LIVER CIRRHOSIS

 

Liver cirrhosis is a condition in which the liver undergoes cellular damage because of scarring which can be due to various diseases affecting the liver, alcohol, and other causes.

Liver disease is a growing concern for mankind as many people are diagnosed with liver problems at some point of time and if the liver condition is not treated with proper preventive measures then small liver disease can slowly damage the liver tissue and its function which can be dangerous.

 CAUSES OF LIVER CIRRHOSIS

 1) Alcohol: chronic alcoholics have more chances of developing liver problems which can slowly progress to cirrhosis.

 

 

 

2) Hepatitis: people who get infected with the hepatitis virus especially hepatitis B and C virus have more chances of developing liver cirrhosis.

 3) Non-alcoholic liver disease: It is most commonly seen in people who have a diet rich in fatty and oily food.

 4) Autoimmune hepatitis: As the name suggests it is a disease that occurs when the body’s own immune system attacks the liver cells and causes hepatitis which can lead to cirrhosis.

 5) Biliary cirrhosis: It occurs when the bile duct is destroyed which can lead to a backflow of bile into the liver and this can damage the cells which lead to cirrhosis.

 Types of biliary cirrhosis:

 A) Primary biliary cirrhosis

 B) Primary sclerosing cholangitis.

 C) Autoimmune cholangiopathy.

 6) Genetic causes:

 A) Hemochromatosis

 B) Alpha 1 antitrypsin deficiency

 C) Wilson’s disease

 7) Cardiac cirrhosis: Those patients with right-sided congestive heart failure may develop liver injury which can lead to cardiac cirrhosis.

 PATHOGENESIS OF LIVER CIRRHOSIS:

Chronic alcoholics are more prone to suffer from cirrhosis of the liver compared to other causes of liver cirrhosis.

Alcohol is mainly absorbed by the small intestine and a little in the stomach.  

 

 

 

 Gastric alcohol dehydrogenase (ADH) is the enzyme which starts the alcohol metabolism

 Alcohol dehydrogenase starts the process of metabolism by oxidation of alcohol which leads to the formation of acetaldehyde which is very reactive.

 Acetaldehyde is metabolized and it is converted to acetate by the enzyme known as aldehyde dehydrogenase (ALDH).

Due to excess intake of alcohol, the fatty acid increases in the body which leads to the accumulation of triglycerides.

All the above-mentioned process causes damage to the liver cells and also activate the kuffer cells. This leads to the formation of profibrogenic cells which causes activation of stellate cells and this increases the production of excess collagen and extracellular matrix.

 With the passage of time, these connective tissues start forming nodules in the liver, loss of hepatocytes occurs and the liver gets small in size.

 Clinical features of liver cirrhosis:

1) Abdominal pain: patients usually complain of pain in the right upper part of the abdomen.

 2) Jaundice can occur due to liver cell death leading to irregular levels of serum bilirubin levels.  

 3) Fever

 4) Nausea and vomiting 

5) Anorexia is a loss of appetite because of improper liver function. 

6) Weakness can be because the liver plays an important role in glucose metabolism and due to cirrhosis this function of the liver can be less.

 7) Edema means swelling which can occur in any part of the body such as legs can be seen.

 8) The liver is responsible for the production of vitamin k which is required to prevent bleeding and liver cirrhotics are more prone to upper gastrointestinal bleeding. Patients can be anemic due to blood loss.

9) Hepatomegaly and splenomegaly can be present.

10) Spider angioma is found in patients with liver cirrhosis. 

11) On palpation, the liver can be firm and nodular.

12) Fingernails clubbing can be present.

13) Ascites which is an accumulation of fluid in the abdominal region can be present that can lead to enlargement of the abdomen. 

14) Parotid glands enlargement is noted in some patients.

15) In men due to excess use of alcohol the body hair can decrease, testicular atrophy and gynecomastia can be seen which can be due to hormonal abnormalities. In women also who are chronic alcoholics can have menstrual abnormalities.

16) Muscle wasting and nutritional deficiency can be present.

 

INVESTIGATION OF LIVER CIRRHOSIS

 

1) A decrease in hemoglobin level which can be due to chronic blood loss. 

2) Platelet count can be low which can be due to hypersplenism.

3) Increase in prothrombin time due to deficiency of vitamin k.

4) Blood tests for the hepatitis virus should be done too.

5) Serum bilirubin levels can be increased or normal in some cases.

 6) Alanine and aspartate levels are also measured through a blood test which can be more than the normal values.

7) A routine urine test should be done too.

8) Ultrasound of the abdomen should be done to look for abnormalities in the liver. It can help in measuring the liver and spleen size.

 9) CT and MRI can be done in cases that require a more detailed study.

10) A liver biopsy can be done too.

 PREVENTION OF LIVER CIRRHOSIS:  

1) It is important to stop drinking alcohol as it is one of the major causes of liver problems.

2) Avoid unprotected sex as it can lead to hepatitis virus infection.

3) Health care workers should also use proper safety measures to prevent themselves from the accidental transmission of the virus from the infected person.

4) The Hepatitis vaccine is given as a preventive measure to protect from hepatitis virus infection.

5) Avoid eating fatty and fried food as they can lead to liver problems too.

6) Decrease salt intake as it can promote water retention and can lead to ascites.

7) Eat more green vegetables and fruits to improve overall health.

8) Reducing the weight if the person is suffering from obesity is important as it can lead to non-alcoholic fatty liver disease which can slowly progress to liver cirrhosis.

 9) Daily exercise is necessary to decrease weight and improve blood circulation in all parts of the body.

 

 

10) Avoid eating spicy food as they have a negative impact on the liver too.

11) Stop self-medication because many medicines have a negative impact on the liver and it can lead to liver disease.

12) If suffering from diabetes, hypertension, or renal problem then take the medicine properly as advised by the doctor because these diseases if not brought under control then they can have a negative impact on the liver too. 

TREATMENT OF LIVER CIRRHOSIS:

1) Diuretics are prescribed if the patient develops ascites.

2) Glucocorticoids are used by doctors in severe cases only when there is no infection in the patients.

3) Oral pentoxifylline are prescribed by doctors depending on the patient’s condition.

 4) Lactulose can be given to prevent the patient from developing hepatic encephalopathy. 

5) Antibiotics are given to the patient when the infection is suspected.

6) Liver transplantation is the last option if medical treatment is not working.

 TAKE HOME MESSAGE:

 Keep the liver healthy by following a proper diet and regular exercise.

Avoid self-medication and get proper medical advice from the doctor to prevent any medicine-related severe side effects on the liver.

STAY SAFE AND STAY HEALTHY

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