Cirrhosis

Liver cirrhosis means a lot of scar tissue spreads everywhere in the liver, which destroys the normal structure and compromises the liver function. The normal liver is a soft organ with smooth surface. A cirrhotic liver is hard and nodular in shape. Normally, the liver filters and detoxes chemicals absorbed from the intestine, secrets bile to help digest of food, and synthesizes proteins to stop bleeding. In cirrhosis, all these normal liver functions are affected. If the liver has difficulty getting rid of toxins, such as ammonium, they can build up in the body causing dysfunction of the brain, which is called hepatic encephalopathy. Also, the liver is rich of blood supply and has a lot of blood vessels connected to it. In cirrhosis, the scarring liver makes it difficult to let blood flow in, which causes increased pressure of the large blood vessel called portal vein, which is called portal hypertension. Portal hypertension leads to leakage of fluid into the belly, which is called ascites. If the ascites gets infected without obvious reason, it is called spontaneous bacterial peritonitis (SBP). SBP has a high risk of death if left untreated. Ascites can affect the blood flow to the kidney, causing kidney failure, which is called hepatorenal syndrome. Portal hypertension can also make the veins that connect to the portal vein dilated, which is called varices, such as esophageal varices, gastric varices, etc. Varices can burst and cause massive bleeding leading to death. Cirrhosis is a major contributor to liver cancer.

Causes and Risk Factors:

Common ones are:

  • Chronic hepatitis B, C, or D
  • Chronic alcohol use
  • Nonalcoholic fatty liver disease (NAFLD)
  • Autoimmune hepatitis
  • Primary biliary cirrhosis (PBC)
  • Primary sclerosing cholangitis (PSC)
  • Some bacteria or parasites infection
  • Some medicines and toxins
  • Some inherited diseases. Such as hemochromatosis, Wilson disease, porphyria, Alpha 1-antitrypsin deficiency (AAT), galactosemia, glycogen storage disease, etc.
  • Cirrhosis from heart failure
  • Reasons unidentified

Symptoms and Signs:

Although cirrhosis occurs in the liver, it affects multiple organ systems of the body. There are varieties of signs and symptoms related to cirrhosis. Common symptoms and signs of cirrhosis or complications of cirrhosis are:

  • Palmar erythema
  • Dupuytren's contracture
  • Clubbing
  • Leg swelling
  • Hypertrophic osteoarthropathy
  • Spider angiomata
  • Gynecomastia
  • Caput medusa
  • Fetor hepaticus
  • Jaundice
  • Impotence, infertility, loss of sexual drive, and testicular atrophy
  • Weakness, fatigue, anorexia, weight loss
  • Hepatic encephalopathy
  • Asterixis
  • Bruising and bleeding
  • Itching
  • Hepatocellular carcinoma
  • Portal hypertension
  • Ascites
  • Spontaneous bacterial peritonitis
  • Splenomegaly (large spleen)
  • Esophageal varices
  • Hepatorenal syndrome
  • Hepatopulmonary syndrome
  • Portal hypertensive gastropathy (see picture at right)

Diagnosis and Treatment:

Diagnosis is to find the underlying cause, to assess liver damage and effects to other organs. This usually involves one or more of the following tests:

  • Blood works
  • Paracentesis
  • Abdominal ultrasound
  • CT scan
  • MRI/MRCP
  • Liver biopsy
  • Endoscopy
  • ERCP
  • EUS

Treatment will be focused on the cause, reducing complications, properly managing complications if they occur, improving quality of life, liver cancer surveillance, transplant evaluation, etc.

References:

  1. PubMed Health.
  2. Wikipedia.
  3. Mayo clinic online health information.
  4. Sleisenger and Fordtran's Gastrointestinal and Liver Disease- by Mark Feldman MD, et al.
  5. The Little Black Book of Gastroenterology-by David W. Hay.
  6. Principles of Clinical Gastroenterology by Tadataka Yamada, et al.


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