Hepatopatía crónica ¿qué es y cómo cuidarme?


El hígado es el principal órgano implicado en procesos de transformación de sustancias que puedan resultar perjudiciales para el organismo, como medicamentos, alcohol, o cualquier sustancia ajena al organismo, convirtiendo estos componentes en sustancias inocuas.
Se denomina hepatopatía crónica a la enfermedad de larga evolución (más de 6 meses) del hígado que provoca que funcione inadecuadamente o que deje de funcionar.

¿Qué causas pueden producir una alteración crónica en el hígado?
Las causas más frecuentes son:

  • Alcohol
  • Virus (Hepatitis B, Hepatitis C)
  • Enfermedades autoinmunes
  • Enfermedades metabólicas (hemocromatosis, enfermedad de Wilson…)

 
Al ser crónica, es decir durante el resto de la vida ¿Cómo va a evolucionar?
Inicialmente el hígado se inflama y aumenta de tamaño, se acumula grasa en él y esto hace que su funcionamiento sea menos adecuado.
A veces, los cambios son reversibles si el estímulo que los ha provocado desaparece, el tejido puede recuperar sus capacidades. Esto se ve con frecuencia en los pacientes que beben alcohol y abandonan su consumo cuando el hígado no está muy alterado. La grasa acumulada y la inflamación pueden desaparecer y el hígado puede llegar a recuperar su forma y funcionamiento normales. Sin embargo, si la enfermedad evoluciona las células del hígado van degenerándose y muriendo, hasta ser sustituidas por tejido cicatricial: ésta es la etapa denominada de cirrosis. Por lo tanto, podríamos decir que la cirrosis es la fase final de una hepatopatía crónica, a la que no tienen por qué llegar todos los pacientes que tienen hepatitis crónica.
 
¿Qué puedo notar?
Este tipo de patología puede ser asintomática, es decir no dar síntomas, y que lo único que esté alterada sea la analítica.
En otras ocasiones los indicios de la hepatopatía puede ser una vaga sensación de enfermedad, incluso en ocasiones, pueden presentar febrícula y molestias en la parte superior del abdomen.
Los primeros síntomas específicos son los de enfermedad hepática crónica o cirrosis, serían los siguientes:

  • Dolor abdominal
  • Cansancio o inapetencia
  • Malestar general
  • Pérdida de peso
  • Ictericia
  • Aumento de tamaño de hígado y bazo
  • Capilares en forma de araña visibles en la piel en cara, abdomen…
  • Enrojecimiento de las palmas de las manos
  • Acumulación de líquido dentro del abdomen (ascitis)
  • Deterioro de la funcionalidad cerebral (encefalopatía hepática)

 
¿Puede haber complicaciones?
Sí, a veces puede afectar a otros órganos como el cerebro.
Se llama encefalopatía hepática al deterioro de la función cerebral que afecta a personas con enfermedad hepática grave, se produce por la llegada al cerebro de sustancias tóxicas acumuladas en la sangre (como el amoniaco) que normalmente deberían haber sido eliminadas por el hígado. Muchos de estos tóxicos son productos de la descomposición normal de la digestión de las proteínas. En la encefalopatía hepática, los tóxicos no quedan eliminados, porque la función hepática está alterada.
El cuadro clínico de la encefalopatía sería: alteraciones neuropsiquiátricas (confusión, desorientación, cambios en la personalidad, en el estado de ánimo…) y asterixis (temblor por sacudidas en ambas manos).
 
¿Cómo puedo saber qué le pasa algo a mi hígado?
El diagnóstico lo realiza un médico partiendo de la historia clínica e indagando sobre nuestros antecedentes familiares y personales (tóxicos, hábitos, enfermedades, fármacos), exploración física y analítica sanguínea.
En ocasiones se puede complementar el estudio realizando otras pruebas de imagen como la ecografía.
 
Si me diagnostican un problema en el hígado ¿Qué cuidados debo tener en mi día a día?

  • Abandono total del alcohol (sea cual sea la causa de la hepatopatía).
  • No fumar.
  • Dieta variada y equilibrada, rica en frutas y verduras y limitando productos con mucha grasa como fritos, rebozados, embutidos…
  • Que ingieran cantidad suficiente de proteínas, y que sean de alto valor biológico.
  • Realizar ejercicio físico de manera regular, evitando realizar abdominales y cualquier ejercicio que ejerza presión en la zona abdominal. Fortalecer la musculatura de extremidades inferiores.
  • Realizar deposiciones de manera regular: con frutas y verduras, agua suficiente, y en caso necesario, administración de laxantes o enemas recetados por un médico especialista. Vigilar el color de las deposiciones.
  • Control del color, aspecto, frecuencia y cantidad de orina. Si percibe orina colúrica (color “refresco de cola”), consultar con el médico.
  • Que se pesen de forma periódica, y en el caso de un aumento significativo en un periodo de tiempo muy corto, comentarlo con el médico.
  • Aplicar crema hidratante 2 veces al día y beber abundante agua (si no hay restricciones).
  • Reducir café, sustancias picantes y todas las sustancias que puedan producir picor e irritación.
  • Evitar el cepillado fuerte por la probabilidad de sangrado de encías.
  • No debe tomar medicación por su cuenta, ya que algunos medicamentos puedes afectar a la función del hígado, por lo que debe consultar con el médico.
  • Consultar también antes de tomar plantas medicinales, vitaminas y/o suplementos.
  • Acudir al médico si percibe síntomas de encefalopatía hepática.

Ester Aparicio Posada

EIR 1 Enfermería Familiar y Comunitaria. C.S. Circunvalación

REFERENCIAS BIBLIOGRÁFICAS:

  1. Alfambra Cabrejas E, Alonso Tost A, de Prada Borgonez G, Durango Limárquez I, Fernéndez Piqueras E, Fuertes Ran C, García Muñoz R, et al. Guía de cuidados para pacientes con cirrosis hepática y sus familiares. Grupo de Trabajo de la Asociación Española de Enfermería de Patología Digestiva (AEEPD). FUDEN. Mayo 2016.
  2. Pereira Jiménez E, Hermosín Alcalde A, Calviño García I. Cuidados de enfermería al paciente con cirrosis hepática. Revista Electrónica de PortalesMedicos.com. 4 de septiembre de 2017. Disponible en: https://www.revista-portalesmedicos.com/revista-medica/cuidados-de-enfermeria-cirrosis-hepatica/
  3. Hepatitis crónica. Portal de salud de la Rioja. Disponible en: https://www.riojasalud.es/ciudadanos/catalogo-multimedia/digestivo/hepatitis-cronica

 
REVISADO: Junio 2020
 

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