two-dimensional shear wave elastography (Supersonic shear wave-elastography, 2D-SWE), tissues are displaced to different depths due to multiple focused acoustic pulses. 2D-SWE is based on the determination of the transverse wave propagation velocity, a quantitative estimate of liver stiffness. The higher the wave speed, the greater the stiffness of the liver tissues. On the basis of the results obtained, a color map is formed – a qualitative assessment of tissue stiffness (with a color change from blue at F0 or absence of fibrosis to red at F4 – present cirrhosis).