Cirrhosis of the liver is the liver disease charecterised by replacement of normal liver tissue by fibrous scar tissue and formation of regenerating nodules. The scar tissue blocks the blood flow to liver and prevents proper functioning of the liver. Cirrhosis of the liver is the twelth leading cause of death by disease, and nearly 26,000 people are dying because of Cirrhosis of the liver in United ststes.
Causes of cirrhosis of the liverNumber of factors causes Cirrhosis of the liver. chronic alcoholism and hepatitis C are very common causes of liver cirrhosis in most of countries.Alcoholic liver disease: chronic alcoholism is the main cause of liver cirrhosis. Drinking of alcohol more than a period of 6 to 10 years has a high risk of development of liver cirrhosis. The nature and amount of alcohol consumption determines the development Cirrhosis of the liver. nearly 15% of individuals who drink heavy alcohol for more than a decade are prone to have cirrhosis of the liver.Autoimmune hepatitis. Autoimmune disease produces imuume cells which attacks the liver and causes inflammation, damage and also cirrhosis of the liver.
Chronic hepatitis C. The hepatitis C virus is also one of the major cause of chronic liver disease and cirrhosis of the liver. Infection and inflammation caused by the virus damages the liver and leads to cirrhosis of the liver.Chronic hepatitis B and D. The hepatitis B virus is probably the most common cause of cirrhosis of the liver. Hepatitis B, like hepatitis C, causes liver inflammation and injury that over several years and causes cirrhosis of liver. Hepatitis D also causes cirrhosis of the liver.Inherited diseases. Alpha-1 antitrypsin deficiency, hemochromatosis, Wilson disease, galactosemia, and glycogen storage diseases and other inherited diseases may alter the normal functioning of liver and liver functions such as storage of enzymes, proteins, metals, and other substances are altered and may cause cirrhosis of the liver.Nonalcoholic steatohepatitis : Excess fat builds up in the liver and eventually causes scar tissue. This steatohepatitis is most of times associated with diabetes, protein malnutrition, obesity, coronary artery disease, and steroid medications. This type of nonalcoholic hepatitis also causes cirrhosis of the liver.
obstruction of bile ducts : because of obstruction of bile ducts bile backs up and damages the liver tissue. The most common cause of bile obstruction is primary biliary cirrhosis, a disease charecterised by inflamed, blocked, and scarred bile ducts. This disorder may cause cirrhosis of the liver.Untreated fatty liver disease also causes cirrhosis of the liver.Drugs, toxins, and infections : prolonged usage of certain drugs, ingestion of some toxins mixed in the foods, exposure to environmental toxins, parasitic infection of liver, recurrent liver congestion can cause cirrhosis of the liver.Cardiac cirrhosis : is caused due to chronic right sided heart failure which causes liver congestion and causes cirrhosis of the liver.
Galactosemia also causes cirrhosis of the liver.
Glycogen storage disease type IV
Cystic fibrosis
any ane of or combination of these may cause cirrhosis of the liver.
Symptoms of cirrhosis of liver : Early symptoms of cirrhosis of liver are asymptomatic. Some people the clinical symptoms area manifested as follows. The scar tissue is replaced by healthy cells, and liver function starts to fail and the following symptoms of cirrhosis of liver are felt by the patients.
* exhaustion
* loss of appetite due to altered liver enzyme level,
* fatigue because of low metabolism,
* nausea may be related abdominal distension and liver congesion,
* Generalised weakness
* weight loss related to poor metabolism of food by liver,
* abdominal pain
* hepatic encephalopathy
* spider-like blood vessels develops on the skin is also the symptom of cirrhosis of the liver.
* Vascular lesions consisting of a central arteriole surrounded by many smaller vessels in liver,
* Palmar erythema is an exaggerations of normal speckled mottling of the palm, due to altered sex hormone metabolism by the liver.
* Changes in nails, such as clubing of nails, paired horizontal bands separated by normal color,
* Chronic proliferative peritonitis, along with pain in long bones.
* Flexion deformities of the fingers caused because of thickening and shortening of palmar fascia.
* Enlarged liver size or hepatomegaley, is the symptom of cirrhosis of the liver.
* Splenomegaly, or increased size of spleen, is the symptom of cirrhosis of the liver.
* Ascities : collection of fliud in peritoneal cavity, leads to flank dullness of stomac, and abdominal distension, is the symptoms may be associated with cirrhosis of the liver.
* Ictrus or jandice : Yellow discoloration of the skin, eye, and mucus membranes due to increased bilirubin level in blood.
* Astrrixis : Bilateral asynchronous flapping of outstretched, dorsiflexed hands seen in patients with hepatic encephalopathy.
* esophageal varices are developed with enlarged liver.
The nodules developed during cirrhosis of the liver are
The micro nodules : nodules are regenerated and not morethan 3mm.
The macro nodules : nodules size are larger than 3 mm
The mixed cirrhosis type where the nodules are of different sizes.
Complications of Cirrhosis of the livercomplications caused by cirrhosis of the liver are as followsEdema and ascites : water accumulates in the legs (ankle edema) and abdomen (ascites).Bruising and bleeding. Decreased production of blood clotting proteins causes blue spots and the person will bruise or bleed easily. palmar erythema, reddish and blotchy palms may develop as the complication of cirrhosis of the liver.
Jaundice : decreased absorbtion of enough bilirubin by the liver casues Jaundice.Itching. increased Bile products are deposited in the skin and causes itching with cirrhosis of the liver.Formation of Gallstones. gallstones are developed when cirrhosis prevents bile to reach the gallbladder.Toxins in the blood or brain. When liver fails to remove toxins from the blood, increased toxins accumulate in the blood and gradually reaches the brain may cause hepatic encephalopathy. these elevated toxins leads to poor mental functioning and causes personality changes, coma, and even death if cirrhosis of the liver is not treated. This is the complication developed in later stage of disease.
Portal hypertension. the portal vein carries the blood from the intestines and spleen to the liver. But cirrhosis of the liver obstructs the normal blood flow through the portal vein, which increases the pressure in portal vein and causes portal hypertension.Insulin resistance and type 2 diabetes. Cirrhosis may cause insulin resistance by body tissues. insulin hormone, produced by the beta cells of pancreas,converts blood glucose into glycogen. when insulin resistance is developed, body muscles, fat, and liver cells do not use insulin properly. but the pancreas produces normal amount of insulin, which becomes more when not used. Liver cancer. Hepatocellular carcinoma, a type of liver cancer may be caused by cirrhosis of the liver.Diagnosis of cirrhosis of the liver
History collection reveals the history of alcohol consumption, and famili history also helps in diagnosis of cirrhosis of the liver.Other diagnostic tests include,
* laboratory tests, physical examination.
* X-ray tests to know the outline of liver damage.
* Ultrasound is also used know a days for diagnosis of liver diseases.
* Firboscan is the advanced technology used to know the stiffness of the liver and is determined by using of elastic waves. Firboscan is a non-invasive technique helps in assessment of extent of liver damage within some minutes. Firboscan is much preferred as it is a pain less procedure and provides result very fast.
* Computed tomography ( CT scan ) which shows the nature of liver cells and helps in easy diagnosis of cirrhosis of the liver.
* magnetic resonance imaging (MRI) : is done after injecting a dye for the confirmation of exact palce of the liver affected and MRI scan gives the clear idea about cirrhosis of the liver.
