Liver Cirrhosis

DEFINITION:-

Cirrhosis is defined as the last stage of the Liver disorder. In this condition, healthy liver tissues are converted into scar tissue. The liver is damaged permanently. Due to the presence of scar tissues the liver is not working properly.    There are many types of liver disorders and conditions which injure healthy liver cells and tissues. They causing death and inflammation of the liver cell. Due to the scar cells, the blood flow through the liver blocks. The blockage of blood flow through the liver causes slows the liver’s ability to process hormones, nutrients, drugs, and natural toxins. The production of protein and other substances made by the liver is also reduced. Due to the cirrhosis disorder, the liver does not work properly. The last stage of cirrhosis is a life-threatening disorder.

 CAUSES:-

• Abuse of Alcohol for many years (>20 years)
• Viral Hepatitis
• Diabetes
• Obesity
• Inject medicines using sharing needles
• History of liver disease
• Have an unprotected sex

SIGN AND SYMPTOMS:-

The Sign and Symptoms of Liver Cirrhosis are depended on the stage of Liver Disorder. These are the followings:-

• Nausea
• Fever
• Loss of Appetite
• Weakness
• Tiredness
• Unexpected Weight Loss

At last stage of Liver cirrhosis, the liver function gets worse, other more common symptoms of cirrhosis appear including:-

• Easy bruising and bleeding.
• Yellowish discoloration of the skin.
• Yellowish discoloration of the eyes.
• Jaundice
• Itching into whole-body skin.
• Edema (Swelling) in the patient’s legs, feet, and ankles.
• Ascites (Accommodation of fluid in the abdomen).
• Orange or Brownishdiscoloration of urine.
• Light-colored stools.
• Loss of memory, Confusion, difficulty thinking, personality changes.
• Melena (Blood in your stool).
• Redness in the palms of the hands.
• Telangiectasias, it’s a condition in which, Spiderlike stricter of the blood vessels that surround small, red spots on the skin.
• In men there is loss of sex drive, Gynecomastia (enlarged breasts), shrunken testicles.
• In women there is premature menopause is seen(no longer menstrual period).
• Long-lasting pain in the abdomen is also seen in some cases.
• Liver cirrhosis also makes severe bone and joint pain.
• General Body pain

CAUSES:-

The most common causes of liver cirrhosis are the following:- 

1. Alcohol abuse – A liver disorder caused by long term use of alcohol
2. Chronic viral liver infections
3. Hepatitis B and Hepatitis C virus infections of the liver
4. Fatty Liver caused by obesity
5. Diabetes
6. Disorders that damage the liver can lead to cirrhosis.

Other causes of Liver Disorders include:-

• Alpha – 1 Antitrypsin deficiency:- Build-up of an abnormal protein in the Liver
• Hemochromatosis:- Excess Iron stored in the Liver
• Wilson Disorder:- Excess Copper stored in the Liver
• Glycogen Storage Disorder:- Glycogen is a form of sugar, Liver can’t build or break down glycogen in this condition
• Cystic Fibroid:- thick mucus build in the Liver
• Alagille Syndrome:- In this condition Patient born with fewer than normal number of bile ducts, affects the bile flow and causes jaundice
• Autoimmune Hepatitis:- In some cases the Immune system attacks the healthy liver tissue that causes the damage of liver cells
• The Disorders that damage or block bile ducts in the liver (tubes that carry bile from the liver to other parts of the digestive system)
• Primary Biliary Cholangitis:- In this condition the Bile ducts become injured and inflamed, which causes permanently damaged to the Liver.
• Primary Sclerosing Cholangitis:- In this condition, inflammation of the Liver bile ducts leads to narrowing and scarring of the bile ducts and buildup of bile in the liver.
• Biliary Atresia:- In this condition, the infants are born with blocked or poorly formed bile ducts, thus causing damage, scarring, loss of liver tissue, and cirrhosis.
• Chronic Heart Failure:- This causes back up of fluids in the liver and this causes swelling in the parts of the body.
• Amyloidosis:- In this is a condition there is the abnormal deposition of abnormal protein in the liver, this is called Amyloid, this disturbs normal liver functions.
• The disorders which cause Liver Cirrhosis can injure to the liver, after injury continues, liver cells start to die, due to that the scar tissue replaces the damaged liver cells and the liver function are properly.

complications of cirrhosis:-

When Liver Cirrhosis develops over many years causes many complications of cirrhosis of the liver. So, the first noticeable signs and symptoms of the disease are the followings:-

• Portal hypertension:- This is the most common serious complication of the Heart in which there is an increase in the pressure in the Portal vein of the heart (This is the largest blood vessel that receives the blood from the digestive organs and supplies to the liver). Due to the blockage of blood flow through the liver, there is an increase in the pressure, this causes Liver cirrhosis.
• Varices:- In this condition when blood flow through veins is partially blocked, The veins present in the esophagus, stomach, or intestines may become enlarged. Due to the more pressure in these veins, the veins can bleed or even burst, this causing severe internal bleeding.

Complications of portal hypertension are following:-

1. Edema:- Swelling in legs, ankles, and feet.
2. Ascites:- Filling fluids in the abdominal cavity.
3. Splenomegaly:- Swelling or enlargement of the spleen.
4. Hepatopulmonary syndrome:- Expansion (Formation and dilation) of blood vessels in the lungs, leading to low levels of oxygen in the blood and whole body causes shortness of breath.
5. Hepatorenal Syndrom:- Due to the Failure of Kidney function, Portal Hypertension can cause, this leads to Cirrhosis. This is a type of failure of the kidney.
6. Hepatic Encephalopathy:- This causes when toxins from the intestines do not remove properly by the damaged liver and circulate in the bloodstream and buildup in the brain. this condition causes confusion, difficulty in thinking properly, changes in behavior, even coma in some cases.
7. Hypersplenisim:- In this condition an overactive spleen. This causes quick and premature destruction of blood cells.
8. Infections:- Liver Cirrhosis can increase the risk of getting and fighting serious infections.
9. Peritonitis:- Recurrent Bacterial infections of the tissues of the inner wall of the abdomen causes peritonitis. 
10. Malnutrition:- The Liver processes nutrients. So, a damaged liver cannot make this properly and causes weight loss and general body weakness.
11. Liver carcinoma:- Most patients who develop Liver Carcinoma have cirrhosis of the liver.
12. Liver failure:- Many disorders and conditions lead to Liver failure such as Cirrhosis of the liver. Liver failure occurs when the Liver does not function properly enough to perform its many functions.

DIAGNOSIS AND TESTS:-

The Diagnosis and Tests of Liver cirrhosis are following:- 

Your Medical Doctor will first ask about your medical history and prescription drug use. The Doctor will also ask about any Herbal products or supplements you may use. The Doctor may suspect if you have Liver Cirrhosis and if you have a long history of alcohol abuse, injectable drug abuse, or if you have Hepatitis B or Hepatitis C-like disorders. To diagnosis cirrhosis, the following tests should perform:-

1. Physical exam:- The Doctor should examine the patient, The signs and symptoms of Liver cirrhosis including The red, spider-like blood vessels on the patient’s skin, yellowing discoloration of the skin and the eyes, bruises on the skin; redness on the palms; swelling of the body, tenderness or pain in your abdomen; bumpy texture to the lower edge of the liver.

2. Blood tests:-

• Albumin and blood clotting factors:- Lower levels of Albumin than normal cause loss of the ability to make the proteins.
• Hemochromatosis is a condition in which Higher levels of Iron.
• Presence of autoantibodies may indicate primary biliary cirrhosis or autoimmune hepatitis.
• Increased bilirubin level causes Liver dysfunctions.
• Increased White Blood corpuscles indicate infection.
• High level of creatinine is a sign of kidney disease that leads to the late stage of cirrhosis.
• Decreased level of sodium is an indicator of cirrhosis.
• Increased level of alpha-fetoprotein indicates the presence of liver carcinoma.
• Increased in Complete Blood Count may indicate the sign and symptom of infection and anemia caused by internal bleeding.
• Viral hepatitis test to check for hepatitis B or C.
• Imaging tests: This test shows the texture, size, and shape of the liver. These tests can also show the amount of fat, the amount of scarring in the liver, and also detect the fluid in the abdomen.
• CT Scan (Computerized Tomography)
• Ultrasound
• MRI (Magnetic Retrograde imaging)
• Endoscopy Retrograde Cholangiopancreatography
• Liver Biopsy

MANAGEMENT AND TREATMENT:-

• Stop drinking alcohol.
• Treat chronic hepatitis.
• Avoid medications that destroy the liver cells.
• Eat a well-balanced, healthy, and low-fat diet.

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