Cirrhosis of the Liver

Liver diseases cause abnormal or decreased liver function, liver failure and health deterioration. There are a number of liver diseases, with Cirrhosis manifesting as a chronic liver disease where cells and tissue in the liver become damaged and die, replaced by fibrosis scar tissue and nodules that prevent healthy liver function.

Role of healthy liver function

The liver organ in the human body is located in the abdominal-pelvic space below the diaphragm. The liver is responsible for metabolic functions, including protein synthesis, glycogen storage, hormone production, red blood cell decomposition, digestion and detoxification (the excretion of bilirubin and bile).

Through these functions the liver regulates the body's biochemical function for healthy survival. When these functions deteriorate and fail, due to liver disease, a person’s health declines and this can be fatal. Due to the liver's inter-dependent role within the human body an unhealthy liver can rapidly cause and accelerate disease, such as Cirrhosis.

How Cirrhosis impacts upon liver function

When liver functions deteriorate due to Cirrhosis, bilirubin is not excreted. Bilirubin is a haematoidin (a component of red blood cells) which is produced when the cells break up and is normally excreted by the liver as bile. Bilirubin can be found in bruises, yellow urine and brown faeces once the liver has excreted it. Liver disease prevents normal liver function and bilirubin excretion, so bile is allowed to build up in the system and cause a range of symptoms related to Cirrhosis.

Causes of Cirrhosis

The cause of Cirrhosis may be unknown (idiopathic) in some cases, nonetheless most cases of liver disease and Cirrhosis result from:

• Hepatitis infection caused by virus or autoimmune poisoning.
• Hereditary conditions such as Haemochromatosis, which causes excess iron production; Wilson's Disease, which causes excess copper production; and Gilbert's Syndrome, which causes the malfunction of the bilirubin metabolism.
• Alcoholism or Dipsomania: uncontrollable craving of alcohol.
• Cancers, such as hepatocellular and cholangio: carcinoma and metastatic cancers which can spread from the gastrointestinal tract.
• Excess fatty tissue due to obesity.
• Liver Diseases: sclerosing cholangitis, biliary cirrhosis, Budd-Chiari Syndrome, Glycogen storage disease II.
• Paediatric Diseases – alagille syndrome, biliary atresia, alpha-1 antitrypsin deficiency and familial intrahepatic cholestasis.
• Other diseases such as cystic fibrosis.

Symptoms of Cirrhosis

Symptoms of liver disease can include light yellow or very pale stools, jaundice, becoming easily bruised, abdominal and joint swelling, dark urine and fatigue. Other symptoms include nausea, sickness, vomiting blood, vascular lesions, nose and gum bleeds, red spider veins on the skin, edema, loss of appetite, weight loss, deformed or discoloured nails and fingers, impotence (male), musty breath, gynaecomastia, enlarged spleen, hypertension, mental confusion and comas.

Complications of Cirrhosis on health

Cirrhosis is highly detrimental to a person’s health causing internal bleeding, organ failure, malnutrition and the malfunction of metabolic processes needed for health and living. As the liver accumulates bilirubin this collected bile can then also accumulate in the brain causing neurological damage, neurotoxicity or Kernicterus, which results in damage to eye function, seizures and irregular reflexes.

Excessive fluid retention due to irregular liver activity can cause pressure to build up in the body, increasing blood pressure and the risk of a stroke or heart disease.

Diagnosis of Cirrhosis

Besides the obvious visual symptoms apparent with jaundice (yellow eyes and skin), a liver biopsy conducted by a medical practitioner is usually what is used to diagnose Cirrhosis. The biopsy is performed using various methods, which include laparoscopic, percutaneous and transjugular procedures.

Laboratory FibroTests may also be used, which involves a six blood serum test to indicate the degree of liver damage. Assessing the levels of markers such as albumin, globulin, bilirubin, aminotransferases and alkaline phosphatase helps determine the severity of the liver damage. Other diagnostic tests include:

• Ultrasound screening of the liver to find fibrosis scar tissue and nodules, to give a liver score and pressure reading.
• Abdominal Computer Tomography Scans and Magnetic Resonance Imaging of the liver area.
• Endoscopy or gastroscopy.

Treatment for Cirrhosis

Cirrhosis cannot be cured but it can be managed. Treatments for Cirrhosis will depend on cause and complications, such as Wilson's disease which may be treated through chelation therapy to remove excess copper from the body. Other treatments for Cirrhosis may include:

• Liver dialysis: liver detoxification with artificial detoxification devices.
• Liver transplant with a healthy donated liver.
• Prophylactic local therapy (sclerotherapy or banding).
• Beta blocker therapy.
• Transjugular intrahepatic portosystemic shunt (TIPS) to cauterise bleeding varices.
• Diuretics to encourage elimination of toxins and suppress ascites.
• Paracentesis to remove excess fluid retention.
• Antibiotics for infection.
• Laxatives for constipation.
• Steroids and medications to reduce itching and discomfort.

Prevention of Cirrhosis

Once someone has chronic liver disease and Cirrhosis, the damage and effects cannot be reversed and treatment is directed at chronic symptoms and trying to prevent complications. People can prevent liver disease in some cases or prevent deterioration by:

• Early intervention for any symptoms that may indicate liver damage.
• Informing your doctor of medications and supplements you take, so that the levels of chemical intake can be monitored for your safety.
• Avoiding hepatitis infection, such as having vaccination and not engaging in unprotected sex.
• Practising infection control, which may include not sharing razors and disinfecting blood spills.
• Early diagnosis and treatment of hereditary conditions, such as Wilson's disease and Gilbert's syndrome and paediatric liver diseases.
• Engaging in a healthy, balanced lifestyle to avoid obesity and alcoholism.
• Not partaking in recreational drug use where needles are shared.
• Reducing intake or contact with liver toxic-chemicals.
• Not abusing medicines such as paracetamol.
• Joining support groups where necessary.