Liver Cirhosis

Liver Disease Information

What is liver Cirrhosis?

Cirrhosis of the liver is a degenerative disease where liver cells are damaged and replaced by scar formation. As scar tissue is accumulated, blood flow through the liver is diminished, which causes more liver cells to die. The healthy liver cells are permanently destroyed and the scarring is irreversible. The liver then becomes nodular in appearance. The scar tissue that forms in cirrhosis harms the function of the liver. The loss of normal liver tissue slows the processing of nutrients, hormones, drugs and toxins by the liver, as well as production of proteins and other substances made by the liver.

What are the conditions that can lead to cirrhosis?

• Excessive intake of alcohol
• Chronic viral hepatitis (such has hepatitis B and C)
• Non Alcoholic steatohepatitis(NASH)/ Fatty liver
• Inherited or congenital diseases such as hemochromatosis, Wilsons disease,
• Alpha-1 antitrypsin disease and autoimmune hepatitis
• Prolonged obstruction of the bile ducts such as primary biliary cirrhosis and
• Primary sclerosing cholangitis
• Prolonged exposure to environmental toxins
• Some forms of heart disease
• Severe reactions to drugs
• Parasitic infections

What are the signs and symptoms of a sick liver?

• Vomiting of blood
• Encephalopathy or mental changes ranging from sleep disturbances and confusion to coma.
• Ascites (abdominal swelling due to an accumulation of fluid caused by the obstruction of blood flow through the liver)
• Jaundice (yellow discoloration of the whites of the eyes and skin because bile pigments can no longer be removed by the liver)
• Kidney function impairment
• Bleeding tendencies
• Increased susceptibility to infection
• Generalized muscle wasting and malnutrition
• Increased sensitivity to drugs, due to the inability of the liver to metabolize them
• Abdominal pain
• Enlargement of the liver (hepatomegaly)
• Enlargement of the spleen (splenomegaly)
• Loss of appetite
• Nausea and vomiting
• Weight loss
• Fatigue
• Dark colored urine
• Gray, yellow, or light colored stools
• Itching (due to the retention of bile products in the skin)
• Abnormal blood sugars
• Loss of sexual drive or performance
• Change in or loss of taste

Not everyone with cirrhosis will have all of the above mentioned signs and symptoms. Many patients may not have any symptoms and are found to have cirrhosis only on physical examination and laboratory tests; this is called compensated liver cirrhosis.

What is Viral Hepatitis?

• Hepatitis A, B, C, and D are viruses that primarily affect the liver.
• Hepatitis A usually causes “acute” hepatitis and is cleared within six months from exposure and does not usually lead to chronic liver failure.
• Hepatitis B and C on the other hand can lead to chronic hepatitis, lasting many years and can lead to cirrhosis and the development of hepatocellular carcinoma (HCC).
• Hepatitis D is only seen in patients who are exposed to Hepatitis B. Other viruses like CMV (Cytomegalovirus), EBV (Epstein - Barr virus), and HSV (Herpes Simplex Virus) can also affect the liver and cause hepatitis.

What is Autoimmune Hepatitis?

Autoimmune hepatitis is a liver disease characterized by the formation of antibodies made by the individual’s immune system that affect the function of the liver, thereby destroying the cells and leading to cirrhosis.

What is Primary Biliary Cirrhosis?

Primary Biliary Cirrhosis is a chronic, progressive cholestatic liver disease that is indicated by the destruction of the small intrahepatic bile ducts leading to fibrosis and cirrhosis characterized by four stages.

What is Primarily Sclerosing Cholangitis?

Primary Sclerosing Cholangitis is a chronic progressive cholestatic liver disease that is characterized by ongoing inflammation, destruction, and fibrosis of both the intra- and extra-hepatic bile ducts. There is an increased incidence of Primary Sclerosing Cholangitis in patients with ulcerative colitis. Patients with primary sclerosing cholangitis have a greater risk of developing cholangiocarcinoma.

What is Alcoholic Liver Disease?

Alcohol related liver disease is associated with the excess use of alcohol. It can be connected to heavy binge drinking or daily use of alcohol more than 45 grams per day. Women are more susceptible to develop alcoholic liver disease than men.

What is NASH?

NASH (non-alcoholic steatohepatitis) is accompanied by the presence of fat deposition within the liver cells that causes inflammation, fibrosis, and cirrhosis, which is not related to alcohol use. Some predisposing conditions linked to NASH are obesity, type 2 diabetes, and high lipid levels in the blood.

What is Cryptogenic Cirrhosis?

Cryptogenic cirrhosis is liver disease with an unknown cause. Basically, every possible cause for impaired liver function must be excluded.

What is Fulminant Hepatic Failure?

Fulminant Hepatic Failure (FHF) is described as a progressive and rapid onset of liver failure in an otherwise healthy individual who did not have any previous history of liver disease. The overall survival of these individuals is 7-30% without transplantation. Some common causes are acute viral hepatitis, acetaminophen overdose, Wilson’s disease, Budd-Chiari Syndrome, mushroom poisoning, and drug-induced hepatitis (INH toxicity for example).

What is Budd-Chiari Syndrome?

Budd-Chiari Syndrome is associated with an acute blockage of the hepatic veins. Patients usually develop fluid accumulation in the abdomen (known as ascites), abdominal pain, enlarged liver and spleen, gastrointestinal bleeding, yellowing of the skin (known as jaundice), and changes in their mental status.

What is Hemochromatosis?

Hemochromatosis is an inherited disorder that causes an overload of iron deposited into the cells of an organ that disrupts its function and can eventually lead to failure of that organ. Hemochromatosis primarily affects the liver but can also affect the heart and other organs as well. Diagnosis is usually made by measuring iron levels in the blood and with an MRI to look carefully at the organs.

What is Wilsons disease?

Wilson’s disease is characterized by a copper storage abnormality associated with an enzyme deficiency that is made in the liver. Copper may be stored in many organs or tissues, but primarily affects the overall function of the liver cells. Diagnosis can be made by measuring Ceruloplasmin levels in the blood and urine, and careful examination of the eyes by an ophthalmologist.

What is Alpha-1 antitrypsin disease?

Alpha-1 antitrypsin disease is associated with an inability of the liver cells to get rid of this particular enzyme. This disease can affect the lungs as well.

Complications of advanced liver disease include:

• Gastrointestinal Bleeding
• Ascites
• Spontaneous Bacterial Peritonitis (SBP)
• Hepatic Encephalopathy (HE)
• Hepatorenal Syndrome(HRS)
• Infection
• Hydrothorax
• Peripheral Edema
• Jaundice
• Muscle Wasting
• Gynecomastia
• Pruritus
• Hepatocellular Carcinoma (HCC)

Prevention of Chronic Liver Disease

• Do not drink excessive alcohol.
• Vaccination against hepatitis A and B.
• Do not use multiple medications or illicit drugs. Never mix alcohol with medications. Always talk to your physician about your medications and get your liver enzymes checked to make sure that the liver is functioning fine.
• Do not make it a habit of share personal care products with anyone, even household members.
• If you work with hazardous chemicals, change clothes before you go home. If you work in the garden and use chemicals, wear long sleeve shirts, gloves and a hat.
• Avoid high risk behavior. No to intravenous drugs, do not share needles or syringes. Never have sex without a condom with a stranger and avoid multiple sex partners.
• If you plan to have tattoos or have your body pierced, choose a place authorized to do so.
• Eat healthy, exercise and keep your weight down. Obesity is a well known cause of chronic fatty liver disease.