Cirrhosis

Definition:
Cirrhosis is scarring of the liver caused by many forms
of liver diseases and conditions, such as hepatitis and chronic
alcohol abuse. The liver carries out several essential functions,
including detoxifying harmful substances in your body, cleaning
your blood and making vital nutrients.
Cirrhosis occurs in response to damage to your liver
over many years. The liver damage done by cirrhosis can't be
undone. But if liver cirrhosis is diagnosed early and the cause
treated, further damage can be limited. As cirrhosis progresses,
more and more scar tissue forms, making it difficult for the liver
to function. Advanced cirrhosis can be life-threatening.

Signs and Symptoms:

A symptom is something the patient feels and reports, while
a sign is something other people, including a doctor or a nurse
may detect. For example, pain may be a symptom while a rash
may be a sign.
Symptoms are not common during the early stages of cirrhosis.
However, as scar tissue accumulates the liver's ability to function
properly is undermined. The following signs and symptoms may
occur:
Blood capillaries become visible on the skin on the upper

abdomen
Fatigue
Insomnia
Itchy skin
Loss of appetite
Loss of bodyweight
Nausea

 Pain or tenderness in the area where the liver is located

Red or blotchy palms
Weakness

The following signs and symptoms may appear as the disease

progresses:
Abdomen fills up with fluid, giving the patient a large tummy

(ascites)
Accelerated heartbeat
Altered personality (as blood toxins build up and affect the

brain)
Bleeding gums
Body and upper arms lose mass
Body finds it harder to process alcohol
Body finds it harder to process drugs
Confusion
Dizziness
Fluid buildup on ankles, feet and legs (edema)
Hair loss
Higher susceptibility to bruising
Jaundice (yellowing of the skin, whites of the eyes, and tongue)
Loss of libido (sex drive)
Memory problems
More frequent fevers (susceptibility to infections)
Muscle cramps
Nosebleeds
Pain on the right shoulder
Panting (breathlessness)
Stools become black and tarry, or very pale
Urine becomes darker
Vomiting blood
Walking problems (staggering)

Causes:
- Abuse of alcohol
- hepatitis B and C infection
- fatty liver disease

Diagnosis:
Cirrhosis in its early stages is often diagnosed when the
patient is being tested for some other condition or disease
because symptoms are not present.
Anybody who has the following symptoms should see their doctor
immediately:
Fever with shivering
Panting (shortness of breath)
Vomiting blood
Dark stools, or tarry stools (as if covered with tar)
Episodes of drowsiness or confusion

A GP (general practitioner, primary care physician) will examine

the patient and feel around the liver area to determine whether it
is enlarged. The patient will be asked about his/her medical
history and lifestyle (drinking, etc).
The following tests may also be ordered:
A blood test - to measure how well the liver is functioning and
determine whether there is any damage. If levels of ALT (alanine
transaminase) are high the patient may have hepatitis.

Imaging tests - this may involve an ultrasound, CT

(computerized tomography), or MRI(magnetic resonance
imaging) scan of the liver. Apart from seeing whether the liver is
enlarged, the doctor will also be able to detect any scarring.
A biopsy - a small sample of liver cells are extracted and
examined under a microscope. The doctor inserts a fine needle in
between the ribs and into the liver. The patient will receive a local
anesthetic. The biopsy not only confirms or rules out cirrhosis, but
may also reveal its cause (if it is cirrhosis).
Endoscopy - an endoscope, a long, thin tube with a light and
video camera at the end goes down the patient's windpipe
(esophagus) and into their stomach. The doctor sees the inside of
the stomach on a screen, and looks out for swollen blood vessels
(varices); a hallmark sign of cirrhosis.
Child-Pugh Score
Also known as the Child-Turcotte-Pugh score, assesses the prognosis
(outlook) of chronic liver disease, mainly cirrhosis. Originally, it was
used to predict mortality during surgery, but is now used to determine
prognosis, as well as the required treatment strength, and whether or
not the patient needs a liver transplant. It is a combination of
numbered points and the letters A, B, C (see below):

Class

Points

One year
survival

Two year
survival

5-6

100%

85%

7-9

81%

57%

10-15

45%

35%

Treatment:
If the cirrhosis is diagnosed early enough, damage may
be minimized by treating its underlying cause.
Alcohol dependency (alcoholism) treatment - it is
important for the patient to stop drinking if their cirrhosis
was caused by long-term, regular heavy alcohol
consumption. In many cases the doctor will recommend a
treatment program for alcoholism.
Medications - the patient may be prescribed drugs to
control liver cell damage caused by hepatitis B or C.

Treating cirrhosis complication:

Ascites or edema - ascites (accumulation of fluid in the
abdomen) or edema (fluid retention in the legs) can be treated
with a low-sodium (salt) diet and water pills. In severe cases the
fluid may have to be drained. Sometimes surgery is required.
Pressure in the portal vein and collateral smaller veins hypertension (high blood pressure) drugs are usually prescribed
to control the increasing pressure in the blood vessels around the
liver; the aim is to prevent severe bleeding. In some cases a stent

may be surgically placed in the portal vein to hold it open. Signs

of bleeding can be detected via an endoscopy.
Treatment of swollen varices - if the patient vomits blood or
passes bloody stools they probably have esophageal varices (in
the food pipe). Urgent medical attention is required. The following
procedures may help:
Banding - a small band is placed around the base of the

varices to control bleeding. An endoscope goes down the

patient's throat and esophagus during the procedure.
Injection sclerotherapy - after an endoscopy a substance is

injected into the varices which triggers a blood clot and scar
tissue to form; this helps stem the bleeding.
A Sengstaken tube with a balloon - the balloon is at the end

of the tube. If endoscopy does not stop the bleeding a tube

goes down the patient's throat and into their stomach. The
balloon is inflated; this places pressure on the varices and
stops the bleeding.
TIPSS (transjugular intrahepatic portosystemic stent

shunt) - if the above-mentioned therapies do not stem the

bleeding, a stent (metal tube) is passed across the liver to
join the portal and hepatic veins, creating a new route for
the blood to flow through. This reduces pressure - pressure
which was causing the varices.
Infections - the patient will be given antibiotics, and some other
treatments.
Screening for liver cancer - patients with cirrhosis have a
much higher risk of developing liver cancer. The doctor may
recommend regular blood tests and imaging scans.
Hepatic encephalopathy (high blood toxin levels) - drugs

can help treat excessive blood toxin levels. The signs and
symptoms need to be explained to the patient so that they know
what to look out for.
Liver transplant - if the cirrhosis is advanced and there is liver
failure (liver does not function) the patient may need a liver
transplant.

Prevention:
Alcohol - do not exceed the recommended daily/weekly alcohol
limit.
Men: maximum of 21 units per week, or three/four units per day
Women: maximum of 14 units per week, or two/three units per

day
Individuals who have cirrhosis should abstain from alcohol
completely. Alcohol accelerates the progression of the disease.
Hepatitis B and C
Use a condom when having sex
Do not share needles when injecting drugs
People at risk of becoming infected with hepatitis B, such as

health care workers, social care workers, and police

personnel can be vaccinated (there is currently no vaccine
for hepatitis C)