Cirrhosis of liver

Hello students and friends, today we are going to discuss cirrhosis of the liver means how the liver gets damaged, its cause, etiology, pathophysiology, risk factors, complications, and medications.

If you are suffering from this condition or your family/friends are suffering from this disease then it might be helpful to you all.

Let us discuss some basics of the liver and its functions.

~The liver is anatomically located in the right upper quadrant of the abdomen below the diaphragm.

Basic functions are-

1. Regulated chemical level in the blood.
2. Secretion of bile.
3. Excretion of bilirubin, cholesterol, and waste products.
4. Metabolize fats, proteins, and carbohydrates.
5. Helps in the synthesis of plasma proteins(albumin and clotting factors).
6. Helps in the activation of enzymes.

When there is cirrhosis of the liver all the functions of the liver get disturbed.

Let us start with cirrhosis of the liver-

~Cirrhosis of the liver is a chronic progressive disease that is characterized by nodule formation and scarring of the liver.

• It is irreversible means if the liver gets damaged then we cant restore its normal shape and size and their functions.
• There are fibrotic regeneration and diffuse destruction of the hepatic cells of the liver.
• In this condition, necrotic tissue is replaced by fibrotic tissue.
• The normal structure of the liver and vasculature of the liver is altered, as there is damage to blood vessels there is impairing of the blood and lymph flow.
• Because of the impairment of blood, hepatic insufficiency, and portal hypertension occur.
• Liver tissue is damaged as this is a chronic disease, there is a replacement of liver tissue by fibrosis, there is scar tissue formation, and regenerative nodules are formed which leads to loss of function of the liver.

Cirrhosis of liver

Causes of cirrhosis of the liver

1. Viral hepatitis B & C
2. Autoimmune hepatitis
3. Gall bladder obstruction
4. Genetic
5. Certain medications(methotrexate, and acetaminophen)
6. High blood pressure
7. Diabetes
8. High body fat
9. Alcohol
10. Liver diseases

Rate of the population affected by cirrhosis of the liver

• About 2.8 million people are affected in which 1.3 million died in 2015.
• The most common cause of cirrhosis is HVB(hepatitis virus B), HBC(hepatitis virus C), and alcohol.

Symptoms

~Initially, it is asymptomatic.

If we see early symptoms of the onset of disease-

1. Nausea
2. Vomiting
3. Abdominal discomfort(mostly upper)
4. Weakness
5. Tiredness or fatigue
6. Diarrhea
7. Mild fever
8. Swelling of ankle

As the disease progresses-

1. Jaundice.
2. Ascites.
3. In male: Loss of hairs from the body, gynecomastia, and testicular atrophy.
4. In females: Reduce in breast size, and loss of sexual drive.
5. Spider naevi.
6. Anemia.
7. Purpura.
8. Fetor hepaticus(musty smell from breath).

Due to portal hypertension

1. Caput medusae(the network of dilated veins that surrounds the umbilicus).
2. Splenomegaly(WBC count decreases and platelet count decreases).
3. oesophageal varices(mouth bleeding).

Other symptoms-

1. Clubbing of nails.
2. Dupuytren's contracture.

When the disease gets advance-

1. Hepatic encephalopathy.
2. Kidney damage.
3. Bruising.
4. Muscle wasting or cachexia.

Pathophysiology

• Liver cells get damaged due to the formation of fibrous tissue.
• The destructed cells are replaced gradually by scar tissue.
• There is obstruction of the blood and lymph flow.
• There are hepatic insufficiency and damage to liver tissue by cirrhosis of the liver.
• Due to etiological factors, there is diffuse destruction and regeneration of the cells and the formation of fibrous tissue.

Classification

1. Alcoholic
2. Post necrotic
3. Biliary
4. Cardiac

Alcoholic- also called portal cirrhosis.

• Men>women.
• Because of some offending agents, there is the formation of small nodules.
• Fibrosis occurs- mainly around the central and portal vein areas.

Post necrotic- most common

• Scar tissue formation.
• Mainly caused by HBV and HBC.
• It is caused by industrial chemicals also.
• Women>men.

Biliary cirrhosis- scarring around the lobes of the liver and bile ducts.

• It results from obstruction of the intrahepatic or extrahepatic biliary system and chronic biliary injury.

Cardiogenic cirrhosis- it is rare.

• It is a chronic liver disease.
• Associated with long-term severe right-sided heart failure.
• Caused by atrioventricular valve disease or constrictive pericarditis.

Etiology and risk factors

1. Cystic fibrosis.
2. Autoimmune hepatitis.
3. Biliary atresia(GI disorder).
4. Hemochromatosis(too much iron in the body).
5. Wilsons disease.
6. Alcohol abuse.
7. Chronic viral infections of the liver.

Diagnosis

1. Blood test(WBC count and platelet count is low).
2. Enzyme test- SGPT, alkaline phosphate, and SGOT.
3. The serum bilirubin level is raised.
4. PTC(percutaneous transhepatic cholangiography)
5. Low protein level.
6. Prothrombin time increases.
7. USG.
8. CT-scan.
9. MRI.
10. Biopsy(later stage).

Management

1. Ask the patient to minimize the deterioration of the liver the use of alcohol, toxic substances, and drugs must be stopped.
2. Treat ascites and electrolytic imbalance.
3. Diuretic therapy is given frequently with spironolactone(Aldactone).
4. Abdominal paracentasis.
5. If ascites are not treated by other means then the TIPS(Transjugular intrahepatic portosystemic shunt) procedure is used to treat it. It is an interventional radiological procedure.
6. Antiemetics.
7. Pain-relieving medications.
8. For hepatic encephalopathy- lactulose(cephulac) or neomycin(myciguent).
9. The original liver of the patient is removed and replaced by the donor liver(organ) in the same anatomical position of the liver. This procedure is called Orthotropic liver transplantation, it may be required.

Complications

1. Bleeding esophageal varices.
2. Coagulopathies(bleeding disorder).
3. Hepatic encephalopathy.
4. Bleeding esophageal varices(when blood flow to the liver is blocked).
5. Hyponatremia(level of sodium gets too low in the body).
6. Water retention.

Hope you all find this helpful for you, if you have any query related to this topic or any other topic then you all are free to contact me via contact us or you can also ask your doubts on the comment box. Thank you! 

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