diease

Cirrhosis


Cirrhosis overview and Definition

It is the terminal point of the chronic liver disease. The liver might appears scarring and the structure of the liver is lost.


Structure of Cirrhosis

The liver is the largest internal organ in the body. It is located in the right upper quadrant of the abdominal cavity below the diaphragm.

The liver is divided into two main lobes — the right lobe is much larger than the left. These lobes are further subdivided into smaller lobules. Each lobule is made up of millions of cells called hepatocytes, which are the basic metabolic cells of the liver.

The liver is highly vascular. Most of its blood supply (80%) comes from the hepatic portal vein, which delivers blood containing digested nutrients from the small intestine. The other 20% is supplied by the hepatic artery, which branches from the aorta and supplies the liver with oxygen. These large blood vessels further subdivide into capillaries to supply blood to each of the lobules.


Pathophysiology

The liver plays a vital role in the synthesis of proteins such as albumin, clotting factors and complement factors, detoxification and storage of Vitamin A , glycogen. It also participates in the metabolism of lipids and carbohydrates.

The fatty liver and the hepatitis results in cirrhosis of liver. The terminal point of the fibrosis of the liver might result in cirrhosis of the liver.

The pathologic hallmark of the cirrhosis of the liver is the development of the scar tissue that replaces the normal tissue. This scar tissue blocks the portal flow of blood through the organ, raising the blood pressure and disturbing the normal function. Stellate cells are star shaped cells that are present in the connective tissue network of the liver that stores the vitamin A. Any damage to the liver results in activation of the stellate cells and increases the production of the myofibroblasta and obstruct the hepatic blood flow. Stellate cells also secreate TGF beta 1 which leads to fibrotic response and increases the proliferation of the connective tissue.

Stellate cells also secreate tissue inhibitor of metalloproteinase(TIMP 1 and TIMP 2) might prevents the breakdown of fibrotic materials in the extracellular matrix

This above process might result in portal hypertension, congestion of spleen might occur and platelet and clotting factors production is also reduced.

Fibrous tissue bands (septae) are replaces the healthy liver cells, resulting in loss of normal architecture of the liver.

Cirrhosis is divided into two categories:

  • Compensated — this means that the liver is heavily scarred but is still able to cope with the damage and carry out most of its functions; a large proportion of people with compensated cirrhosis experience few or no symptoms;
  • Decompensated — this means that the liver is extensively scarred and unable to function properly; patients with decompensated cirrhosis develop a range of symptoms and disease complications.


Routes of Transmission

Hepatitis might get spread from faeco oral route or using the contaminated injection.

Food contamination might also result in hepatitis


Clinical signs & symptoms

  • Fatigue
  • Easily bleeding or bruising
  • Loss of appetite
  • Nausea
  • Swelling in your legs, feet or ankles (edema)
  • Weight loss
  • Itchy skin
  • Yellow discoloration in the skin and eyes (jaundice)
  • Fluid accumulation in your abdomen (ascites)
  • Spiderlike blood vessels on your skin
  • Redness in the palms of the hands
  • For women, absent or loss of periods not related to menopause
  • For men, loss of sex drive, breast enlargement (gynecomastia) or testicular atrophy
  • Confusion, drowsiness and slurred speech (hepatic encephalopathy


Differential Diagnosis

Biopsy:

It is the removal of a small amount of tissue for examination under the microscope. A biopsy is the confirmatory test for cirrhosis of liver.

Fine needle aspiration:

In this type of biopsy the physician moves the fine needle  through the abdomen and take the tissue needed for the diagnosis.

Endoscopic biopsy:

In this type of biopsy, the physician uses an endoscope an hollow tube . light emitting structure to down the liver and tissues are obtained.

Blood test:

Patient with the cirrhosis of liver  tends to show low levels of platelets,  red blood cells.  This results in the aneamia in patients.

Leucopenia and thrombocytopenia(decrease in platelet count) might occur.

Mallory’s bodies formation is the salient featutre of alcohol liver cirrhosis.

Computed tomography:

A CT scan takes three dimensional pictures of the abnormal tissues from different angles.

Magnetic Resonance Imaging:

A MRI scan uses the combination of the magnetic and radiowave frequency to view the abnormal tissues.

An dye is injected in the vein or the patient is asked to swallow the dye and the results are observed.

Abdominal ultrasound:  ultrasound uses sound waves to detect the abnormality in the liver. Doppler ultrasound might be used to detect the blood flow to the liver.

Endoscopic ultrasound: in this method the doctor uses an ultrasound probe, and with the guidance of endoscope it is passed in to the liver to view the structures.

 Magnetic resonance cholangiopancreatography: The physician uses the endoscope which is the thin, flexible tube with a tiny camera is placed down the small intestine , liver and through the pancreas. This is mainly used when the doctor wants to view the ampulla of vater where the common bile ducts empties in to the small intestine. The liver and biliary system both can be viewed using this image.

Magnetic resonance elstography: this test reveals the elasticity of the liver.

 

Liver function test:

              The bilirubin levels and the level of other digestive enzymes and liver enzymes such as Alanine transaminase, Aspartate transaminase and Alkaline phosphatase should be checked.

 


Prognosis

The life expectancy of advanced stage of cirrhosis of liver is 6months – 2 year.

 


Prevention

 Reduce the consumption of alcohol

Take low amount of salt in the diet

Maintain hygienic environment

Get proper medicine or vaccinated for hepatitis