Cirrhosis
What is Cirrhosis?
This is a chronic liver disease in which there is extensive scarring of the liver and the liver cells are replaced by fibrous tissue (cirrhosis in Greek, means a hard, brown liver). This results in a progressive deterioration of liver function and ultimately death.
What are the causes?
Excessive intake of alcohol over a prolonged period is the leading cause of cirrhosis. In India, viral infections of the liver (hepatitis - particularly hepatitis B and C) and disorders of bile drainage due to obstruction in bile flow may also cause cirrhosis.
What are the symptoms?
Initially the symptoms may be vague, like weakness, weight loss, indigestion, nausea and loss of interest in sex. Later features of liver cell failure appear. These include jaundice, vomiting blood, impotence, breast development in males and swelling all over the body. The increased collection of fluid in the body is due to a decrease in body proteins. The veins in the oesophagus (food pipe) are engorged due to increased pressure in the vein carrying blood to the liver. When these engorged veins burst, blood is lost in the vomit. Clotting of blood is also retarded because the factors responsible for clotting are not produced in sufficient quantities by the liver. The failing liver also is unable to remove poisonous products that accumulate in the body and affect the brain leading to drowsiness and, later, unconsciousness (liver encephalopathy).
How is the diagnosis made?
The doctor will advise blood tests to determine the functional status of the liver (Liver function tests - LFTs). Other tests may be necessary to establish the underlying cause of cirrhosis. A liver biopsy may be `necessary to confirm the presence of cirrhosis. The biopsy is performed by piercing the liver with a needle and through this needle taking a small piece of the liver for examination. This procedure can be safely done without anaesthesia with minimum discomfort to the patient.
What is the treatment?
Cirrhosis is an irreversible change in the liver. It can and should be prevented by restricting alcohol intake or by using anti-virus medicines like lamivudine, interferon and ribavarin. Once cirrhosis has set in, the complications and ultimate liver failure can be delayed by a good balanced diet, adequate vitamin supplementation, avoiding further insult to the liver and adequate rest. Endoscopic therapy to prevent bleeding from engorged veins in the food pipe has become an important treatment in the effort to prolong life. However, once there are features of end stage liver failure, the only treatment available is liver transplantation where the diseased organ is replaced by a normally functioning liver from a brain-dead or a live donor.