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Cirrhosis

cirrhosis

The liver is in the upper right part of the abdomen. It has many functions which include.

  • Storing glycogen (fuel for the body) which is made from sugars.
  • Helping to process fats and proteins from digested food.
  • Making proteins that are essential for blood to clot.
  • Processing many medicines that you may take.
  • Helping to remove or process alcohol, poisons and toxins from the body.
  • Making bile which passes from the liver to the gut and helps to digest fats.

What is cirrhosis?

Cirrhosis is a condition where normal liver tissue is replaced by scar tissue. The scar tissue affects the normal structure and regrowth of liver cells. Liver cells become damaged and die as scar tissue gradually develops. Therefore, the liver gradually loses its ability to function well. The scar tissue can also affect the blood flow through the liver which can cause back pressure in the blood vessels which bring blood to the liver. This back pressure is called portal hypertension.

What causes cirrhosis?

  • Alcoholic cirrhosis

Your liver cells break down alcohol, but too much alcohol can damage the liver cells. About 1 in 10 heavy drinkers will eventually develop cirrhosis. It tends to occur after 10 or more years of heavy drinking.

  • Hepatitis C and cirrhosis

Chronic (persistent) infection with the hepatitis C virus causes long-term inflammation in the liver. This can eventually lead to liver scarring and cirrhosis. Up to 1 in 5 people with chronic hepatitis C develop cirrhosis but this usually takes about 20 years or even longer from the initial infection.

  • Chronic infection with the hepatitis B virus.
  • Autoimmune hepatitis.
  • Diseases that cause blockage of the bile ducts can cause back pressure and damage to the liver cells. For example, primary biliary cirrhosis, sclerosing cholangitis, and congenital problems of the bile ducts.
  • Non-alcoholic steatohepatitis (NASH). This is a condition which causes fat to build up in the liver. This can lead to scarring and cirrhosis. Being overweight/obese increases your risk of developing NASH.
  • Severe reactions to certain medicines.
  • Certain poisons and environmental toxins.
  • Certain infections caused by bacteria and parasites which are usually found only in tropical countries.
  • Severe heart failure which can cause back pressure of blood and congestion in the liver.
  • Some rare inherited diseases which can cause damage to liver cells.
    • Haemochromatosis.
    • Wilson's disease.

What are the symptoms of cirrhosis?

  • In the early stages of the condition, often there are no symptoms.
  • Fails to make enough proteins such as albumin that help to regulate the fluid composition in the body.
  • Fails to make enough clotting factors needed for blood clotting.
  • Is less able to process waste chemicals in the body such as bilirubin.
  • Is less able to process medicines, toxins, and other chemicals which may then build up in the body.

The symptoms that may develop include:

  • Tiredness.
  • Swelling in the legs (oedema) and abdomen (ascites).
  • Loss of appetite, feeling sick, and vomiting.
  • Weight loss.
  • A tendency to bleed and bruise more easily.
  • Jaundice.
  • Itch.

Mental health changes can develop in severe cases as toxins build up in the bloodstream and affect the brain.

As the cirrhosis becomes worse, this causes back pressure in the portal vein (known as portal hypertension). Increased pressure in this vein can cause swellings (varices) to develop in the branches of the vein in the lining of the oesophagus (gullet) and stomach. These varices have a tendency to bleed easily into the gut. If a bleed occurs, you may vomit blood, or pass blood with your stools (faeces).

How is cirrhosis diagnosed?

A doctor may suspect, from your symptoms and a physical examination, that you have cirrhosis. Blood tests may show abnormal liver function. An ultrasound scan (or a CT or MRI scan) may show that you have a damaged liver. To confirm the diagnosis, a biopsy (small sample) of the liver may be taken.

What is the treatment for cirrhosis?

Stop drinking alcohol
Be cautious when taking medicines
Treatment for underlying causes

  • Not drinking alcohol if alcohol is the cause.
  • Interferon and other medication may be used to treat viral hepatitis.
  • Steroid medicines or other immunosuppressant medicines may be used to treat autoimmune diseases causing liver damage.
  • Regular removal of a pint or so of blood can remove excess iron which occurs in haemochromatosis.

Treatment to ease symptoms and prevent complications

  • Adequate food intake (including calories and protein) and regular exercise.
  • A low-sodium diet or diuretics to reduce fluid accumulating in the body.
  • Medicines to reduce itch.
  • Zinc  supplements may be used.
  • Vaccination to protect against hepatitis A, influenza and pneumococcal infections.
  • Osteoporosis may occur and so prevention and treatment of osteoporosis is important.
  • Medicines that may help to reduce portal hypertension.
  • Drainage of fluid that builds up in the abdomen (ascites).

Treatment of bleeding varices

A bleed from varices is a medical emergency. Various surgical techniques can be used to stop the bleeding and to help reduce the risk of further bleeds.

Liver transplant

In severe cases, where the scarring is extensive and the liver can barely function, then a liver transplant may be the only option.

What is prognosis?

The outlook depends on factors such as the underlying cause, how early the condition is diagnosed, and how early treatment is given. Many people who have cirrhosis which is not too extensive live a normal life for a number of years. The outlook is not so good if there is a lot of liver damage, especially if you have alcoholic cirrhosis and do not stop drinking.
If you have cirrhosis, you have an increased risk of developing cancer of the liver (hepatocellular carcinoma). The greatest risk is with cirrhosis caused by hepatitis C infection, followed by cirrhosis caused by hereditary haemochromatosis.


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