Cirrhosis

What is cirrhosis?

A clinical disease which affects the liver slowly and leads to a chronic injury. This is the end stage of liver disease. Healthy liver tissue is replaced with scar tissue and thus partially blocks the flow of blood through the liver. This scarring impairs some functions of the liver. They are as follows:

1. control of infections

2. removal of bacteria and toxins from the blood

3. processing of nutrients, hormones, and drugs

4. making of proteins that regulate blood clotting

5. production of bile to help absorb fats and fat-soluble vitamins

When the liver is damaged it can regenerate most of its own cells but in the case of end-stage cirrhosis, the liver is not able to effectively replace the damaged cells.


Causes of Cirrhosis

Cirrhosis is caused due to a number of predisposing factors such as heavy alcohol consumption and obesity. The onset of cirrhosis is not sudden it usually requires years of chronic injury.

Alcohol-related liver disease

Moderate intake of alcohol causes lipid droplets to accumulate in hepatocytes. Liver enlarges in size due to deposition of fats. It increase in size from 1 1kg to about 6 kg in size the cells bulges and then bursts and the contents in the cells are released after this the size decreases and the liver shrinks leading to cirrhosis.

Hepatitis

Hepatitis virus spreads by contact with an infected person’s blood, semen, or other body fluid leading to liver inflammation which thus leads to cirrhosis.

Obesity

An obese person accumulates more fat than a non-obese person. The fat gets deposited in the liver as droplets, then leads to fatty streaks which develops to cirrhosis.

Autoimmune hepatitis

In this case of hepatitis antibodies are produced against one’s own liver cells causing inflammation, damage, and eventually to cirrhosis.


Diseases that damage or destroy bile ducts

Some diseases damage or destroy the ducts that carry bile from the liver, causing bile to regurgitate in the liver and thus leading to cirrhosis. They are as follows:

1. Primary biliary cirrhosis

2. Secondary biliary cirrhosis

3. Primary sclerosing cholangitis

4. Biliary atresia


Inherited diseases

Some types of inherited diseases may also lead to cirrhosis. They are as follows:

1. Cystic fibrosis

2. Alpha-1 antitrypsin deficiency

3. Hemochromatosis

4. Wilson disease

5. Galactosemia

6. Glycogen storage diseases


Symptoms of cirrhosis

In the early stages of the disease many people with cirrhosis will have no symptoms. However, as the disease progresses the following symptoms may be experienced by the affected person:

• nausea

• vomiting

• loss of appetite

• spiderlike blood vessels on the skin

• weakness

• weight loss

• abdominal pain and bloating

• itching

• fatigue


Complications of cirrhosis

Edema and Ascites

As the liver damage progresses to an advanced stage it may lead to edema and ascites. The collection of fluid in the legs is called edema and that in the abdomen is called ascites. Ascites can lead to serious bacterial infections.

Bleeding

Liver slows or stops the production of proteins needed for blood clotting as the damage progresses which makes the person to bleed easily.

Portal hypertension

The portal vein carries blood from the intestines and spleen to the liver. In cirrhotic liver normal flow of blood is slowed which increases the pressure in the portal vein and leads to a condition called portal hypertension.

Splenomegaly

Enlargement of spleen is a major complication.

Jaundice

Jaundice occurs when the diseased liver does not remove enough bilirubin from the blood.

Gallstones

If cirrhosis causes obstruction of bile flowing freely to and fro the gallbladder, the bile hardens and leads to gallstones.

Hepatic Encephalopathy

A damaged liver cannot remove toxins from the blood and they accumulate in the brain leading tohepatic encephalopathy.


Insulin resistance and type 2 diabetes

Cirrhosis may lead to Insulin resistance and thus glucose accumulates in the blood.


Other problems

1. Kidney failure

2. Lung failure

3. Liver cancer


Diagnosis of cirrhosis

1. Physical examination

2. Blood tests

3. Abdominal examination

4. Computerized tomography (CT) scan,

5. Ultrasound

6. Magnetic resonance imaging (MRI), or liver scan

7. Liver biopsy


Treatment for cirrhosis

Depends on the cause of the disease and whether complications are present or not. The goals of treatment are to slow down the progression of scars in the liver.

1. Eating a nutritious diet

2. Avoiding alcohol and other substances

3. Beta-blocker or nitrate for portal hypertension.

4. Cleansing the bowel with lactulose

5. Hemodialysis

6. Medications

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