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Cirrhosis of the Liver| Causes, signs and treatment

The liver, the largest internal organ in the body, is essential in keeping the body functioning properly. It removes or neutralizes poisons from the blood, produces immune agents to control infection, and removes germs and bacteria from the blood. It makes proteins that regulate blood clotting and produces bile to help absorb fats and fat-soluble vitamins.
You cannot live without a functioning liver.


You cannot live without a functioning liver.
Liver cirrhosis simply means scarring of the liver. Scarring of the liver is a concern as it causes healthy liver cells to die and be replaced by stiff scar tissue. This process happens slowly and is often irreversible and may lead to the whole liver hardening and becoming scarred and shrunken.



Causes of Liver Cirrhosis

Cirrhosis has many causes. In the United States, chronic alcoholism and hepatitis C are the most common ones.

Alcoholic liver disease. To many people, cirrhosis of the liver is synonymous with chronic alcoholism, but in fact, alcoholism is only one of the causes. Alcoholic cirrhosis usually develops after more than a decade of heavy drinking. The amount of alcohol that can injure the liver varies greatly from person to person. In women, as few as two to three drinks per day have been linked with cirrhosis and in men, as few as three to four drinks per day. Alcohol seems to injure the liver by blocking the normal metabolism of protein, fats, and carbohydrates.

Chronic hepatitis C. The hepatitis C virus ranks with alcohol as a major cause of chronic liver disease and cirrhosis in the United States. Infection with this virus causes inflammation of and low grade damage to the liver that over several decades can lead to cirrhosis.

Chronic hepatitis B and D. The hepatitis B virus is probably the most common cause of cirrhosis worldwide, but it is less common in the United States and the Western world. Hepatitis B, like hepatitis C, causes liver inflammation and injury that over several decades can lead to cirrhosis. Hepatitis D is another virus that infects the liver, but only in people who already have hepatitis B.

Autoimmune hepatitis. This disease appears to be caused by the immune system attacking the liver and causing inflammation, damage, and eventually scarring and cirrhosis.

Inherited diseases. Alpha-1 antitrypsin deficiency, hemochromatosis, Wilson disease, galactosemia, and glycogen storage diseases are among the inherited diseases that interfere with the way the liver produces, processes, and stores enzymes, proteins, metals, and other substances the body needs to function properly.

Nonalcoholic steatohepatitis (NASH). In NASH, fat builds up in the liver and eventually causes scar tissue. This type of hepatitis appears to be associated with diabetes, protein malnutrition, obesity, coronary artery disease, and treatment with corticosteroid medications.

Blocked bile ducts. When the ducts that carry bile out of the liver are blocked, bile backs up and damages liver tissue. In babies, blocked bile ducts are most commonly caused by biliary atresia, a disease in which the bile ducts are absent or injured. In adults, the most common cause is primary biliary cirrhosis, a disease in which the ducts become inflamed, blocked, and scarred. Secondary biliary cirrhosis can happen after gallbladder surgery if the ducts are inadvertently tied off or injured.

Drugs, toxins, and infections. Severe reactions to prescription drugs, prolonged exposure to environmental toxins, the parasitic infection schistosomiasis, and repeated bouts of heart failure with liver congestion can all lead to cirrhosis.

Signs and symptoms

There are two different stages of cirrhosis – compensated and decompensated. Compensated cirrhosis often has little or no symptoms. This is because there are still enough healthy cells in the liver to do its job. At this point the liver can ‘compensate’ or make up for the previous damage.
However, if the liver continues to be damaged (from untreated hepatitis, poor diet or alcohol use) the healthy liver cells will become stressed and no longer function well. Symptoms you may feel include;
* Fatigue * Poor Appetite * Weight loss

When the healthy liver cells become too overwhelmed you may progress from compensated to decompensated cirrhosis. Decompensated cirrhosis is very serious. People with decompensated cirrhosis notice a rapid decline in their health and will experience signs and symptoms of liver failure.

Some signs and symptoms of decompensated

1. Variceal Bleeding
Because of increased pressure in the veins, some of the larger blood vessels in your oesophagus (swallowing tube) become swollen and enlarged. This can put you at risk of the vessels bursting open – these are called bleeding varices.

2. Encephalopathy (Mental Confusion)
When you have cirrhosis your liver is unable to filter toxins out of your body. When this happens toxins such as ammonia can enter the brain and cause confusion. This is called encephalopathy (en-cef-a-lop-a-thy). Early stages of encephalopathy affect your sleep patterns. You may notice that you have trouble sleeping at night and feel very sleepy during the day. You or your loved ones may also notice changes to your mood and concentration. All of these symptoms may be early stages of encephalopathy and need to be mentioned at your next appointment.

3. Ascites
High pressure in the veins that is caused by cirrhosis can also cause a build-up of fluid in the stomach. This is called ascites (uh-sigh-teez ). The belly becomes very large and you will notice a sudden increase in weight. You will probably feel quite uncomfortable and eating will become difficult as you will always feel full.

4. Jaundice
Jaundice is yellowing of the skin and whites of the eyes that is caused by a build-up of bilirubin. Bilirubin is a substance that is normally filtered by the healthy liver. If you notice jaundice for the first time, it could be a sign that your liver may be getting worse or a sign of an infection.

Treatment

Liver damage from cirrhosis cannot be reversed, but treatment can stop or delay further progression and reduce complications. Treatment depends on the cause of cirrhosis and any complications a person is experiencing. For example, cirrhosis caused by alcohol abuse is treated by abstaining from alcohol. Treatment for hepatitis-related cirrhosis involves medications used to treat the different types of hepatitis, such as interferon for viral hepatitis and corticosteroids for autoimmune hepatitis.

Cirrhosis caused by Wilson disease, in which copper builds up in organs, is treated with medications to remove the copper. These are just a few examples treatment for cirrhosis resulting from other diseases depends on the underlying cause. In all cases, regardless of the cause, following a healthy diet and avoiding alcohol are essential because the body needs all the nutrients it can get, and alcohol will only lead to more liver damage. 

Light physical activity can help stop or delay cirrhosis as well.
Treatment will also include remedies for complications. For example, for ascites and edema, the doctor may recommend a low-sodium diet or the use of diuretics, which are drugs that remove fluid from the body. Antibiotics will be prescribed for infections, and various medications can help with itching. Protein causes toxins to form in the digestive tract, so eating less protein will help decrease the buildup of toxins in the blood and brain. The doctor may also prescribe laxatives to help absorb the toxins and remove them from the intestines.

For portal hypertension, the doctor may prescribe a blood pressure medication such as a beta-blocker. If varices bleed, the doctor may either inject them with a clotting agent or perform a so-called rubber-band ligation, which uses a special device to compress the varices and stop the bleeding.
When complications cannot be controlled or when the liver becomes so damaged from scarring that it completely stops functioning, a liver transplant is necessary. 

In liver transplantation surgery, a diseased liver is removed and replaced with a healthy one from an organ donor. About 80 to 90 percent of patients survive liver transplantation. Survival rates have improved over the past several years because of drugs such as cyclosporine and tacrolimus, which suppress the immune system and keep it from attacking and damaging the new liver.





Reference
https://www.mayoclinic.org/diseases-conditions/cirrhosis/symptoms-causes/syc-20351487
https://www.medicinenet.com/cirrhosis/article.htm
https://www.webmd.com/digestive-disorders/understanding-cirrhosis-basic-information
https://my.clevelandclinic.org/health/diseases/15572-cirrhosis-of-the-liver
https://www.medicalnewstoday.com/articles/172295
https://www.healthline.com/health/cirrhosis
https://www.nhs.uk/conditions/cirrhosis/
https://www.liver.ca/patients-caregivers/liver-diseases/cirrhosis/

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