Cirrhosis Of The Liver
What is Cirrhosis Of The Liver?
Liver cirrhosis refers to scarring of the liver which results in liver failure. This is due to chronic (long-term) inflammation in the liver. When liver cirrhosis is confirmed, the damage to the liver is generally irreversible. This leads to progressive liver failure, impairment of the synthetic function of the liver, complications of cirrhosis related to portal hypertension, liver cancer and death.
Portal hypertension refers to increased blood pressure in the portal vein which is the main blood vessel supplying the liver. This is a significant complication of liver cirrhosis which generally signals irreversible damage. Blood flow through the liver meets increasing resistance leading to elevated pressures in the portal vein. This can lead to an enlarged spleen (splenomegaly), swollen veins around and in the stomach and oesophagus (varices) and the accumulation of fluid in the abdominal cavity (ascites). Most of the symptoms and signs of liver cirrhosis stemmed from the development of portal hypertension.
- Ascites (swelling of the abdomen due to accumulation of fluid)
- Lower limb oedema (swelling of the ankles and feet)
- Encephalopathy or confusion
- Jaundice
- Loss of weight and loss of appetite
- Gastrointestinal bleeding
- Spider naevi (dilated blood vessels on the upper chest and arms)
Common causes of liver cirrhosis include:
- Hepatitis B
- Hepatitis C
- Hepatitis D
- Fatty Liver Disease
- Alcohol
- Autoimmune Hepatitis
- Primary Biliary Cirrhosis or Primary Biliary Cholangitis
- Primary Sclerosing Cholangitis
- Wilson’s Disease
- Haemochromatosis
Prevention of liver cirrhosis is usually managed by treating the underlying cause. These include hepatitis B vaccination, treatment of hepatitis B, C and D with antiviral agents, immunosuppression for autoimmune disease and alcohol cessation.
- Fibroscan Liver Stiffness Measurement
- Blood Tests
- Ultrasound
- Computerised Tomography (CT) Scan
- Magnetic Resonance Imaging (MRI)
Treatment of liver cirrhosis also involves treatment of the underlying cause of liver disease but also involves treating the many complications of liver cirrhosis.
- diuretic agents to decrease the volume and degree of ascites and lower limb swelling.
- laxatives and antibiotics (e.g. lactulose and rifampicin). to treat encephalopathy.
- Non-selective beta blocker medication (e.g. propranolol) to reduce the risk of variceal bleeding.
- Endoscopic band ligation of oesophageal varices to treat bleeding acutely or as a prophylactic measure for future variceal bleeding.
- Endoscopic sclerotherapy of gastric varices to treat acute bleeding.
- Ultimately, patients with end-stage liver cirrhosis or liver cancer may benefit from liver transplantation.
