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Liver Cirrhosis

Liver Cirrhosis

Liver Cirrhosis is a condition in which the liver does not function properly due to long-term damage. This damage is characterized by the replacement of normal liver tissue by scar tissue. Typically, the disease develops slowly over months or years. Early on, there are often no symptoms. As the disease worsens, a person may become tired, weak, itchy, have swelling in the lower legs, develop yellow skin, bruise easily, have fluid build up in the abdomen, or develop spider-like blood vessels on the skin. The fluid build-up in the abdomen may become spontaneously infected. Other complications include hepatic encephalopathy, bleeding from dilated veins in the esophagus or dilated stomach veins, and liver cancer. Hepatic encephalopathy results in confusion and may lead to unconsciousness

Cirrhosis is most commonly caused by alcohol, hepatitis B, hepatitis C, and non-alcoholic fatty liver disease. Typically, more than two or three alcoholic drinks per day over a number of years is required for alcoholic cirrhosis to occur. Non-alcoholic fatty liver disease has a number of causes, including being overweight, diabetes, high blood fats, and high blood pressure. A number of less common causes of cirrhosis include autoimmune hepatitis, primary biliary cholangitis, hemochromatosis, certain medications, and gallstones. Diagnosis is based on blood testing, medical imaging, and liver biopsy.
Some causes of cirrhosis, such as hepatitis B can be prevented by vaccination. Treatment partly depends on the underlying cause, but the goal is often to prevent worsening and complications. Avoiding alcohol is recommended in all cases of cirrhosis. Hepatitis B and C may be treatable with antiviral medications. Autoimmune hepatitis may be treated with steroid medications. Ursodiol may be useful if the disease is due to blockage of the bile ducts. Other medications may be useful for complications such as abdominal or leg swelling, hepatic encephalopathy, and dilated esophageal veins. In severe cirrhosis, a liver transplant may be an option.
Symptoms of cirrhosis
Symptoms are not common during the early stages of cirrhosis. However, as scar tissue accumulates, the liver's ability to function properly is undermined. The following signs and symptoms may occur:
• blood capillaries become visible on the skin on the upper abdomen.
• fatigue
• insomnia
• itchy skin
• loss of appetite
• loss of bodyweight
• nausea
• pain or tenderness in the area where the liver is located
• red or blotchy palms
• weakness

The following signs and symptoms may appear as liver cirrhosis progresses:
• abdomen fills up with fluid, giving the patient a large tummy (ascites).
• accelerated heartbeat
• altered personality (as blood toxins build up and affect the brain)
• bleeding gums.
• body and upper arms lose mass
• body finds it harder to process alcohol
• body finds it harder to process drugs
• confusion
• dizziness
• fluid buildup on ankles, feet, and legs (edema)
• hair loss
• higher susceptibility to bruising
• jaundice (yellowing of the skin, whites of the eyes, and tongue)
• loss of libido (sex drive)
• memory problems
• more frequent fevers (susceptibility to infections)
• muscle cramps
• nosebleeds
• pain on the right shoulder
• panting (breathlessness)
• stools become black and tarry, or very pale.
• urine becomes darker.
• vomiting blood
• walking problems (staggering)
Diagnosis of cirrhosis
Because there are rarely symptoms early on in the condition, cirrhosis is often diagnosed when the patient is being tested for some other condition or disease.
Anybody who has the following symptoms should see their doctor immediately:
• Fever with shivering.
• Panting (shortness of breath).
• Vomiting blood.
• Dark or tarry stools (as if covered with tar).
• Episodes of drowsiness or confusion.
A doctor will examine the patient and feel around the liver area to determine whether it is enlarged. The patient will be asked about their medical history and lifestyle, including drinking.
The following tests may also be ordered:
• Blood test - to measure how well the liver is functioning. If levels of ALT (alanine transaminase) and AST (aspartate transaminase) are high, the patient may have hepatitis.
• Imaging tests - ultrasound, CT, or MRI scans. Apart from seeing whether the liver is enlarged, the doctor will also be able to detect any scarring or nodules.
• A biopsy - a small sample of liver cells are extracted and examined under a microscope. The biopsy can confirm cirrhosis and its cause.
• Endoscopy - a long, thin tube with a light and video camera at the end goes down the patient's foodpipe (esophagus) and into their stomach. The doctor looks out for swollen blood vessels (varices), a hallmark sign of cirrhosis.
Complications of liver cirrhosis
• Ascites or edema - ascites (accumulation of fluid in the abdomen) or edema (fluid retention in the legs) can be treated with a low-sodium (salt) diet and water pills. In severe cases, the fluid may have to be drained repeatedly. Sometimes surgery is required.
• Pressure in the portal vein - blood can "back up" in the portal vein that supplies the liver with blood, causing hypertension (high blood pressure) in the portal vein. Drugs are usually prescribed to control the increasing pressure in other blood vessels; the aim is to prevent severe bleeding. Signs of bleeding can be detected via an endoscopy.
• Swollen varices - if the patient vomits blood or passes bloody stools, they probably have esophageal varices (in the food pipe). Urgent medical attention is required. The following procedures may help:
• Banding - a small band is placed around the base of the varices to control bleeding.
• Injection sclerotherapy - after an endoscopy, a substance is injected into the varices which triggers a blood clot and scar tissue to form; this helps stem the bleeding.
• A Sengstaken-Blakemore tube with a balloon - the balloon is at the end of the tube. If endoscopy does not stop the bleeding a tube goes down the patient's throat and into their stomach. The balloon is inflated; this places pressure on the varices and stops the bleeding.
• TIPSS (transjugular intrahepatic portosystemic stent shunt) - if the above-mentioned therapies do not stem the bleeding, a stent (metal tube) is passed across the liver to join the portal and hepatic veins, creating a new route for the blood to flow through. This reduces the pressure that was causing the varices.
• Infections - the patient will be given antibiotics, and some other treatments.
• Screening for liver cancer - patients with cirrhosis have a much higher risk of developing liver cancer. The doctor may recommend regular blood tests and imaging scans.
• Hepatic encephalopathy (high blood toxin levels) - drugs can help treat excessive blood toxin levels. The signs and symptoms need to be explained to the patient so that they know what to look out for.
• Liver transplant - if the cirrhosis is advanced and there is liver failure (liver does not function) the patient may need a liver transplant.
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.
Preventing cirrhosis
Practicing safe sex with condoms can reduce the risk of getting hepatitis B or C. The U.S. Centers for Disease Control and Prevention recommend that all infants and at-risk adults (such as healthcare providers and rescue personnel) be vaccinated against hepatitis B.
Becoming a nondrinker, eating a balanced diet, and getting adequate exercise can prevent or slow cirrhosis. The World Health Organization reports that only 20 to 30 percent of people infected with hepatitis B will develop cirrhosis or liver cancer. The National Institute of Health reports that 5 to 20 percent of people infected with hepatitis C will develop cirrhosis over a period of 20 to 30 years.
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