Liver Cirrhosis

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Before examining this disease, one must first understand the importance of the liver. This organ weighs approximately three pounds and performs a myriad of functions.

These include :the production of blood proteins that aid in clotting, oxygen transport, immune system function, storage of excess nutrients and the return of some of those into the bloodstream, manufacturing bile; a substance needed to help digest food, helping the body store sugar (glucose) in the form of glycogen, ridding the body of harmful substances in the bloodstream; including drugs and alcohol and finally, breaking down saturated fat and producing cholesterol.

Now what is Cirrhosis? Cirrhosis is a slowly progressing disease in which the normally healthy liver tissue is replaced with scar tissue. This eventually prevents the liver from carrying out its functions properly. The scar tissue prevents the flow of blood through the liver thereby  slowing the processing of nutrients, hormones, drugs and all naturally produced toxins. It also causes slothfulness in the production of proteins and other substances made by the liver.

As it relates to the specific causes of this disease, most persons would be au fait with the fact that alcohol abuse can lead to liver cirrhosis, but it is not the only cause. Liver cirrhosis can also be caused by Hepatitis C and fatty liver disease. Basically, anything that causes damage to the liver can cause cirrhosis. These could include one or more of the following:

  • Fatty liver, associated with chronic diseases such as obesity and diabetes
  • Chronic viral infections of the liver, e.g., Hepatitis types B, C, and D (although D is very rare)
  • Blockage of the bile duct. The bile duct allows for the passage of bile, formed in the liver, to the intestines where it helps in the digestion of fats. In babies, this is usually caused by biliary atresia, in which bile ducts are absent or damaged, causing bile to back up in the liver. In adults, bile ducts may become inflamed, blocked, or scarred due to another liver disease called primary biliary cholangitis.
  • Repeated heart failure with fluid backing up into the liver
  • Certain inherited diseases such as:

−             Cystic fibrosis

−             Glycogen storage diseases, in which the body is unable to process glycogen, a form of sugar that is converted to glucose and serves as a source of energy for the body

−             Alpha 1 antitrypsin deficiency, the absence of a specific enzyme in the liver

 

  • Diseases caused by abnormal liver function, such as hemochromatosis
  • Reactions to prescription drugs, prolonged exposure to environmental toxins or parasitic infections.

 

While it is true that alcoholics can harm their liver in more ways than one with constant drinking, not all of them usually get liver cirrhosis. Coincidentally, female alcoholics are at a higher risk for developing cirrhosis than men. Also, people who have either hepatitis B or C are more likely to suffer liver damage from alcohol consumption.

 

Symptoms

The symptoms of cirrhosis of the liver differ with each stage of the disease. In the earlier stages, it might be asymptomatic or present with no symptoms. However, as the illness progresses, symptoms may include:

  • Loss of appetite
  • Lack of energy (fatigue)
  • Weight loss or sudden unexplained weight gain
  • Unexplained bruises
  • Jaundice and itchy skin
  • Fluid retention which leads to swelling in the ankles, legs, and abdomen
  • Darkening urine colour
  • Light-coloured stools
  • Confusion, disorientation, personality changes
  • Blood in the stool
  • Fever

 

Diagnosis

Cirrhosis of the liver is diagnosed through several methods. These include the following:-

  • History and Physical exam – This is the mainstay of all diagnoses as, 90 per cent of the time, the doctor can tell what disease you are suffering from based on your history and physical examination. During a physical exam, the doctor can observe changes in how your liver feels or how large it is (a cirrhotic liver is bumpy and irregular instead of smooth).
  • Blood tests- If cirrhosis is suspected, blood tests can be done to find out if liver disease is present.
  • Other tests- Sometimes images of the liver are needed to make a definitive diagnosis. As such a computerized tomography (CT scan), ultrasound or another specialized procedure called a radioisotope liver/spleen scan may be recommended.
  • Biopsy- Diagnosis can be confirmed by taking a sample of tissue from the liver and looking at it both macroscopically and microscopically.

 

Complications

Some of the complications associated with cirrhosis of the liver include:

  • Variceal bleeding- This is caused by portal hypertension which is an increase in pressure within the portal vein (the large vessel that carries blood from the digestive organs to the liver). This increase in pressure is caused by a blockage of blood flow through the liver as a result of cirrhosis. Increased pressure in the portal vein causes other veins in the body to enlarge (varices), such as those in the esophagus and stomach, to bypass the blockage. These varices become fragile and can bleed easily, causing severe hemorrhaging and fluid in the abdomen.
  • Altered Mental Status which includes confused thinking and other mental changes brought about by hepatic encephalopathy. This occurs after prolonged cirrhosis and the liver cannot break down toxins, which gets into the bloodstream and then affects the brain.
  • Kidney failure
  • Reduced oxygen in the blood
  • Diabetes
  • Changes in blood counts
  • Increased risk of infections
  • Excessive bleeding and bruising
  • Breast enlargement in men
  • Premature menopause
  • Loss of muscle mass

 

Treatment

It must be noted that there is no cure for cirrhosis of the liver. However, there are treatments that can help to stop or delay its progression, minimize liver cell damage and reduce complications.

Treatment all depends on the underlying cause. For example, when the cirrhosis is caused by alcohol abuse, stopping the consumption of alcohol would help to stop the progression. If a person has hepatitis, steroids or antiviral drugs may be prescribed to reduce liver cell injury. For those with cirrhosis caused by autoimmune diseases, Wilson’s disease, or hemochromatosis, the treatment varies.

Symptomatic management is also key to survival, so medications may be given to help with symptoms. Edema and ascites are treated through the reduction of salt in the diet and drugs called diuretics are used to remove excess fluid and to prevent edema from recurring. Liver transplantation may be necessary for some people with the advanced form of the disease.

Remember that prevention is always better than cure, so it would be better to safeguard yourself. If you do drink alcohol, limit the quantity and frequency with which you drink. Abstain or keep away from having casual, unprotected sex with multiple partners. Always take caution when handling or using synthetic chemicals, such as cleaning products and pesticides. And one of the most important precautionary measures is getting vaccinated against Hepatitis B.

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Columns · Health · Issue 28 · Publication

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