CIRRHOSIS

What’s it?

Cirrhosis is a diffuse disease of the liver that alters the functions of its cells and of the systems of bile ducts and blood vessels.

It results from diverse processes, among which are the death of liver cells and production of a non-functional fibrous tissue. This harms the whole structure and the liver performance.

How is it acquired and how does it develop?

After different periods of time, individuals with chronic liver inflammations are subject to developing cirrhosis.

It isn’t possible to predict what individuals with liver disease will have cirrhosis.

Its most common causes are:
 

chronic hepatitis by B and C viruses
alcoholism

More rare causes include:
 

medication-induced hepatitis
autoimmune hepatitis
genetic diseases ( hematochromatosis, Wilson’s disease)
primary or secondary biliary cirrhosis (chronic impairment, without definite cause, of the bile flow from within the liver, or occasionally resultant from a complex surgery of the gallbladder, bile ducts or liver).

In newborns, biliary atresia (malformation of the canals that conduce the bile from the liver to the bowel) constitutes a significant cause for the fast onset of cirrhosis in babies, a condition cured only by liver transplantation.

What does one experience?

The disease develops slowly and may go on unnoticed for years.

Non-specific symptoms may occur, such as:
 

weakness and fatigue
weight loss
sleep alterations
non-localized abdominal pain

With its evolution, a number of manifestations appear, which, depending on the patient, will belong to one or another set of symptoms.

Alterations related to hormones are:
 

loss of sexual interest
impotence
sterility
interruption of menses
breast enlargement in men
loss of body hair

Alterations related to blood circulation in the liver (hypertension of the portal vein) lead to:
 

Due to the inability of the liver cells to work, bile accumulates in the bloodstream, giving rise to jaundice, which may be associated to itching.

Many other alterations can occur, such as:
 

enlargement of the spleen
varices in the esophagus and stomach with risk for severe hemorrhage (vomiting or feces with blood).
ascites
leg swelling
malnutrition (weight loss, muscle atrophy, brittle nails)
easy bleeding (gums, nose, skin)
Hepatic encephalopathy – a syndrome with brain alterations arising from improper liver function that generates:
agitated behavior or excessive drowsiness
difficulty sleeping, writing, speaking, driving vehicles, performing simple calculations

Hepatic encephalopathy has several degrees, and when leading to a coma it may result in death. Encephalopathy can occur through the progressive evolution of liver disease or acute inter-occurrences of infection, bleeding, nutritional excess of proteins or constipation (difficulty evacuating).

How does the doctor diagnose it?

The definite diagnosis of cirrhosis is made by means of liver biopsy (obtained by a puncture in the liver with a special needle) and microscopic examination of the material collected in the biopsy.

In many cases, when the patient goes to a doctor their condition is already typical of the disease, and a more simple supplementary evaluation with echography, digestive tract endoscopy and a few blood tests suffices to establish the clinical diagnosis.

When there is a history of excessive intake of alcoholic beverage or blood tests positive for hepatitis B or C virus, the diagnosis of cirrhosis is made easier.

Many other exams are available for investigation of less common causes of cirrhosis.

How is it treated?

Interruption of the aggressor agent (alcohol, drugs) or elimination of the hepatitis virus can slow down or stop the disease evolution, avoiding more severe complications. Cirrhosis, however, is an irreversible process.

Each one of the complications demands specific treatment, usually aiming at the management of acute situations as bleeding, infections, ascites or encephalopathy.

Liver transplantation appears as the sole option for curing the disease and achieve good results. It still is a hard-to-follow treatment in view of the shortage of donors and complexity of the surgery.

How is it prevented?

The best prevention for cirrhosis of viral origin is vaccination against hepatitis B and rigorous criteria for control of the blood utilized in transfusions.

Wearing condom in sexual relations and individualized use of syringes by drug injectors are also crucial.

Chronic hepatitis B and C carriers have to be treated before they evolve into cirrhosis. Early-stage cirrhosis sufferers should be treated in order to prevent them from reaching more advanced stages.

Concerning alcohol, its excessive consumption must be avoided. Individuals with hepatitis B or C are required to quit alcoholic beverages altogether.

Although just a minority that drinks excessively has cirrhosis, the risk increases proportionally to the amount and time of consumption. It’s also known that smaller shots of alcohol can cause cirrhosis in women.

Questions you can ask your doctor about:

What can I do to prevent the disease from becoming worse?

Is cirrhosis a kind of cancer?

Am I at risk for cancer because of cirrhosis?

Am I electable for a liver transplant?

Should I always take the medications? And what about when the current prescription is done?

Does this disease interfere with the medications I’ve been taking for other reasons?

What can I take for headache or the flu?

Should I change something in my daily life to manage cirrhosis?

 

 

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