cirrhosis of the liver

Cirrhosis is a condition that is characterized by abnormal structure and function of the liver. It is the scarring of the liver. Scar tissue forms because of injury or long-term disease. Scar tissue cannot do what healthy liver tissue does – make protein, help fight infections, clean the blood, help digest food and store energy. The diseases that lead to cirrhosis do so because they injure and kill liver cells, and the inflammation and repair that is associated with the dying liver cells causes scar tissue to form. The liver cells that do not die multiply in an attempt to replace the cells that have died. This results in clusters of newly-formed liver cells within the scar tissue.
There are many causes of cirrhosis. They include chemicals such as alcohol, fat, and certain medications. The most common causes of cirrhosis are long-term alcohol abuse, hepatitis B and C infection, and fatty liver disease. Toxins, including alcohol, are broken down by the liver. However, if the amount of alcohol is too high the liver will be overworked and liver cells can eventually become damaged. Heavy, regular, long-term drinkers are much more likely to develop cirrhosis, compared to other healthy people. It is a myth that only alcoholics are at risk – regular and heavy social drinking is also linked to a higher probability of developing cirrhosis. Typically, heavy drinking needs to be sustained for at least ten years for cirrhosis to develop. The period varies according to each individual. Regular heavy female drinkers are more likely to develop symptoms compared to men who consume the same amount. Heavy drinkers will eventually develop fatty liver. The liver breaks down alcohol into carbon dioxide and water, causing fatty liver. As soon as excessive drinking stops the symptoms of fatty liver go away.

Hepatitis C, a bloodborne infection, can damage the liver and eventually lead to cirrhosis. Hepatitis C is a common cause of cirrhosis in Western Europe, North America, and many other parts of the world. Cirrhosis can also be caused by hepatitis B and D. NASH is more likely to occur with people who are obese, diabetes patients, those with high blood lipid levels, as well as individuals with high blood pressure. NASH, in its early stages, begins with the accumulation of too much fat in the liver. The fat causes inflammation and scarring, resulting in possible cirrhosis later on. The person’s own immune system attacks healthy organs in the body as though they were foreign substances. Sometimes the liver is attacked. Eventually the patient can develop cirrhosis.
Some conditions and diseases, such as cancer of the bile ducts, or cancer of the pancreas can block the bile ducts, increasing the risk of cirrhosis. Other causes of cirrhosis include drug reactions, prolonged exposure to toxic chemicals, parasitic infections, and repeated bouts of heart failure with liver congestion.

Many people with cirrhosis do not experience any symptoms in the early stages of the disease. However, as scar tissue replaces healthy cells, liver function may begin to fail, causing the following symptoms. Early symptoms includes development of spider-like red spots on the chest, face or arms. Fatigue, loss of appetite, nausea, weakness and weight loss. Advanced symptoms includes difficulty concentrating, impaired sleep, poor memory, accumulation of fluid in the abdomen and/or legs, yellowish color of the skin and eyes, dark urine, weakness and decreased muscle mass.

The complications of cirrhosis may include edema/ascites , spontaneous bacterial peritonitis, bleeding from esophageal varices, hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, hypersplenism and liver cancer.

As cirrhosis of the liver becomes severe, signals are sent to the kidneys to retain salt and water in the body. The excess salt and water first accumulates in the tissue beneath the skin of the ankles and legs because of the effect of gravity when standing or sitting. This accumulation of fluid is called edema or pitting edema. The swelling often is worse at the end of a day after standing or sitting and may lessen overnight as a result of the loss of the effects of gravity when lying down. As cirrhosis worsens and more salt and water are retained, fluid also may accumulate in the abdominal cavity between the abdominal wall and the abdominal organs. This accumulation of fluid causes swelling of the abdomen, abdominal discomfort, and increased weight.
In cirrhosis, the fluid that collects in the abdomen is unable to resist infection normally. In addition, more bacteria find their way from the intestine into the ascites. Therefore, infection within the abdomen and the ascites, referred to as spontaneous bacterial peritonitis or SBP, is likely to occur.
In the cirrhotic liver, the scar tissue blocks the flow of blood returning to the heart from the intestines and raises the pressure in the portal vein. When pressure in the portal vein becomes high enough, it causes blood to flow around the liver through veins with lower pressure to reach the heart. The most common veins through which blood bypasses the liver are the veins lining the lower part of the esophagus and the upper part of the stomach. As a result of the increased flow of blood and the resulting increase in pressure, the veins in the lower esophagus and upper stomach expand and then are referred to as esophageal and gastric varices; the higher the portal pressure, the larger the varices and the more likely a patient is to bleed from the varices into the esophagus or stomach.
When cirrhosis is present, liver cells cannot function normally either because they are damaged or because they have lost their normal relationship with the blood. In addition, some of the blood in the portal vein bypasses the liver through other veins. The result of these abnormalities is that toxic substances cannot be removed by the liver cells, and, instead, the toxic substances accumulate in the blood. When the toxic substances accumulate sufficiently in the blood, the function of the brain is impaired, a condition called hepatic encephalopathy.Ultimately, severe hepatic encephalopathy causes coma and death.
Patients with worsening cirrhosis can develop the hepatorenal syndrome. This syndrome is a serious complication in which the function of the kidneys is reduced. It is a functional problem in the kidneys, that is, there is no physical damage to the kidneys. Instead, the reduced function is due to changes in the way the blood flows through the kidneys themselves. This suggests that the reduced function of the kidneys is the result of the accumulation of toxic substances in the blood when the liver fails.
Rarely, some patients with advanced cirrhosis can develop the hepatopulmonary syndrome. These patients can experience difficulty breathing because certain hormones released in advanced cirrhosis cause the lungs to function abnormally.
The spleen normally acts as a filter to remove older red blood cells, white blood cells, and platelets. The blood that drains from the spleen joins the blood in the portal vein from the intestines. As the pressure in the portal vein rises in cirrhosis, it increasingly blocks the flow of blood from the spleen. The blood “backs-up” and accumulates in the spleen, and the spleen swells in size, a condition referred to as splenomegaly. Sometimes, the spleen is so swollen that it causes abdominal pain.
As the spleen enlarges, it filters out more and more of the blood cells and platelets until their numbers in the blood are reduced. Hypersplenism is the term used to describe this condition, and it is associated with a low red blood cell count, low white blood cell count, and/or a low platelet count. The anemia can cause weakness, the leucopenia can lead to infections, and the thrombocytopenia can impair the clotting of blood and result in
Cirrhosis due to any cause increases the risk of primary liver cancer. Primary refers to the fact that the tumor originates in the liver. A secondary liver cancer is one that originates elsewhere in the body and spreads to the liver. The most common symptoms and signs of primary liver cancer are abdominal pain and swelling, an enlarged liver, weight loss, and fever
The scar tissue that forms in the liver due to cirrhosis of the liver is permanent. The goal of treatment is to stop or slow the progression of damage to the liver and minimize and quickly treat any complications, such as portal hypertension, liver failure, and hemorrhage. Treatment plans include a multifaceted, individualized approach that varies depending on the underlying cause of the disease. Alcoholism treatment includes abstaining from alcohol, which often requires participation in an alcohol treatment program. Hepatitis treatment may include corticosteroid drugs for autoimmune hepatitis or the medication, interferon, to treat a hepatitis infection. Complications of cirrhosis of the liver are also treated as appropriate. In some cases, treatment of liver failure may include liver transplant. This major surgical procedure involves using a healthy donor liver to replace a severely diseased liver.