diease

Cirrhosis


OVERVIEW OF Cirrhosis :

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.


CAUSES :

Other causes of cirrhosis include the following:

Alcohol:

Cirrhosis is common among the people who tends to shows the chronic alcoholism.

Hepatitis c virus:

The hepatitis c virus spreads by horizontal transmission such as the usage of objects from the contaminated persons or from the inanimate objects or from the contact with the faecal matter of the infected persons

Hepatitis B:

It can cause liver inflammation and damage that can lead to cirrhosis. The hepatitis B virus spreads by vertical transmission or by blood transmission or usage of syringes of the infected person. Needle stick injury can also cause hepatitis B.

Hepatitis D:

It can cause leads to cirrhosis of lilver. It also occurs in people with who already has hepatitis B.

Autoimmune hepatitis:

It causes inflammation that can leads  to cirrhosis.

Damage to the bile ducts which obstructs the flow of bile. This condition is called as Primary biliary cholangitis.

Hemochromatosis and Wilson’s disease makes the body difficult to handle iron and copper.

Drugs such as acetaminophen, certain depressants can lead to cirrhosis.


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


COMMON CLINICAL SIGNS AND 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


DIAGNOSTIC :

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.

 


TREATMENT AND PROGNOSIS :

Change in the lifestyle:

Alcohol should be forbidden and follow the diet such as proteins and amino acids.

Oral Pentoxiphylline 400 mg thrice daily

Tumour necrosis inhibitor factor:

Infliximab

Etanercept

 In case of biliary cirrhosis(if cirrhosis of liver is due to the obstruction of bile duct):

Colchicine in the dose of 0.6mg orally twice daily

Methotrexate and cyclosporin are used to slow the progression or arrest the disease

Vitamin A,D,K are parenterally given to correct the deficiency

Surgery:

In advanced cases of cirrhosis, when the liver ceases to function, a liver transplant may be the only treatment option. A liver transplant is a procedure to replace your liver with a healthy liver from a deceased donor or with part of a liver from a living donor. Cirrhosis is one of the most common reasons for a liver transplant.

 


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


Medicines used in the Treatment :

Oral Pentoxiphylline 400 mg thrice daily

Tumour necrosis inhibitor factor:

Infliximab

Etanercept

Colchicine in the dose of 0.6mg orally twice daily

Methotrexate and cyclosporin