Health

Cirrhosis

Overview.

Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism.

Each time your liver is injured — whether by disease, excessive alcohol consumption or another cause — it tries to repair itself. In the process, scar tissue forms. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function (decompensated cirrhosis). Advanced cirrhosis is life-threatening.

The liver damage done by cirrhosis generally can’t be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited and, rarely, reversed.

The liver is located in the upper right side of the abdomen below the ribs. It has many essential body functions. These include:

▪️ producing bile, which helps your body absorb dietary fats, cholesterol, and vitamins A, D, E, and K.

▪️ storing sugar and vitamins for later use by the body.

▪️ purifying blood by removing toxins such as alcohol and bacteria from your system.

▪️ creating blood clotting proteins.

How cirrhosis develops.

The liver is a very hardy organ and is normally able to regenerate damaged cells. Cirrhosis develops when the factors that damage the liver (such as alcohol and chronic viral infections) are present over a long period of time. When this happens, the liver becomes injured and scarred. A scarred liver can’t function properly, and ultimately, this may result in cirrhosis.

Cirrhosis causes the liver to shrink and harden. This makes it difficult for nutrient-rich blood to flow into the liver from the portal vein. The portal vein carries blood from the digestive organs to the liver. The pressure in the portal vein rises when blood can’t pass into the liver.

The end result is a serious condition called portal hypertension, in which the vein develops high blood pressure. This high-pressure system causes a backup, which leads to esophageal varices (like varicose veins), which can then burst and bleed.

Symptoms of cirrhosis.

Cirrhosis often has no signs or symptoms until liver damage is extensive. When signs and symptoms do occur, they may include:

▪️ Fatigue.

▪️ Easily bleeding or bruising.

▪️ Loss of appetite.

▪️ Nausea.

▪️ Swelling in your legs, feet or ankles (edema).

▪️ Weight loss.

▪️ Itchy skin.

▪️ Yellow discoloration in the skin and eyes (jaundice).

▪️ Fluid accumulation in your abdomen (ascites).

▪️ Spiderlike blood vessels on your skin.

▪️ Redness in the palms of the hands.

▪️ For women, absent 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).

Causes.

A wide range of diseases and conditions can damage the liver and lead to cirrhosis.

Some of the causes include:

▪️ Chronic alcohol abuse.

▪️ Chronic viral hepatitis (hepatitis B, C and D).

▪️ Fat accumulating in the liver (nonalcoholic fatty liver disease).

▪️ Iron buildup in the body (hemochromatosis).

▪️ Cystic fibrosis.

▪️ Copper accumulated in the liver (Wilson’s disease).

▪️ Poorly formed bile ducts (biliary atresia).

▪️ Alpha-1 antitrypsin deficiency.

▪️ Inherited disorders 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 (primary biliary cirrhosis).

▪️ Hardening and scarring of the bile ducts (primary sclerosing cholangitis.

▪️ Infection, such as syphilis or brucellosis.

▪️ Medications, including methotrexate or isoniazid.

Risk factors.

▪️ Drinking too much alcohol. Excessive alcohol consumption is a risk factor for cirrhosis.

▪️ Being overweight. Being obese increases your risk of conditions that may lead to cirrhosis, such as nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.

▪️ Having viral hepatitis. Not everyone with chronic hepatitis will develop cirrhosis, but it’s one of the world’s leading causes of liver disease.

Complications.

Complications of cirrhosis can include:

▪️ High blood pressure in the veins that supply the liver (portal hypertension). Cirrhosis slows the normal flow of blood through the liver, thus increasing pressure in the vein that brings blood to the liver from the intestines and spleen.

▪️ Swelling in the legs and abdomen. The increased pressure in the portal vein can cause fluid to accumulate in the legs (edema) and in the abdomen (ascites). Edema and ascites also may result from the inability of the liver to make enough of certain blood proteins, such as albumin.

▪️ Enlargement of the spleen (splenomegaly). Portal hypertension can also cause changes to and swelling of the spleen, and trapping of white blood cells and platelets. Decreased white blood cells and platelets in your blood can be the first sign of cirrhosis.

▪️ Bleeding. Portal hypertension can cause blood to be redirected to smaller veins. Strained by the extra pressure, these smaller veins can burst, causing serious bleeding. Portal hypertension may cause enlarged veins (varices) in the esophagus (esophageal varices) or the stomach (gastric varices) and lead to life-threatening bleeding. If the liver can’t make enough clotting factors, this also can contribute to continued bleeding.

▪️ Infections. If you have cirrhosis, your body may have difficulty fighting infections. Ascites can lead to bacterial peritonitis, a serious infection.

▪️ Malnutrition. Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss.

▪️ Buildup of toxins in the brain (hepatic encephalopathy). A liver damaged by cirrhosis isn’t able to clear toxins from the blood as well as a healthy liver can. These toxins can then build up in the brain and cause mental confusion and difficulty concentrating. With time, hepatic encephalopathy can progress to unresponsiveness or coma.

▪️ Jaundice. Jaundice occurs when the diseased liver doesn’t remove enough bilirubin, a blood waste product, from your blood. Jaundice causes yellowing of the skin and whites of the eyes and darkening of urine.

▪️ Bone disease. Some people with cirrhosis lose bone strength and are at greater risk of fractures.

▪️ Increased risk of liver cancer. A large proportion of people who develop liver cancer have pre-existing cirrhosis.

▪️ Acute-on-chronic cirrhosis. Some people end up experiencing multiorgan failure. Researchers now believe this is a distinct complication in some people who have cirrhosis, but they don’t fully understand its causes.

Diagnosis.

People with early-stage cirrhosis of the liver usually don’t have symptoms. Often, cirrhosis is first detected through a routine blood test or checkup. To help confirm a diagnosis, a combination of laboratory and imaging tests is usually done.

Tests.

Tests can reveal how damaged the liver has become. Some of the tests used for evaluation of cirrhosis are:

▪️ complete blood count (to reveal anemia).

▪️ coagulation blood tests (to see how quickly blood clots).

▪️ albumin (to test for a protein produced in the liver).

▪️ liver function tests.

▪️alpha fetoprotein (a liver cancer screening).

Additional tests that can evaluate the liver include:

▪️ upper endoscopy (to see if esophageal varices are present).

▪️ ultrasound scan of the liver.

▪️ MRI of the abdomen.

▪️ CT scan of the abdomen.

▪️ liver biopsy (the definitive test for cirrhosis).

Treatment for cirrhosis.

Treatment for cirrhosis varies based on what caused it and how far the disorder has progressed. Some treatments your doctor might prescribe include:

▪️ beta blockers or nitrates (for portal hypertension).

▪️ quitting drinking (if the cirrhosis is caused by alcohol).

▪️ banding procedures (used to control bleeding from esophageal varices).

▪️ intravenous antibiotics (to treat peritonitis that can occur with ascites).

▪️ hemodialysis (to purify the blood of those in kidney failure).

▪️ lactulose and a low protein diet (to treat encephalopathy).

▪️ Liver transplantation is an option of last resort, when other treatments fail.All patients must stop drinking alcohol. Medications, even over-the-counter ones, should not be taken without consulting your doctor.

Is cirrhosis cancer?

No, cirrhosis of the liver isn’t cancer. However, most people who have liver cancer have cirrhosis. If you have cirrhosis, you have an increased risk of liver cancer. If you have hepatitis B or hepatitis C, you have an increased risk of liver cancer because these diseases often lead to cirrhosis. Any cause of liver disease can lead to cirrhosis, which increases your chance of liver cancer. (Even if you have hepatitis B or fatty liver disease without cirrhosis, you are at increased risk of liver cancer.)

Is cirrhosis a hereditary disease?

Cirrhosis itself is not an inherited (passed from parent to child) disease. However, some of the diseases that can cause liver damage that lead to cirrhosis are inherited diseases.

Reference :

Cirrhosis /https://www.mayoclinic.org/diseases-conditions/cirrhosis/symptoms-causes/syc-20351487

Cirrhosis /https://www.mayoclinic.org/diseases-conditions/cirrhosis/diagnosis-treatment/drc-20351492

Cirrhosis/https://www.healthline.com/health/cirrhosis

Cirrhosis of the Liver/https://my.clevelandclinic.org/health/diseases/15572-cirrhosis-of-the-liver

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