Cirrhosis

5 mins read

Introduction
Cirrhosis is a late-onset; slow progression scarring of the liver. In this condition, the healthy tissue of the liver is replaced by the scar tissue, which ultimately leads to liver dysfunction. Cirrhosis occurs as a result of various factors such as alcohol abuse, hepatitis, or liver infection. All these cases, eventually leading to cirrhosis, lead to the loss of liver function. However, early diagnosis and treatment is effective in reducing the progression of the disease.

Cirrhosis is usually identified as yellowing of the skin, and results in weakness, bruising, loss of appetite, weight loss or in some severe cases jaundice. Late-stage cirrhosis is most commonly treated by liver transplantation.

Causes of Cirrhosis
Cirrhosis is one of the most common liver disorders that results from alcohol abuse, fatty liver, hepatitis, and chronic viral infections. However, many studies have demonstrated that cirrhosis also results from factors such heart failure and bile duct blockage. Additionally, diseases such as cystic fibrosis, autoimmune diseases, and glycogen storage diseases have been found to be the genetic causes associated with the development of cirrhosis.

Symptoms
Symptoms of cirrhosis vary with the developmental stage. These symptoms may either due to the direct manifestation of the disease or the secondary features associated with its causes. However, in most of the cases, cirrhosis may progress without any symptoms during the initial stages. As the disease progresses, some of the most apparent symptoms are:

Jaundice Or Yellowing Of The Skin: Skin and the eye become pale. Nails and fingers turn to shy yellow in color.

Swelling And Fatigue: Edema is the most common manifestation, where arms, legs, and belly become swelled due to fluid retention

Indigestion And stool color: Most commonly, indigestion occurs in adults. Stool color becomes yellow. At times, blood is also visible in the stool.

Hepatic Encephalopathy: Increased concentration of ammonia and nitrogenous substances in the blood. This results in various obnoxious developments like loss of memory, change in sleep patterns, decreased metabolism, cerebral dysfunction and unresponsiveness to medicines.

Reduced immunity: Response to medications decreases during cirrhosis which results in decreased immunity and more susceptibility to various infections.

Diagnosis
Unlike other liver infections, cirrhosis is not a communicable disease. However, cirrhosis is often preceded by various infections and liver disorders such as hepatitis, fatty liver, thus it becomes essential to diagnose the disease for effective treatment before it progresses to advanced stages. Signs and symptoms associated with cirrhosis, most of the times, are common for various infections not related to liver.

For cirrhosis, liver biopsy has been considered as the ‘gold standard’ for the diagnosis. In this procedure, platelet count is used to identify the stage of the disease based on the apparent symptoms. Additionally, liver ascites and spider angiomata are also used to establish the progression of the disease. Furthermore, tests like liver function test, complete blood count, and blood albumin level are also used to measure the liver function to establish the disease more effectively.

Treatment Strategies In Cirrhosis
Although the disease is progressive in nature, various treatment modalities have been used in the management of cirrhosis

Surgical Intervention
Endoscopic treatment is used to dilate the veins to open the closed ducts. This procedure is followed by removing the excess fluid from the body. However, for advance-stage cirrhosis, liver transplantation has been found to be most effective.

Lifestyle Modifications

  • Less intake of alcohol is one of the most critical lifestyle modifications of cirrhosis
  • Healthy diet along with regular exercise has been indicated in cirrhosis
  • Adequate knowledge on the complications and consequences associated with the disease

Medication And Vaccination

  • To ward off the infections associated with liver disease, vaccinations for hepatitis C, hepatitis B, influenza, and pneumonia have been recommended
  • Various antibiotics have been found to be beneficial in managing late-onset infections associated with lungs, liver, and intestine
  • Vitamin-K supplements to reduce excess bleeding
  • Diuretics

Conclusion
Cirrhosis is late-onset scarring of the liver. The condition is characterized by the replacement of normal liver tissue with scar tissues. Liver biopsy is the gold standard in the diagnosis; however, various symptoms such as jaundice, swelling, and acute liver disease have been found to be effective in its diagnosis. Lifestyle modifications, vaccinations, and liver transplantation for advanced stage are some of the treatment strategies in cirrhosis.

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References
1. Li CP, Lee FY, Hwang SJ, et al. Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function.Scand J Gastroenterol. 1999;34(5):520–3.

2. van Thiel DH, Gavaler JS, Spero JA, et al. Patterns of hypothalamic-pituitary-gonadal dysfunction in men with liver disease due to differing etiologies. 1981;1(1):39–46.

3. Mehta G, Rothstein KD. Health maintenance issues in cirrhosis. Med Clin North Am. 2009;93:901–

4. Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Ausiello D (ed). Cecil Medicine. 24th Philadelphia, Pa: Saunders Elsevier; 2011:156.

5. O’Shea RS, Dasarathy S, McCullough AJ, et al. AASLD Practice Guidelines: Alcoholic liver disease. Hepatol. 2010;51(1).

6. Sanai FM, Alswat K, Al-Hamoudi W, et al. Combined Fibrosis Indices: More Than 1 Way to Skin a Cat. J Clin Gastroenterol. 2014. [Epub ahead of print].

7. Kamath PS, Kim WR. The model for end-stage liver disease (MELD). Hepatol. 2007;45(3):797–805.

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