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Cirrhosis is the result of liver scarring, which can lead to impaired liver function and, in severe cases, liver failure. What is cirrhosis? What are its causes and possible symptoms? How can we manage it?"
◉ What is Cirrhosis?
Cirrhosis is a chronic and progressive liver disease characterized by the replacement of normal liver tissue with fibrous scar tissue, resulting from continuous, long-term liver damage.
This irreversible damage can arise from various persistent conditions, including chronic alcohol consumption, among others (see causes below).
The symptoms of cirrhosis can be diverse due to the liver's wide range of functions. As this condition advances and compromises the liver's functionality, a variety of symptoms and complications can emerge.
Prompt diagnosis, effective management of the causes and appropriate treatment strategies play a central role in slowing the progression of this condition and preventing complications.
◉ What causes cirrhosis?
There are several potential causes of liver cirrhosis, including:
- Chronic alcoholism: Excessive and long-term alcohol consumption is one of the most significant risk factors for developing liver cirrhosis. Alcohol can damage liver cells leading to inflammation and scarring.
- Chronic viral hepatitis: Hepatitis B and C viruses can cause chronic infection and inflammation in the liver, leading to cirrhosis over time. These viruses are primarily transmitted through blood contact, such as sharing needles or having unprotected sex.
- Nonalcoholic fatty liver disease (NAFLD): This condition occurs when fat accumulates in the liver, often due to obesity, diabetes, high cholesterol, or high blood pressure. In some cases, NAFLD progresses to nonalcoholic steatohepatitis (NASH), which can eventually lead to cirrhosis.
- Chronic autoimmune hepatitis: This is a condition in which the body's immune system mistakenly attacks the liver, causing inflammation and liver damage. Over time, this damage can lead to cirrhosis.
- Genetic or metabolic diseases: Certain genetic conditions, such as Wilson's disease, hemochromatosis, and alpha-1 antitrypsin deficiency, can disrupt normal liver function and result in cirrhosis.
- Chronic bile duct blockage: Conditions like primary biliary cholangitis (PBC) or primary sclerosing cholangitis (PSC), which cause chronic inflammation and scarring of the bile ducts, can lead to cirrhosis.
- Drug-induced liver injury: Certain medications, such as long-term use of high-dose acetaminophen (paracetamol) or high daily doses of vitamin A, can cause liver damage and eventually progress to cirrhosis.
- Chronic heart failure (CHF) or "cardiac cirrhosis" The increased pressure in the veins (portal hypertension) can affect the blood flow within the liver.
◉ What are the symptoms of cirrhosis?
Symptoms of liver cirrhosis can range from being asymptomatic to being associated with potentially fatal complications, depending on the severity of the condition. Common symptoms of cirrhosis may include:
- Fatigue and weakness: due to inability of liver to function properly.
- Nausea and vomiting: The buildup of toxins in the bloodstream can lead to feelings of nausea and frequent vomiting.
- Jaundice: due to a buildup of bilirubin, a yellow pigment produced by the liver.
- Ascites: accumulation of fluid in the abdominal cavity, causing bloating and abdominal discomfort.
- Edema, or fluid retention, can occur in the legs, ankles, and feet.
- Itchy skin: because of liver's reduced ability to eliminate toxins from the body.
- Easy bruising and bleeding: When the liver is damaged, the production of blood-clotting proteins is affected, leading to easy bruising and prolonged bleeding time.
- Loss of appetite and weight loss: Decreased appetite and unintended weight loss may occur due to the liver's dysfunction and changes in metabolism.
- Mental confusion and forgetfulness: The liver's inability to filter toxins can affect brain function, causing trouble concentrating, memory loss, and confusion.
- Spider-like blood vessels "Spider angiomas": Small, visible blood vessels on the skin, may appear due to the liver's dysfunction.
- Dark Urine and Pale Stools: Bilirubin buildup can lead to dark urine, while pale stools can result from reduced bile flow.
- Increased sensitivity to medications and risk of infections
◉ Complications of cirrhosis
Cirrhosis of the liver can give rise to various complications, including
- Portal Hypertension: is elevated blood pressure in your portal vein and the smaller veins that branch off from it.
- Hepatic Encephalopathy: is characterized by a spectrum of neuropsychiatric abnormalities resulting from the accumulation of neurotoxic substances
- Spontaneous Bacterial Peritonitis: is infection of ascitic fluid without an apparent source
- Hepatorenal Syndrome: kidney dysfunction as a result of advanced cirrhosis and portal hypertension.
- Coagulopathy: Cirrhosis can lead to reduced production of clotting factors that help prevent excessive bleeding.
- Hepatocellular Carcinoma
◉ Diagnosis of cirrhosis
Liver cirrhosis is typically diagnosed through a combination of medical history evaluation, physical examination, blood tests, imaging tests, and sometimes a liver biopsy.
- The medical history evaluation will involve the doctor asking about the patient's symptoms, alcohol and drug use, family history of liver disease, and any other relevant factors.
- During the physical examination, the doctor may look for signs of liver damage, such as jaundice, enlarged liver or spleen, or fluid accumulation in the abdomen.
- Blood tests can help measure liver function and detect certain markers of liver disease, such as elevated liver enzymes, levels of bilirubin, viral markers and prothrombin time.
- Additional investigations may include imaging studies like ultrasound, CT scan, or MRI to visualize the liver and assess its condition.
◉ Treatment
The treatment modalities for liver cirrhosis depend on the severity of the disease and the underlying cause. Some of the common treatment options include:
- Lifestyle modification: Making lifestyle changes such as abstaining from alcohol, maintaining a healthy diet, and exercising regularly can help slow down the progression of liver cirrhosis.
- Medications: Medications may be prescribed to manage the symptoms and complications of cirrhosis. For example:
- Diuretics may be given to reduce fluid retention
- Beta-blockers to help prevent bleeding from esophageal varices
- Antibiotics to treat infections.
- Treatment of underlying cause: If cirrhosis is caused by conditions like hepatitis B or C, medication options to manage the infection may be explored. In cases of alcoholic liver disease, counseling & rehabilitation programs can be used to help give up alcohol addiction.
- Management of complications if present: Complications associated with cirrhosis may require specific treatments.
- Liver transplantation: In severe cases of cirrhosis where the liver is severely damaged and no longer functions properly, a liver transplant may be necessary. This involves replacing the diseased liver with a healthy liver from a deceased or living donor.
◉ Conclusion
This chronic liver condition, marked by the gradual transformation of healthy tissue into unyielding scar tissue, is a consequence of various underlying factors that span from chronic alcohol consumption to viral infections and beyond.
The collaboration between healthcare professionals, patients, and support networks is instrumental in achieving optimal outcomes.