What is Liver cirrhosis?
Cirrhosis is the severe scarring of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism. The scarring is often caused by excessive consumption of alcohol or viral infections and every time your liver is injured; it tries to repair itself. As cirrhosis progresses, more and more scar tissue will form making it difficult for the liver to function. A scarred liver cannot function properly and the liver damage done by cirrhosis generally cannot be undone. Advanced cirrhosis is life-threatening, but if it is diagnosed early and the cause is treated, further damage can be limited but rarely reversed. The scar tissue reduces the liver’s ability to carry out vital functions of the liver which are:
- Blood clotting
- Cleansing the blood from toxins
- Digesting food and beverages
- Fighting infection
- Metabolizing medications and other substances
- Producing bile for digestion of food
- Producing proteins, enzymes, and healthy blood
- Removing waste
- Storing vitamins, minerals and energy
How does cirrhosis of the liver develop?
The liver is normally able to regenerate damaged cells but when a person daily consumes large amounts of alcohol, the liver cannot take it. Cirrhosis causes the liver to shrink and harden. This makes it difficult for nutrient-rich blood to flow through the portal vein into the liver. The portal vein carries blood from the digestive organs into the liver. The pressure in the portal vein rises if blood cannot pass into the liver. This will result in a serious condition called portal hypertension, in which the vein develops high blood pressure. The consequence of portal hypertension is that this high-pressure system causes a backup leading to esophageal varices (like varicose veins), which could burst and bleed.
What are the causes and risk factors of liver cirrhosis?
The causes and risk factors of liver cirrhosis include:
- Chronic viral hepatitis such as hepatitis B, C and D.
- Fat accumulation in the liver (non-alcoholic fatty liver disease)
- The iron build-up in the body (hemochromatosis)
- Poorly formed bile ducts (biliary atresia)
- Alpha-1 antitrypsin deficiency
- A family history of sugar metabolism (galactosemia or glycogen storage disease)
- Genetic digestive disorder (Alagille syndrome)
- Liver disease caused by your body’s immune system (autoimmune hepatitis)
- Destruction of the bile ducts such as primary biliary cirrhosis
- Hardening and scarring of the bile ducts (primary sclerosing cholangitis
- Infection, such as syphilis or brucellosis
- Excessive alcohol consumption is one of the major risk factors for cirrhosis.
- Being obese increases your risk of conditions that can lead to cirrhosis.
- Cystic fibrosis
- Wilson’s disease is when too much copper is stored in the liver
- Autoimmune diseases that cause your body to attack liver cells
- Congestive heart failure (inability of the heart to effectively pump blood)
- Hemochromatosis (excessive levels of iron in the body that can cause liver damage)
Symptoms & treatment of liver cirrhosis:
Cirrhosis has no signs or symptoms until liver damage is extensive, but when signs and symptoms do occur, they include the following:
- Easily bleeding or bruising
- Loss of appetite
- Swelling in the legs, feet or ankles (edema)
- Weight loss
- Itchy skin
- Jaundice (yellow discolouration in the skin and eyes)
- Fluid accumulation in your abdomen (ascites)
- Spiderlike blood vessels on your skin
- Redness in the palms of the hands
- For women, absence or loss of periods not related to menopause
- For men, loss of sex drive, breast enlargement (gynecomastia) or testicular atrophy
- Confusion, drowsiness and slurred speech (hepatic encephalopathy)
- Vomiting blood
- Severe muscle cramps
- Brownish urine
- Enlarged spleen
What are the serious symptoms that might indicate a life-threatening condition of liver cirrhosis?
If your blood is unable to pass through the liver then it will create a backup through other veins such as those in the esophagus. This backup is called esophageal varices. These veins cannot handle high pressure, and begin to bulge from the extra blood flow. The severe complications from cirrhosis include:
- Bruising (this is caused due to low platelet count and/or poor clotting)
- Bleeding (this is caused due to decreased clotting proteins)
- Kidney failure
- Liver cancer
- Insulin resistance and type 2 diabetes
- Hepatic encephalopathy (confusion due to the effects of blood toxins on the brain)
- Gallstones (interfere with bile flow and can cause bile to harden and form stones)
- Esophageal varices (A condition where the veins in the esophagus get enlarged)
- Enlarged spleen (splenomegaly)
- Edema and ascites
What are the treatment options for cirrhosis?
The scar tissue which forms in the liver due to cirrhosis of the liver is permanent. The goal of the treatment is to stop or slow the progress of damage to the liver and minimize and quickly treat any complications.
Treatment for cirrhosis varies based on how it was caused and how far the disorder has progressed. Some treatments that your doctor might prescribe include:
- Controlling pressure in the portal vein (for portal hypertension): Blood can “back up” in the portal vein that supplies the liver with blood, causing high blood pressure in the portal vein. Drugs are prescribed to control the increasing pressure in other blood vessels. The aim is to prevent severe bleeding. Signs of bleeding can be detected via an endoscopy.
- Stop drinking (if the cirrhosis is caused by alcohol)
- Intravenous antibiotics can treat peritonitis which occurs with ascites.
- Hemodialysis (purification of blood using a dialysis machine of those in kidney failure)
- Lactulose and a low protein diet (to treat encephalopathy)
- The patient could be prescribed medications to control liver cell damage caused by hepatitis B or C.
If the patient vomits blood or passes bloody stools, then urgent medical attention is required because they have esophageal varices (A condition where the veins in the esophagus get enlarged). The following procedures may help in such cases:
- Banding: A small band is placed around the base of the varices to control bleeding from esophageal varices.
- Injection sclerotherapy: After an endoscopy, a substance is injected into the varices, which triggers a blood clot and scar tissue to form. This helps stem the bleeding.
- A Sengstaken-Blakemore tube with a balloon: If endoscopy does not stop the bleeding, the tube goes to the patient’s throat and into their stomach. The balloon is inflated. This puts pressure on the varices and stops the bleeding.
- Transjugular intrahepatic portosystemic stent shunt (TIPSS): If the therapies mentioned above do not stem the bleeding, a metal tube is passed across the liver joining the portal and hepatic veins, creating a new route for the blood to flow through thus reducing the pressure that was causing the varices.
Liver transplantation is the last option when other treatments fail.
What is the outcome of liver cirrhosis?
The survival rate of a person with liver cirrhosis will depend on the severity of the scarring. A 15-year follow-up study of 100 people in Norway with severe alcoholic cirrhosis showed that 71% of the people in the study died within 5 years of diagnosis and the mortality rate 15 years after diagnosis was 90%.
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