Cirrhosis

What is Cirrhosis?

In Cirrhosis of the liver, progressive scarring (fibrosis) of the liver causes scar tissue to replace normal liver tissue. The scar tissue damages the normal structure of the liver which affects the normal flow of blood through the liver. The liver itself becomes distorted, hardened and lumpy. Without a good blood flow the liver can't work as it should and its normal functions are impaired.

The liver is the largest organ in the body and is a very important organ to keep the body functioning properly. It is involved in the processing of nutrients and fats, poisons or toxins that find their way into the body, hormones and medications. It controls blood clotting and produces proteins. So, Cirrhosis of the liver can affect the functioning of the entire body.

Course of Cirrhosis

Cirrhosis happens when the cells of the liver are damaged by toxins, or by inflammation and disorders of the body's normal metabolic processes. Although many people associate liver Cirrhosis with alcoholism, it can have other origins, all of which cause the same characteristic damage.

What causes it?

Cirrhosis of the liver has a number of different causes. Long-term heavy drinking of alcohol. It usually takes about 10 years of heavy drinking of alcohol for Cirrhosis to develop. Women can develop Cirrhosis with a daily intake of 2-3 alcoholic drinks a day, which might not be considered by some to be 'heavy'. Similarly, men who have 3-4 alcoholic drinks a day can also develop Cirrhosis.

Chronic viral hepatitis types B, C & D. These hepatitis viruses cause inflammation of the liver and liver damage that after a few decades can cause Cirrhosis.

• Wilson's disease. This is an inherited disorder where excessive amounts of copper are absorbed in body tissues, particularly the liver

Haemochromatosis - Another inherited disorder, this time one in which too much iron is absorbed by the body and the excess is deposited in the liver.

Other inherited metabolic disorders, such as cystic fibrosis. Certain disorders that interfere with the body's metabolism and how the liver stores substances can result in Cirrhosis.

Autoimmune hepatitis - This is hepatitis caused by a problem in the body's immune system. The immune system doesn't recognise its own cells and tissues as 'self' and attacks them thinking they are 'foreign', like invading bacteria.

Blocked bile ducts - Bile is made in the liver and then the bile ducts carry the bile out of the liver to the gallbladder where it is stored. If the bile ducts become blocked due to scarring or inflammation, bile backs up in the liver and damages the liver tissues causing Cirrhosis. Primary biliary Cirrhosis is a disease of adults where the bile ducts become damaged. Biliary atresia is a condition of babies in which they are born without bile ducts or the bile ducts are damaged causing build-up of bile in the liver.

Toxic hepatitis - This is rare and is caused by severe reactions to medications or environmental toxins.

Chronic congestive heart failure with liver congestion - Repeated episodes of congestive heart failure with liver congestion can cause Cirrhosis of the liver.

Diagnoses

Tests can reveal liver problems including

• Physical Examination
• Blood tests, including FBC, Liver Function Tests Coagulation studies
• Abdominal X-ray
• CT scan

A liver biopsy confirms Cirrhosis.

Treatment

Treatment is directed at managing the complications of Cirrhosis and preventing further liver damage.

• Offending medications and alcohol are stopped
• Bleeding varices are treated by upper endoscopy with banding or sclerosis
• Ascites (excess abdominal fluid) is treated with diuretics, fluid and salt restriction, and removal of fluid (paracentesis)
• Coagulopathy may be treated with blood products or vitamin K
• Encephalopathy is treated with the medication lactulose; sometimes antibiotics are used and patients should avoid a diet high in protein
• Infections are treated with antibiotics
• If Cirrhosis progresses and becomes life-threatening, a liver transplant should be considered