Cirrhosis

Itching:
Vomiting Blood:
Melena or tarry black stools:
Fever:
Confusion or encephalopathy:
Loss of weight:
Enlargement of liver:
Increased effect of medicines and alcohol:
Diagnosis
Imaging:
Biopsy:
Prevention
Treatment:
More Information
Alcohol and Cirrhosis
Alcohol in Moderation

 

Cirrhosis is a medical term, which means that hard fibrous tissue is increased in the liver as a result of any condition. Usually when the liver is injured, some of the cells die, but the liver repairs itself, restores its previous condition and is not scarred. However, if this injury is repetitive or continuous, the liver becomes scarred. Usually this process starts slowly and can continue for years without exhibiting any symptoms. Eventually, this scarring increases to the extent that the most important functions of the liver are affected. At this point a liver cannot restore itself. The symptoms can appear at any time, but usually in this process of scarring, they appear relatively late. Many of the symptoms appear as a result of complications of cirrhosis, when the liver starts to fail in its usual functions. Cirrhosis can result from various illnesses, the following list is incomplete, but details the usual causes.
 

• Viral hepatitis (Hepatitis B & C)

• Alcoholic Liver Disease

• Fatty liver disease

• Autoimmune hepatitis

• Primary Biliary Cirrhosis or PBC

• Other conditions of the biliary tubes, such as primary sclerosing, cholangitis or biliary atresia (reduced growth of biliary tubes among children)

• The disease of the blood vessels of the liver, such as Budd-Chiari syndrome

• Hereditary illnesses for example Wilson's disease, which leads to excess of copper in the body

• Haemohromatosis, which causes excess of iron in the body

• Long term use of some special medicines or exposure to toxins

 

It should be remembered that the cirrhosis of the liver can be due to a number of causes, most of which have nothing to do with alcohol, although alcohol remains the commonest cause of cirrhosis in the western world.
 

SYMPTOMS

 

Cirrhosis does not cause any specific symptoms; most of the patients with cirrhosis do not have any symptoms and are diagnosed by chance on medical examination or due to laboratory tests done to investigate an unrelated illness.

Sometimes, one or more of the following symptoms can be seen: Loss of appetite, tiredness, feeling weary and unwell.
If your cirrhosis has recently been diagnosed, you should be vigilant for the following symptoms and if they appear, you should seek medical help, because sometimes immediate treatment will be needed.

Nausea, vomiting and jaundice (the yellowness of skin and the white of the eyes, because liver starts failing in getting rid of bile).

Itching:

Swelling of tummy (ascites) and swelling of the legs (edema), this is due to accumulation of water. If the situation arises, the weight can increase dramatically and sometimes if this accumulation of water is infected by bacteria, it can also cause pain.


Vomiting Blood:

SwelliSometimes lower part of the gullet or upper part of the stomach starts bleeding due to swollen blood vessels. The reason is that the blood flowing to the liver from the digestive system faces increased resistance, therefore the pressure in the blood vessels increases and as a result the blood vessels swell up and can burst, leading to loss of blood.


Melena or tarry black stools:

When the blood passes through the intestines, it is partially digested, therefore its consistency is typical and odour is very offensive.


Fever:

Fever is sometimes accompanied by shivering, it is an indication of infection. Infection can be of different kinds, however the patients with cirrhosis are more susceptible to infection in the skin, ascites and also infection of the blood.


Confusion or encephalopathy:

When the liver starts failing in neutralizing the toxins produced in the body, it can affect the brain. The initial symptoms can be mild, for example weak memory or behavioural changes, when the illness progresses coma can ensue.


Loss of weight:

Loss of weight and accompanied with this loss of the bulk of the muscles, which is often seen in loss of bulk of the upper part of the arms.


Enlargement of liver:

It can be felt on the right side below the rib cage.


Increased effect of medicines and alcohol:

Because the ability of the liver to neutralize these is diminished.


DIAGNOSIS

The doctor will take medical history, do a physical examination and then arrange further tests, for example liver function tests, which measure the enzymes of liver.


Imaging:

For example x-ray, ultrasounds, CT scan or MRI scan.


Biopsy:

This is usually done under local anesthetic and a sample is taken from the liver with a thin needle for microscopic exmanination. Usually the patient can go home the same day; sometimes an overnight stay in hospital is necessary.


Prevention

To avoid cirrhosis, it is necessary to prevent the liver conditions which lead to it. In Pakistan, the most important among these is viral hepatitis (hepatitis B and C). Some liver diseases cannot be prevented, for example hereditary, metabolic or autoimmune liver diseases, it is also essential not to indulge in excess alcohol intake.


Prevention

It depends on the nature and stage of cirrhosis, and the aim of treatment is to try and stop the progress of cirrhosis if possible and to try and remedy the damage that has already occurred. And also to treat the complications, which can be life threatening and can make you ill. In some patients, liver transplant can be helpful and please consult your specialist doctor or nurse regarding the best treatment choice for you.


More Information

Until recently, most specialists were of the view that cirrhosis is irreversible. In most circumstances this view is correct because most of the diseases causing cirrhosis are chronic and are difficult to treat. However, recent research has shown that if the liver disease is effectively treated (for example use of antiviral drugs and hepatitis B and C), the scarring of liver can be reduced and there are some examples of reversal of cirrhosis.

These initial reports are encouraging and there is the possibility that the process of cirrhosis can be understood and medications can be developed, which can prevent the scarring of liver. However, for the general availability of such medication, a lot of research is required.


Alcohol and Cirrhosis

Almost everybody, who drinks alcohol to excess, has sustained some liver damage. Most of the people, who drink excess alcohol will be affected by fatty liver and about 10% will end up having cirrhosis of liver. The risk of cirrhosis increases in proportion to the amount of alcohol used, inadequate diet can also increase this danger. All drinks containing alcohol can cause liver disease.


Alcohol in Moderation

The risk of cirrhosis of liver can be reduced by consuming alcohol within limits. According to the Department of Health in the UK, the maximum recommended amount of alcohol is as follows: Women 14 units per week. Men 21 units per week. Women are more at risk from alcoholic liver disease because their body structure and volume is different. If there is a preexisting liver disease, the danger of alcohol increases further.