Cirrhosis Of Liver

 

Rene Laennec who discovered the stethoscope  also is credited for the name cirrhosis of liver. The word cirrhosis is derived from a Greek word which means yellow and tawny.  This is generally the colour of a cirrhotic liver.

 

  1. What is cirrhosis of liver ? This is a chronic liver disease in which the liver does not function properly due to long term damage. The disease comes on gradually over months or years. In early phase there may not be any symptoms. As the disease worsens symptoms become evident.
  2. What are the main causes of cirrhosis of liver ?  Cirrhosis is most commonly caused by alcohol, hepatitis B, hepatitis C and non- alcoholic fatty liver disease. Typically more than 2 or 3 drinks per day over many years are required for alcoholic cirrhosis to occur. Nonalcoholic cirrhosis can occur due to obesity, diabetes, high body fats and hypertension.  Less common causes include defective metabolism of Iron and Copper. These metals can get deposited in liver in excess amount and cause chronic liver disease . Auto immune hepatitis , primary biliary cirrhosis , certain medications including few herbal medicines can cause cirrhosis.
  3. Can cirrhosis be prevented ? Avoiding excess alcohol intake, proper balanced diet is important. Proper vaccination against hepatitis B is extremely important. Hepatitis B and C can be treated by anti viral drugs. Auto immune hepatitis can be treated by steroids and thus cirrhosis can be prevented. Specific drugs for hemachromatosis and Wilson’s disease are available and thus cirrhosis can be prevented in these people. In non alcoholic fatty liver , weight reduction, proper exercises and treatment of diabetes and high triglyceride and cholesterol levels is the key. Few may require liver transplant .
  4. What are the early symptoms of cirrhosis ? In many there may not be any symptoms . The liver though cirrhotic , can be in compensated phase. There could be deterioration due to infections, superadded viral hepatitis , excess alcohol or internal bleeding. In a few there could be swelling at the ankles and distension of abdomen due to excess fluid collection. Jaundice, easy bruising of the skin and loss of appetite and weight could also be early symptoms . Low blood glucose levels are suggestive of poor prognosis .
  5. What are the late features? Vomiting of blood, passage of blood in stools, progressive drowsiness and severe jaundice are generally commonly observed. Coma, severe jaundice, kidney failure are pre-terminal symptoms .
  6. How is the diagnosis of cirrhosis made ? The gold standard is a liver biopsy through the jugular vein or per cutaneous route. However biopsy is not necessary in all cases. Indirect way to diagnose cirrhosis is by a good clinical examination and certain blood tests.
  7. What are important blood tests required to diagnose liver cirrhosis ?  The blood albumin levels are low and the globulin levels are high. The haemoglobin and platelets are low. The bilirubin levels would be high and the liver enzymes known as transaminases are high. The prothrombin test is a sensitive test for liver function and very high levels are associated with bleeding tendency and poor prognosis . In addition tests for hepatitis B and  C are always done. Cardiac assessment is also done to rule out cardiac cirrhosis. This occurs due to chronic passive congestion in the liver due to poor cardiac function .
  8. Why is upper gastrointestinal endoscopy performed in cirrhosis of liver ?  This is to rule out oesophageal varices. These are enlarged veins in the food pipe due to increased pressure in portal veins due to cirrhosis . These veins can bleed torrentially . This can be prevented by band ligation of these varices or injection of a sclerosing  agent in these varices.
  9. Is cirrhosis linked with liver cancer ? Major cause of liver cancer is an underlying liver cirrhosis . This is more common in cirrhosis due to hepatitis B and C virus. Alcohol induced liver cirrhosis also predisposes to liver cancer.
  10. What about ultrasound and CT scan of liver ? Ultrasonography is of immense benefit in the management of liver cirrhosis . It can help us to diagnose fatty liver, cirrhosis, portal hypertension , ascites and sometimes liver cancer. C T scan of abdomen and liver are useful in suspected liver cancer patients.

Cirrhosis of liver is a serious disease. It can be prevented by reducing alcohol intake and proper vaccination against hepatitis B virus. Cirrhosis due to nonalcoholic liver disease is on the rise due to improper left style. Obesity and diabetes need to be carefully managed to prevent cirrhosis . Liver transplant is a useful option in selected cases.

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