What is Liver Cirrhosis?

CEBU, Philippines - Actor Mark Gil passed away last week due to liver cirrhosis. It got many of us asking, "What is cirrhosis?

In cirrhosis of the liver, progressive scarring, or fibrosis, causes scar tissue to replace normal liver tissue. The scar tissue damages the normal structure of the liver which affects the  flow of blood through the blood filtering organ. The liver itself becomes distorted, hardened and lumpy. Without a good blood flow the liver can't work as it should and its normal functions are impaired.

The liver is the largest organ in the body and is a very important to keep the body functioning properly. It is involved in the processing of nutrients and fats, poisons or toxins that find their way into the body, hormones and medications. It controls blood clotting and produces proteins. So, cirrhosis of the liver can affect the functioning of the entire body.

Causes. Cirrhosis happens when there are repeated episodes of inflammation and attempted healing in the liver. The initial damage can be caused by toxins, viruses, auto-immune inflammation or disorders of the body's normal metabolic processes. Although many people associate liver cirrhosis with alcoholism, it can have many other origins, all of which lead to the same characteristic damage:

.Long-term heavy drinking of alcohol. It usually takes about 10 years of heavy drinking of alcohol for cirrhosis to develop. Women can develop cirrhosis with 2-3 alcoholic drinks a day, which might not be considered by some to be "heavy." Similarly, men who have 3-4 alcoholic drinks a day can also develop cirrhosis.

.Chronic viral hepatitis types B, C and D. These hepatitis viruses cause inflammation of the liver and liver damage that after a few decades can result in cirrhosis.

.Wilson's disease. This is a rare inherited disorder where excessive amounts of copper are absorbed in body tissues, particularly the liver.

.Haemochromatosis. It is one of the most common inherited disorders in Australia, where too much iron is absorbed by the body and the excess is deposited in the liver and other organs.

.Other inherited metabolic disorders, such as cystic fibrosis. Certain disorders that interfere with the body's metabolism and how the liver stores substances can result in cirrhosis.

.Autoimmune hepatitis. This is hepatitis caused by a problem in the body's immune system. The immune system doesn't recognize its own cells and tissues, and attacks them, like it does invading bacteria.

.Blocked bile ducts. Bile is made in the liver and then the bile ducts carry the fluid out to the gallbladder, where it is stored. If the bile ducts become blocked due to scarring or inflammation, bile goes back to the liver and damages the liver tissues causing cirrhosis.

.Toxic hepatitis. This is rare and is caused by severe reactions to medications or environmental toxins.

.Chronic congestive heart failure with liver congestion. Repeated episodes of congestive heart failure with liver congestion can cause cirrhosis of the liver.

.Non-alcoholic fatty liver disease. In this condition, fat accumulates in the liver, which can cause inflammation and cirrhosis. This disorder is increasingly common, and is associated with obesity and diabetes.

.Cryptogenic cirrhosis. In about 10 percent of cases, no cause for cirrhosis is found - this type of cirrhosis is called cryptogenic cirrhosis.

Symptoms. Often, especially in the early stages of liver cirrhosis, there may be no symptoms at all or some people may notice only minor changes in their body. Early symptoms of cirrhosis include loss of appetite, weight loss, tiredness and weakness, and nausea.

Later on, as the cirrhosis progresses and liver function gets poorer, other symptoms can develop including the following:

.Ascites, a build-up of fluid in the abdominal cavity.

.Bruising and bleeding. The patient may bruise more easily due to a decrease in proteins needed for blood clotting.

.Intense itching. The patient may experience intense itching due to bile products being deposited in the skin.

.Jaundice. Because bilirubin is not secreted so easily from the cells in cirrhosed livers, it builds up in the blood, leading to jaundice.

.Spider naevi, dilated blood vessels in the skin with a spidery appearance often  seen on the face and chest of people with cirrhosis.

.Gallstones, which can occur in cirrhosis because not enough bile is being secreted from the liver and reaches the gallbladder.

.Reddening of the palms of the hands.

.Gynaecomastia, or enlarged breast tissue in men, as estrogen is not broken down as normal in the liver cells and so it builds up.

.Mental disturbances. A cirrhosed liver no longer effectively filters out toxins, which can build up in the blood and eventually cause mental impairment, starting with poor concentration, forgetfulness or not being able to complete simple tasks, but may progress to personality changes, even coma.

.Sensitivity to medicines, where cirrhosed liver no longer filters medications effectively, causing the taken medications to build up in the body and results in side effects.

.Varices, enlarged veins that form in the esophagus due to high venous blood pressure in the liver. Swelling of the spleen and hemorrhoids are two other consequences of raised portal venous pressure.

Diagnosis. The doctor can quite easily diagnose cirrhosis by physically examining the patient and taking a history of any symptoms experienced. The examination usually entails a gentle push on the patient's abdomen. If cirrhosis is suspected, other tests such as blood tests, ultrasounds or a liver biopsy are prescribed to confirm the diagnosis.

Treatment. Because cirrhosis is irreversible, treatment can only aim to stop the disease from getting any worse, and depending on the particular cause of the problem. A heavy drinker, for example, must stop the habit. If the cause is viral hepatitis, anti-viral drugs may reduce permanent damage. Treatment of hepatitis B and C in the early stages is increasingly successful at preventing cirrhosis, while autoimmune hepatitis may be treated with steroids or other medicines that supress the immune system.

Cirrhosis caused by Wilson's disease is treated with medications to remove the excess copper from the body. Similarly, cirrhosis caused by haemochromatosis is treated by letting blood, every so often, to use up the excess iron in the body. Ascites and fluid retention can be treated with medicines known as diuretics that help remove excess fluid. Medications are also available to augment reduced mental functioning.

If cirrhosis is so severe and the liver stops working, liver transplantation may be the only option. It is often recommended when symptoms become difficult to control by other methods. Such recommendation should only come from a qualified doctor.

In all cases of liver cirrhosis, a healthy, balanced diet and avoidance of alcohol are essential. (FREEMAN)