Cirrhosis

Definition:Cirrhosis is scarring of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcohol abuse. The liver carries out several essential functions, including detoxifying harmful substances in your body, cleaning your blood and making vital nutrients.

Cirrhosis occurs in response to damage to your liver over many years. The liver damage done by cirrhosis can't be undone. But if liver cirrhosis is diagnosed early and the cause treated, further damage can be limited. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function. Advanced cirrhosis can be life-threatening.

Signs and Symptoms:A symptom is something the patient feels and reports, while a sign is something other people, including a doctor or a nurse may detect. For example, pain may be a symptom while a rash may be a sign.

Symptoms are not common during the early stages of cirrhosis. However, as scar tissue accumulates the liver's ability to function properly is undermined. The following signs and symptoms may occur:Blood capillaries become visible on the skin on the upper abdomenFatigueInsomniaItchy skinLoss of appetiteLoss of bodyweightNauseaPain or tenderness in the area where the liver is locatedRed or blotchy palmsWeaknessThe following signs and symptoms may appear as the disease progresses:Abdomen fills up with fluid, giving the patient a large tummy (ascites)Accelerated heartbeatAltered personality (as blood toxins build up and affect the brain)Bleeding gumsBody and upper arms lose massBody finds it harder to process alcoholBody finds it harder to process drugsConfusionDizzinessFluid buildup on ankles, feet and legs (edema)Hair lossHigher susceptibility to bruisingJaundice (yellowing of the skin, whites of the eyes, and tongue)Loss of libido (sex drive)Memory problemsMore frequent fevers (susceptibility to infections)Muscle crampsNosebleedsPain on the right shoulderPanting (breathlessness)Stools become black and tarry, or very paleUrine becomes darkerVomiting bloodWalking problems (staggering)

Causes:- Abuse of alcohol- hepatitis B and C infection- fatty liver disease

Diagnosis:Cirrhosis in its early stages is often diagnosed when the patient is being tested for some other condition or disease because symptoms are not present.

Anybody who has the following symptoms should see their doctor immediately:Fever with shiveringPanting (shortness of breath)Vomiting bloodDark stools, or tarry stools (as if covered with tar)Episodes of drowsiness or confusionA GP (general practitioner, primary care physician) will examine the patient and feel around the liver area to determine whether it is enlarged. The patient will be asked about his/her medical history and lifestyle (drinking, etc).

The following tests may also be ordered:

A blood test - to measure how well the liver is functioning and determine whether there is any damage. If levels of ALT (alanine transaminase) are high the patient may have hepatitis.

Imaging tests - this may involve an ultrasound, CT (computerized tomography), or MRI(magnetic resonance imaging) scan of the liver. Apart from seeing whether the liver is enlarged, the doctor will also be able to detect any scarring.

A biopsy - a small sample of liver cells are extracted and examined under a microscope. The doctor inserts a fine needle in between the ribs and into the liver. The patient will receive a local anesthetic. The biopsy not only confirms or rules out cirrhosis, but may also reveal its cause (if it is cirrhosis).

Endoscopy - an endoscope, a long, thin tube with a light and video camera at the end goes down the patient's windpipe (esophagus) and into their stomach. The doctor sees the inside of the stomach on a screen, and looks out for swollen blood vessels (varices); a hallmark sign of cirrhosis.

Child-Pugh Score

Also known as the Child-Turcotte-Pugh score, assesses the prognosis (outlook) of chronic liver disease, mainly cirrhosis. Originally, it was used to predict mortality during surgery, but is now used to determine prognosis, as well as the required treatment strength, and whether or not the patient needs a liver transplant. It is a combination of numbered points and the letters A, B, C (see below):

Class

PointsOne year survivalTwo year survivalA5-6100%85%B7-981%57%C10-1545%35%

Treatment:If the cirrhosis is diagnosed early enough, damage may be minimized by treating its underlying cause.

Alcohol dependency (alcoholism) treatment - it is important for the patient to stop drinking if their cirrhosis was caused by long-term, regular heavy alcohol consumption. In many cases the doctor will recommend a treatment program for alcoholism.

Medications - the patient may be prescribed drugs to control liver cell damage caused by hepatitis B or C.

Treating cirrhosis complication:

Ascites or edema - ascites (accumulation of fluid in the abdomen) or edema (fluid retention in the legs) can be treated with a low-sodium (salt) diet and water pills. In severe cases the fluid may have to be drained. Sometimes surgery is required.

Pressure in the portal vein and collateral smaller veins - hypertension (high blood pressure) drugs are usually prescribed to control the increasing pressure in the blood vessels around the liver; the aim is to prevent severe bleeding. In some cases a stent may be surgically placed in the portal vein to hold it open. Signs of bleeding can be detected via an endoscopy.

Treatment of swollen varices - if the patient vomits blood or passes bloody stools they probably have esophageal varices (in the food pipe). Urgent medical attention is required. The following procedures may help:Banding - a small band is placed around the base of the varices to control bleeding. An endoscope goes down the patient's throat and esophagus during the procedure. Injection sclerotherapy - after an endoscopy a substance is injected into the varices which triggers a blood clot and scar tissue to form; this helps stem the bleeding. A Sengstaken tube with a balloon - the balloon is at the end of the tube. If endoscopy does not stop the bleeding a tube goes down the patient's throat and into their stomach. The balloon is inflated; this places pressure on the varices and stops the bleeding. TIPSS (transjugular intrahepatic portosystemic stent shunt) - if the above-mentioned therapies do not stem the bleeding, a stent (metal tube) is passed across the liver to join the portal and hepatic veins, creating a new route for the blood to flow through. This reduces pressure - pressure which was causing the varices.Infections - the patient will be given antibiotics, and some other treatments.

Screening for liver cancer - patients with cirrhosis have a much higher risk of developing liver cancer. The doctor may recommend regular blood tests and imaging scans.

Hepatic encephalopathy (high blood toxin levels) - drugs can help treat excessive blood toxin levels. The signs and symptoms need to be explained to the patient so that they know what to look out for.

Liver transplant - if the cirrhosis is advanced and there is liver failure (liver does not function) the patient may need a liver transplant.

Prevention:

Alcohol - do not exceed the recommended daily/weekly alcohol limit.Men: maximum of 21 units per week, or three/four units per dayWomen: maximum of 14 units per week, or two/three units per dayIndividuals who have cirrhosis should abstain from alcohol completely. Alcohol accelerates the progression of the disease.

Hepatitis B and CUse a condom when having sex Do not share needles when injecting drugs People at risk of becoming infected with hepatitis B, such as health care workers, social care workers, and police personnel can be vaccinated (there is currently no vaccine for hepatitis C)