Cirrhosis is the condition in which the liver does not function properly due to chronic damage. It is characterized by healthy tissue being replaced by scar tissue due to the damage.
It is a chronic disease, in which you may not see any symptoms at the start. The disease can slowly progress from chronic liver inflammation.
SIGNS & SYMPTOMS
- Pain in the upper right abdomen.
- Nausea & vomiting
- Rashes & Fatigue
- Swelling in the leg.
- Spider like blood vessels.
- Redding of the palms
- Hypogonadism, is a decrease in male sex hormones may manifest as impotence & loss of sexual drive.
- Gynecomastia, that is an increase in breast tissue in males due to an increase of estrogen.
- Increase in liver size and change in shape.
- Portal hypertension: An increase in the blood pressure of the veins in livers.
- Changes in the coloring & appearance of the nails due to inadequate production of albumin & clubbing.
- Chronic inflammation of the connective tissue of that surrounds the bone which can lead to pain.
- Thickening & contracting of the tissue on the palm of the hand that can lead to deformities in the fingers.
- Easy bruising & bleeding.
CAUSES & RISK FACTORS
- Alcoholic liver disease: Due to very heavy drinking over a long period of time, that can manifest alcoholic hepatitis.
- Non-alcoholic steatohepatitis (NASH) : This is mostly associated with obese patients. Fat is built up in the liver, causing formation of scar tissue.
- Chronic hepatitis C infection: This is due to an infection by the hepatitis C virus. It causes inflammation of the liver, which ultimately leads to cirrhosis.
- Chronic hepatitis B infection: The hepatitis B virus causes inflammation and damage to the liver leading to cirrhosis. Hepatitis D can manifest in presence of HBV & accelerate the damage.
- Primary biliary cholangitis/cirrhosis: It is the inflammation and damage of the bile duct due to an autoimmune disease leading to secondary liver damage.
- Autoimmune hepatitis: It is caused by lymphocytes attacking the liver.
- Hereditary hemochromatosis: It is a genetic condition presenting with cirrhosis & diabetes
- Indian childhood cirrhosis: This is due to the deposition of copper on the liver in neonates.
- Wilson’s Disease
- Alpha 1-antitripsin Disorder
- Cardiac Cirrhosis
- Glycogen Storage Disease Type IV
- Cystic Fibrosis
- Drug induced liver injury, therefore drugs that can damage & reduce the life of liver.
COMPLICATIONS ARISING FROM CIRRHOSIS
- Ascites, accumulation of fluid in the abdomen.
- Internal bleeding in the liver due to high blood pressure in the veins of the liver.
- Hepatic Encephalopathy, the damage to the brain & CNS caused due to liver dysfunction.
- Hepatorenal syndrome is defined as a urine sodium less than 10 mmol/L, and a serum creatinine > 1.5 mg/dl (or 24 hour creatinine clearance less than 40 ml/min).
- Change in the mucosa of the gastric lining.
- Spontaneous bacterial peritonitis, development of bacterial infection in the peritoneum.
- Clubbing & inflammation of the small joints in the hands.
- Reduced immune function leading to infections & diseases.
- Testicular atrophy
- A musty breath odor
- Enlarged spleen
- Liver Cancer.
DIAGNOSIS FOR CIRRHOSIS
- Liver biopsy is the gold standard for diagnosis & classification of the cause of cirrhosis.
- Imaging Tests:
a) Ultrasound imaging is done for viewing the damage to liver due to cirrhosis, similarly widening of the fissure & enlargement of the spleen are monitored.
b) CT scans & MRI are done to assess the extent of damage to the liver & bile ducts.
- Gastroscopy (endoscopic examination of the esophagus, stomach, and duodenum) is performed in patients with established cirrhosis to exclude the possibility of esophageal varices.
- Pathological tests of the liver tissue.
- Some Lab findings in cirrhosis:
- Thrombocytopenia ( low platelet count)
- High bilirubin levels
- Elevated aminotransferases level
- Decreased albumin levels
- Increase in clotting time
- Leukopenia ( decrease in leukocytes)
- High renin levels
- Increased glucagon levels
- Antibiotics for infection
- Laxatives for constipation
- Chelation therapy to remove copper
- Antivirals for Viral Hepatitis
- Anti-diabetic medication, statins & anti-hypertensive medications for management of diabetes, obesity & high blood pressure.
- ORS supplements
- Liver transplant is the only option in severe cirrhosis & cancer.
PREVENTION & MANAGEMENT OF CIRRHOSIS
- Cutting off alcohol consumption & smoking
- Maintaining a healthy weight
- Diet that is low on sodium & sugar
- Hepatitis A & B vaccination
- Not drinking contaminated water
- Engaging in safe sexual intercourse
- Not coming in contact with infected blood
- Screening for hereditary & genetic risk factors
- Management of underlying diseases & disorders that are risk factors.