Liver cirrhosis

The liver, the largest organ in the body, is essential in keeping the body functioning properly. It removes/ neutralizes poisons from the blood, produces several 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 liver.

In cirrhosis of the liver, scar tissue replaces normal, healthy tissue, blocking the flow of blood through the organ and preventing it from working as it should. Cirrhosis is the twelfth leading cause of death by disease, killing about 26,000 people each year. Also, the cost of cirrhosis in terms of human suffering, hospital costs, and lost productivity is high.

Causes

Cirrhosis has several causes. 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 several causes. Alcoholic cirrhosis usually develops after more than a decade of heavy drinking.

Chronic hepatitis C. The hepatitis C virus ranks with alcohol as a very major cause of chronic liver disease and cirrhosis. 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, Thus, hepatitis B, like hepatitis C, causes liver inflammation and injury that over many decades can lead to cirrhosis. Hepatitis D is another virus that infects the liver, but only in those 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 then cirrhosis.

Inherited diseases. Alpha-1 antitrypsin deficiency, hemochromatosis, Wilson disease, galactosemia, and glycogen storage diseases are among the several 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 this finally causes scar tissue. This type of hepatitis appears to be usually 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, then 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 / injured. In adults, the most common cause is primary biliary cirrhosis, a disease in which the ducts become inflamed/ blocked/ 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 then lead to cirrhosis.

Symptoms

Many people with cirrhosis have no symptoms in the early stages of the disease. However, as scar tissue replaces healthy cells, liver function starts to fail and then a person may experience the following symptoms:
• exhaustion
• fatigue
• loss of appetite
• nausea
• weakness
• weight loss
• abdominal pain
• spider-like blood vessels (spider angiomas) that develop on the skin
As the disease progresses, complications may then develop. In some people, these may be the very first signs of the disease.

Complications of Cirrhosis

Loss of liver function affects the body in many complex ways. Following are the common problems, or complications, caused by cirrhosis.

When the liver loses its ability to make the protein albumin, water accumulates in the legs (edema) and abdomen (ascites). When the liver slows or maybe stops production of the proteins needed for blood clotting, a person will bruise or bleed easily. The palms of the hands may be reddish and blotchy with palmar erythema. Then, jaundice is a yellowing of the skin and eyes that occurs when the diseased liver does not absorb enough bilirubin. Bile products deposited in the skin may sometimes cause intense itching.

If cirrhosis prevents bile from reaching the gallbladder, gallstones may develop. A damaged liver also cannot remove toxins from the blood, causing them to accumulate in the blood and eventually the brain. There, toxins can dull mental functioning and cause personality changes, coma, and even death. Signs of the buildup of toxins in the brain include neglect of personal appearance, unresponsiveness, forgetfulness, trouble concentrating, or changes in sleep habits. Similarly, cirrhosis slows the liver's ability to filter medications from the blood. Because the liver does not remove drugs from the blood at the usual rate, they act longer than expected and build up in the body. This causes a person to be more sensitive to medications and their side effects.

Normally, blood from the intestines and spleen is carried to the liver through the portal vein. But cirrhosis slows the normal flow of blood through the portal vein, which increases the pressure inside it causing portal hypertension. When blood flow through the portal vein slows, blood from the intestines and spleen backs up into blood vessels in the stomach and esophagus. These blood vessels may become enlarged because they are not meant to carry this much blood. The enlarged blood vessels, called varices, have thin walls and carry high pressure, and thus are more likely to burst. If they do burst, the result is a serious bleeding problem in the upper stomach or esophagus that requires immediate medical attention.