CIRRHOSIS

The liver is the biggest organ of the human body and it is essential for life. It eliminates the toxins from the blood, produces proteins to control infections and eliminates germs and bacteria. It produces the molecules that regulate coagulation of the blood and produces substances to help digestion of fat and fat soluble vitamins.

In cirrhosis, healthy tissue is replaced by a scar tissue that blocks the blood flow through this organ and preventing it to function correctly. Cirrhosis is a very important cause of death in the world.

Cirrosis Hepática

Causes

Cirrhosis has several causes; in general the most common are alcoholism and hepatitis. Liver disease by alcoholism is called Alcoholic cirrhosis and generally develops a decade after heavy drinking. Alcohol appears to lesion the liver by blocking the normal metabolism of proteins, fats and carbohydrates.

Chronic Hepatitis C. Infection with this virus causes the inflammation of the organ and mildly affects it, however with time cirrhosis develops.

Chronic Hepatitis B and D. Hepatitis B was probably the most common cause of cirrhosis in the world, but vaccines to prevent it have lowered its incidence. Hepatitis D is another virus that infects the liver, but only to people who have already had hepatitis B.

Autoimmune Hepatitis. This type of hepatitis appears to be caused when the immune system does not recognize and attacks the liver causing inflammation and taking it to cirrhosis.

Nonalcoholic steatohepatitis (NASH). This is the affection of the liver because of fat accumulation in it. In time and for unknown causes fat induces the formation of scar tissue and then cirrhosis. This problem is associated by Diabetes, malnutrition, obesity, heart disease or corticosteroid treatment.

Obstruction of bile ducts. When bile ducts are obstructed bile accumulates and causes liver damage. In some babies bile ducts are obstructed or missing or damaged, this is known as biliary atresia. In adults this can happen after gall bladder surgery, if the ducts are closed or accidentally damaged.

Drugs, toxins and infections. Some people react in a special way to certain drugs, injuring the liver. There are also infections, usually parasitic, that can injure the liver. Continued exposure to environmental toxins is also a cause of cirrhosis. When the heart does not function properly some substances may accumulate in the liver and this may lead to cirrhosis.

Hereditary diseases. There are several hereditary diseases like hemocromatosis, Alpha-1-antitripsin deficiency, Wilson’s disease, Galactosemia, and Glycogen Storage Diseases. They all affect the way the liver functions and can lead to cirrhosis.

Symptoms

At fist the patient will have no symptoms, however as time passes by and scar tissue starts replacing healthy cells the liver’s function deteriorates. The patient may start having a combination of fatigue, low appetite, nausea and weakness. There can also be weight loss, stomach ache and blood vessels start appearing on the skin. With time there will be complications of the disease, but in many people these could be the first symptoms.

Complications of Cirrhosis

Edema and ascitis. When the liver reduces the production of albumin, water will start to accumulate in the legs (edema) and in the abdomen (ascitis).

Bruises and hematomas. When the liver reduces the production of substances necessary for coagulation, the patient can start presenting hematomas or bleeding with ease. Reddening of the palms can also happen, this is called "palmar erythema".

Jaundice. Jaundice is a yellowing discoloration of the skin, scleare (white of the eyes) and mucous membranes caused by hyperbilirubinemia (increased levels of bilirubin in the blood). This happens when the liver stops processing bilirubin adequately.

Itching or Pruritus. The byproducts of bilirubin are deposited in the skin and usually lead to itching.

Biliary stones. When cirrhosis prevents bilis to get to the gall bladder, the patient can develop stones which can also affect digestion.

Toxins in the blood and the brain. When toxins can not be eliminated by the liver, they accumulate and reach the brain. This causes various symptoms but usually confusion. Patients can experience indifference to their surroundings, disregard to their personal appearance, partial memory loss, difficulty maintaining concentration, deterioration of writing and sleep disturbances.

Sensibility to medication. Cirrhosis makes the liver slower to process drugs and because they are not metabolized they will not be eliminated from blood in the usual speed. They will accumulate in the system and act longer, making the patient more sensitive and prone to adverse effects.

Portal hypertension. Usually blood from the digestive system and the spleen are transported to the liver by the portal vein. The transit through the liver is altered in the cirrhotic liver so blood flows slower thru the portal vein, increasing pressure. This is known as portal hypertension.

Varicose veins. When there is portal hypertension, the blood from the digestive tract and the spleen increase their size and they become varicose veins. They have thin walls and high blood pressure inside so they are prone to injuries and bleeding. If they burst, they will originate a bleeding that is usually lethal. In some cases varicose veins appear in the abdomen or in the rectal area (hemorrhoids).

Insulin resistance and type 2 Diabetes. Cirrhosis will cause insulin resistance; this makes muscle, fat and hepatic cells low on insulin. The pancreas will not be able to produce insulin enough for the body and type 2 Diabetes will develop.

Liver cancer. Hepatocellular carcinoma is a type of cancer caused by cirrhosis; it starts in the liver tissue itself and has a high mortality rate.

Problems in other organs. Cirrhosis can make the immune system to malfunction and this can lead to infections. Ascites (water in the abdomen) can infect with bacteria, that are usually found in the digestive system, and peritonitis can occur. Cirrhosis can also cause erectile dysfunction or kidney failure as well as osteoporosis.

Diagnosis

With the diagnostic suspicion of cirrhosis the doctor evaluates symptoms, clinical history of the patient and performs a physical evaluation. Then he will ask for blood tests that will confirm the presence of cirrhosis. If the doctor considers it necessary he can ask for imaging studies such as Cat scan ultrasound or MRI and maybe a nuclear liver study using a radioisotope. Sometimes the doctor may want also want to the examine the liver using a laparospic device or complete the evaluation with esophagus and stomach endoscopy. A liver biopsy will confirm the diagnosis. For the biopsy, the doctor uses a fine needle guided by real time X-ray images to get a small sample or liver tissue and examine it under the microscope. He will look for scar tissue and other signs of disease.