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Diseases

Liver Cirrhosis

Liver damage is usually repaired or replaced with normal tissue by the regenerative ability of the liver. However, significant liver damage continuously over time causes irreversible liver damage by forming scar tissue. The scar tissue loses the ability perform normal liver functions. The scarring is called fibrosis and the texture of the liver changes from smooth liver tissue to irregular bumps called nodules in a condition called cirrhosis of the liver. Advanced cirrhosis leads to liver failure and is life threatening.

Existing evidence shows that liver cirrhosis is getting more prevalent both in the West and the East. Cirrhosis takes years to develop and treatment can slow its progression. Liver transplant is the final treatment option when all treatments fail.

Risk Factors and Causes

 A wide range of diseases and conditions can damage the liver and lead to cirrhosis. Cirrhosis always develops because of another liver problem or disease.

  • Excessive alcohol consumption
  • Obesity increases the risk for non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH), liver diseases that lead to cirrhosis
  • Viral infections of the liver from chronic hepatitis B and C infections
  • Liver disease caused by the body’s own immune system (autoimmune hepatitis)
  • Iron buildup in the body (hemochromatosis)
  • 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)
  • Destruction of the bile ducts (primary biliary cirrhosis)
  • Hardening and scarring of the bile ducts (primary sclerosing cholangitis)
  • Bacterial infection, such as syphilis or brucellosis
  • Medications, including methotrexate or isoniazid

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    Symptoms

    Cirrhosis often has no signs or symptoms until the liver damage is extensive (compensated cirrhosis). The liver still has enough healthy cells to make up for the damaged cells and scar tissue caused by cirrhosis. This stage can continue for many years. Most persons will learn that they have cirrhosis

    during a routine check-up, or through blood tests. Treatment must be provided at this stage to prevent it from getting worse and be able to stop or slow down liver damage.

    The signs and symptoms are varied and may include:

    • Fatigue
    • Loss of appetite
    • Weight loss as the liver loses its ability to process nutrients to maintain healthy body weight
    • Nausea

    Decompensated cirrhosis is the stage that comes after compensated cirrhosis. At this point, the liver has too many complications of irreversible liver damage, and the symptoms become obvious:

    • Yellow discoloration in the skin and eyes (jaundice), high colored urine, since the diseased liver is unable to remove enough bilirubin
    • Swelling in the legs, feet or ankles (edema)
    • Itchy skin
    • Fluid accumulation in the abdomen (ascites)
    • Spiderlike blood vessels on your skin (spider angiomas)
    • Redness in the palms of the hands
    • High blood pressure in the veins that supply the liver (portal hypertension) resulting in:
    • Enlargement of the spleen (splenomegaly), which leads to a decrease in the white blood cells and platelets in the blood
    • Blood is redirected to smaller veins, which due to the extra pressure can cause serious bleeding Enlarged veins in the esophagus (esophageal varices), or the stomach (gastric varices) and lead to life-threatening bleeding
    • Tendency to bleed or bruise easily (coagulopathy) as the liver is unable to make enough clotting factors
    • For women, absent or loss of periods not related to menopause
    • For men, loss of sex drive, breast enlargement (gynecomastia) or testicular atrophy
    • Confusion, drowsiness and slurred speech (hepatic encephalopathy), coma because of a buildup of toxins in the brain
    • Kidney failure (hepatorenal syndrome)
    • Increased risk for liver cancer
    • Susceptibility to bacterial infections; ascites can lead to bacterial peritonitis, a serious life threatening infection
    • Some persons can lose bone strength and are at greater risk of fractures
    • Multiorgan failure

    Treatment

    The goals of treatment are to slow the progression of scar tissue in the liver and to prevent or treat symptoms and complications of cirrhosis. Treatment for cirrhosis depends on the cause and extent of liver damage. Hospitalization is needed in severe liver damage.

    Treatments are provided for

    • Alcohol addiction
    • Weight loss
    • Control of viral hepatitis
    • Medications for relief of itching, fatigue and pain
    • Nutritional supplements for malnutrition and to prevent weak bones (osteoporosis)

    Treatment for complications include

    • Low-sodium diet and medication to prevent and help control ascites
    • More-severe fluid buildup may require drainage of the fluid or surgery to relieve pressure
    • Blood pressure medications may control portal hypertension and prevent severe bleeding
    • Upper endoscopy at regular intervals to look for esophageal or gastric varices
    • Ligating the varices (band ligation) can stop or prevent further bleeding
    • In severe cases, a transjugular intrahepatic portosystemic shunt is used to reduce blood pressure in the liver
    • Antibiotics to treat infections
    • Vaccinations for influenza, pneumonia and hepatitis
    • Medications for hepatic encephalopathy

    Liver Transplant

    In advanced cases of cirrhosis, a liver transplant may be the only treatment option. A liver transplant is a procedure to replace your liver with a healthy liver from a deceased donor or with part of a liver from a living donor. Candidates for liver transplant have extensive testing to determine whether they are healthy enough to have a good outcome following surgery. Liver transplant patients regain full and normal function post-transplant and can lead normal lives by following post-transplant guidelines offered by the surgical team.

    People who have alcoholic cirrhosis will need a lifelong commitment to alcohol abstinence as well as other requirements of the specific transplant centre.

    Prevention

    Caring for the liver reduces the risk for developing decompensated cirrhosis

    • Abstain from alcohol
    • Eat a healthy fat free diet
    • Maintain a healthy weight and exercise regularly
    • Reduce risk of hepatitis B and C