cirrhosis of the liver

Liver Cirrhosis: Causes, Symptoms, Diagnosis and Treatments




The Liver is the second largest organ of the body weighing around 3 pounds and is responsible for carrying out various important functions. The primary function is the making of blood protein that is required by the body cells for clotting, immune system function, and oxygen transport. The Liver also plays the following roles in our body:

  • It’s responsible for the production of bile that helps to digest food.
  • It stores excess nutrients and returns them to the bloodstream when required.
  • Your body won’t store excess sugars in the form of glycogen if your liver isn’t functioning properly.
  • It detoxifies your body of harmful substances like drugs and alcohol.
  • It also breaks down saturated fats in the body, producing cholesterol as a by-product.

 

What happens to your liver with Cirrhosis?

Just like any other organ in your body, liver also requires timely healing and repairing of tissues. Liver Cirrhosis leads to the loss of healthy liver tissue and is replaced with scar tissues. This prevents liver from functioning to its full potential. The body doesn’t get rid of the harmful substances in time; nutrients aren’t distributed within the body, and production of protein reduces substantially.

In US, Cirrhosis of liver is the 12th leading cause of deaths (National Institutes of Health).

 

Liver Cirrhosis: Causes

In U.S., There are three leading factors for liver cirrhosis: alcohol abuse, fatty liver and Hepatitis C. But anything else that can also damage the liver will eventually cause cirrhosis.

  • Obesity and diabetes are responsible for a fatty liver.
  • Other viral infections that are associated with liver, like Hepatitis B and D.
  • Damaged or blocked bile duct that helps emulsification of fats in the body. Babies usually suffer from biliary atresia, in which either bile duct is damaged or absent in the body. The blockage of bile in the liver causes inflammation and scarring. This type of liver damage is called biliary cirrhosis.
  • Heart failure can also be responsible for cirrhosis due to backing up of bile in the liver.
  • Inherited diseases like cystic fibrosis, hemochromatosis, glycogen storage diseases, Wilson’s diseases, etc.
  • Binge alcohol consumption can also contribute to deteriorating liver condition. Women are more likely to be at risk of cirrhosis due to heavy drinking.

 

Less common causes include:

  • Haemochromatosis.
  • Primary biliary cirrhosis.
  • Biliary obstruction (may be due to biliary atresia/neonatal hepatitis, congenital biliary cysts or cystic fibrosis)
  • Autoimmune hepatitis.
  • Inherited metabolic disorders – eg, tyrosinaemia, Wilson’s disease, porphyria, alpha-1-antitrypsin deficiency, glycogen storage diseases.
  • Sarcoidosis or other granulomatous disease
  • Primary sclerosing cholangitis.
  • Venous outflow obstruction in Budd-Chiari syndrome or veno-occlusive disease
  • Drugs and toxins including methotrexate, amiodarone and isoniazid
  • Congestive heart failure or tricuspid regurgitation (although this is rarely seen now due to improved management).
  • Infections including congenital and tertiary syphilis and schistosomiasis

 

Symptoms

How the affected person may feel, depends on the stage of cirrhosis. There might be no symptoms in the beginning, but as the condition worsens, it can lead to:

  • Low energy
  • Loss of appetite
  • Itchy skin
  • Yellowing of the skin in the case of jaundice
  • Fluid retention
  • Orange or brownish tint in urine
  • Personality changes; disorientation and confusion
  • Blood in the stool or light colored stools
  • Bruises
  • Fever

 

Cutaneous features of cirrhosis include:

  • Jaundice.
  • Scratch marks secondary to pruritus.
  • Spider angiomata/naevi (mainly found on the trunk and face).
  • Skin telangiectasias (called ‘paper money skin’).
  • Palmar erythema.
  • Petechiae or purpura.
  • Hair loss.
  • White nails (horizontal white bands or a proximal white nail plate; sign of hypoalbuminaemia).
  • Finger clubbing.
  • Dupuytren’s contracture.

 

Other signs include:

  • Hepatomegaly and a nodular liver.
  • Oedema.
  • Gynaecomastia and male hair loss pattern.
  • Hypogonadism/testicular atrophy/amenorrhoea (due to the direct toxic effect of alcohol in alcoholic cirrhosis or ironin haemochromatosis).
  • Kayser-Fleischer ring (a brown-green ring of copper deposit around the cornea, pathognomonic for Wilson’sdisease)

Signs of portal hypertension include:

  • Ascites (can be detected clinically when ≥ 1.5 liters of fluid is present).
  • Caput medusae (veins seen radiating from the umbilicus).
  • Enlarged spleen.

Signs of hepatic encephalopathy:

  • Asterixis (‘flapping tremor’); suggests hepatic encephalopathy. To detect asterixis, take the patient’s hand andgently hyperextend the wrist and joints of the hand, pushing gently on the tips of the four fingers. Ignore the thumb. Hold that position for several seconds and you will feel a slow, clonic flexion-relaxation movement against your hand if asterixis is present.

 

How liver cirrhosis is diagnosed?

There are different methods, like physical exam, blood test and biopsies. Sometimes, during a surgery when the doctor is able to examine the entire liver, it can also diagnose this disease. Ultrasounds and CT scan are also used in some cases.

 

Life Expectancy?

The Child-Pugh-Turcotte (CPT) classification system is a widely used and validated way to estimate prognosis in those with cirrhosis. A score of 5-6 is class A (life expectancy 15-20 years); a score of 7-9 is class B (life expectancy 4-14 years); a score of 10-15 is class C (life expectancy 1-3 years).

 

Treatment

Most treatment for cirrhosis is directed toward relief of complications. Some underlying causes of cirrhosis, such as Wilson’s disease, can be treated with medication.

Many medicines have been studied, such as steroids, penicillamine (Cuprimine, Depen), and an anti-inflammatory agent (colchicine), but they have not been shown to prolong survival or improve survival rate.

Researchers are studying various experimental treatments for liver cirrhosis.

 

Portal hypertension

Some people are treated with a drug called a beta-blocker to lower the pressure in the blood vessels.

 

Ascites

The slowing of blood flow through your liver increases the pressure in the blood vessels. This forces fluid out of the blood vessels and into other tissues, where it is retained.

Your health care provider may prescribe water pills (a diuretic), which removes extra fluid from your body. This medication will make you urinate more often.

Your health care provider may insert a needle into your abdomen to directly remove large amounts of fluid. However, the fluid usually collects again. (but cutting down on your sodium intake will reduce this)

If the fluid becomes infected, you will have to stay in the hospital and receive IV antibiotics.

 

Hepatic encephalopathy

If symptoms are severe, you will have to stay in the hospital, especially if you have become so confused you cannot care for yourself.

You may be given lactulose, a drink that reduces the amounts of toxins absorbed into your intestinal tract.

You may be started on a low-protein diet.

Combining these 2 treatments improves symptoms in 75 percent of cases.

If your symptoms are mild, your doctor may send you home and instruct you to take lactulose every day and change to a low-protein diet, but to return if symptoms come back. We have some very helpful information on diets for your liver here.

 

Clotting disorders

Adequate protein intake and vitamin supplements can help to correct clotting disorders.

 

Stop drinking alcohol. You need to quit completely.

Talk to your doctor about all of the medicines you take, including non-prescription drugs such as acetaminophen (for example, Tylenol), aspirin, ibuprofen. These could increase the risk of liver damage and bleeding. (my doctor basically said, “If you have any pain, like a headache or toothache, you could take up to one (1) paracetamol per day)

Get immunized (if you have not already) against hepatitis A and hepatitis B, influenza, and pneumococcus.

Begin following a low-sodium diet if you have fluid build-up (ascites). Reducing your sodium intake can help prevent fluid build-up in your belly and chest.

 

Treatment for complications of cirrhosis

Cirrhosis can cause other problems (complications) that need treatment with medicines or procedures. Complications include:

Fluid build-up in the belly (ascites). It can be deadly if it is not controlled. Treatment can include:

  •         Following a low-sodium diet.
  •         Medicines such as diuretics and antibiotics.
  •         Removing fluid with a needle (paracentesis).
  •         Transjugular intrahepatic portosystemic shunt (TIPS). This procedure diverts fluid from the belly.

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Liver Cirrhosis

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