Liver cirrhosis

 Cirrhosis is a late-stage liver disease in which healthy liver tissue is replaced with scar tissue and the liver is permanently damaged. The scarring is most often caused by long-term exposure to toxins such as alcohol or viral infections

Liver functions: 

The liver is located in the upper right side of the abdomen below the ribs. It has many essential body functions. These include: 

• Producing bile, which helps your body absorb dietary fats, cholesterol, and vitamins A, D, E, and K 

• Storing sugar and vitamins for later use by the body 

• Purifying blood by removing toxins such as alcohol and bacteria from your system 

• Creating blood clotting proteins 

Pathophysiology: 

1. The liver is a very hardy organ and is normally able to regenerate damaged cells. Cirrhosis develops when the factors that damage the liver (such as alcohol and chronic viral infections) are present over a long period of time. When this happens, the liver becomes injured and scarred. A scarred liver can’t function properly, and ultimately this may result in cirrhosis. 

1. Cirrhosis causes the liver to shrink and harden. This makes it difficult for nutrient-rich blood to flow into the liver from the portal vein. The portal vein carries blood from the digestive organs to the liver. The pressure in the portal vein rises when blood can’t pass into the liver. The end result is a serious condition called portal hypertension, in which the vein develops high blood pressure. The unfortunate consequence of portal hypertension is that this high-pressure system causes a backup, which leads to esophageal varices (like varicose veins), which can then burst and bleed. 

Causes: 

A wide range of diseases and conditions can damage the liver and lead to cirrhosis. 

Some of the causes include: 

• Chronic alcohol abuse 

• Chronic viral hepatitis (hepatitis B, C and D) 

• Fat accumulating in the liver (nonalcoholic fatty liver disease) 

• Iron buildup in the body (hemochromatosis) 

• Cystic fibrosis 

• Copper accumulated in the liver (Wilson's disease) 

• Poorly formed bile ducts (biliary atresia) 

• Alpha-1 antitrypsin deficiency 

• Inherited disorders of sugar metabolism (galactosemia or glycogen storage disease) 

• Genetic digestive disorder (Alagille syndrome) 

• Liver disease caused by your body's immune system (autoimmune hepatitis) 

• Destruction of the bile ducts (primary biliary cirrhosis) 

• Hardening and scarring of the bile ducts (primary sclerosing cholangitis 

• Infection, such as syphilis or brucellosis 

• Medications, including methotrexate or isoniazid 

 

Risk factors: 

• Drinking too much alcohol. Excessive alcohol consumption is a risk factor for cirrhosis. 

• Being overweight. Being obese increases your risk of conditions that may lead to cirrhosis, such as nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. 

• Having viral hepatitis. Not everyone with chronic hepatitis will develop cirrhosis, but it's one of the world's leading causes of liver disease

Symptoms of cirrhosis: 

The symptoms of cirrhosis occur because the liver is unable to purify the blood, break down toxins, produce clotting proteins, and help with absorption of fats and fat-soluble vitamins. Often there are no symptoms until the disorder has progressed. Some of the symptoms include: 

• Decreased appetite 

• Nose bleeds 

• Jaundice (yellow discoloration) 

• Small spider-shaped arteries underneath the skin 

• Weight loss 

• Anorexia 

• Itchy skin 

• Weakness 

More serious symptoms include: 

• Confusion and difficulty thinking clearly 

• Abdominal swelling (ascites) 

• Swelling of the legs (edema) Impotence 

• Gynecomastia (when males start to develop breast tissue) 

Stages of Cirrhosis Classification System: 

Patients with cirrhosis can be subcategorized by disease stage, with stages 1 and 2 classified under Compensated category and stages 3 and 4 in the Decompensated category. In this figure, bleeding refers to variceal bleeding. The risk of death increases significantly with each more advanced stage. 

                                         Treatment

There is no cure for cirrhosis. The damage to liver is already permanent.  

*Measures to decrease getting worse cirrhosis:  

• Stop drinking alcohol. 

• Treat chronic hepatitis (if present). 

• Avoid medications that stress the liver. 

• Eat a healthy, well-balanced, low-fat diet. 

Goals of cirrhosis treatment: 

• Slow further damage to the liver. 

• Prevent and treat symptoms. 

• Prevent and treat complications. 

Treatments for the causes of cirrhosis are as follows: 

• Alcohol-related liver disease:  stop drinking alcohol.  

• Hepatitis B or C: Several approved antiviral medications are available to treat hepatitis types B and C. 

• Nonalcoholic fatty liver disease: Management of nonalcoholic fatty liver disease includes losing weight, following a healthy diet, getting physical exercise and following doctor instructions for managing diabetes. 

• Autoimmune hepatitis:  medications to suppress immune system. 

• Diseases that damage or block bile ducts in the liver: Treatments include medications such as ursodiol (Actigall®) or surgery to open narrowed or blocked bile ducts.