Cirrhosis

An Educational Overview

By Grace Adams, Mark Hoffman, Grace Rohs, Timothy Thomas, Abigail Thompson, Andrew Truax

What is cirrhosis?

Cirrhosis is a disease of a non-functioning liver that has been caused due to long-term damage.
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Diagnostics

People with early stages of cirrhosis sometimes do not show symptoms. It is usually discovered through a routine blood test or checkup without realizing that one is experiencing problems. From there, a doctor may order more tests to verify that one truly has cirrhosis. This tests include:

· Blood tests


  • Liver functions- to check for excess bilirubin and certain enzymes
  • Albumin and total serum proteins
  • Kidney functions- to checked for creatinine
  • Checked for Hepatitis B and C in the blood
  • Ability for blood to clot
  • Partial thromboplastin time
  • Blood alcohol levels- show alcohol use



· Imaging tests


  • Magnetic resonance elastography (MRE)- noninvasive; detects the hardening or stiffening of the live
  • MRI
  • CT
  • Ultrasounds



· Biopsy


  • To identify the severity and cause of the liver disease
  • If if it discovered that one does have cirrhosis, then the doctor may order to have regular tests done to monitor for signs and progression of the disease.
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Pathogenesis

During the early stages of any form of liver disease, the liver may become inflamed due to the immune system trying to fight some sort of infection or heal the liver from injury. The main difference between liver inflammation and inflammation of another part of the body is liver inflammation often does not cause pain or tenderness. This means someone could have liver inflammation and have no idea, because they do not notice any severe symptoms or reasons to get their liver checked for problems. If the liver inflammation is not treated over an extended period of time, the liver will start to scar. The scars will start to grow and will go through a process called fibrosis. Fibrosis is when the scar tissue within the liver increases in size and replaces the healthy tissue of the liver. During the process of fibrosis intrahepatic venous resistance occurs, which causes portal hypertension. As a result of the scarring and portal hypertension, damage occurs to the liver cells or hepatocytes inhibiting their ability to synthesize substances such as clotting factors or ethyl alcohol. Liver disease must be caught at this point if the patient wants their liver to recover. If the liver disease is not treated and continues to scar, the damage done to the liver will enter the stage of cirrhosis, which means the damages irreversible or cannot be cured completely. Cirrhosis has been linked with the cause of many different diseases: liver cancer, liver disease, and many other liver complications. After someone reaches the point of cirrhosis, all they can do is prevent the liver damage from getting worse. One of the main issues to avoid after the liver reaches cirrhosis is chronic liver failure. This happens when the liver has very little function or no longer functions at all. If chronic liver failure has been caused by cirrhosis that means the liver has been progressively failing for a long period of time.

Clinical Manifestations

Cirrhosis often shows no signs or symptoms until the damage to the liver is extensive. Once this damage is bad enough, a patient may experience fatigue, weakness, bleeding and bruising easily, itchy skin, jaundice, ascites, loss of appetite and nausea, swelling in the extremities, weight loss, fever, brownish or orange tint to urine, light color or blood in the stool, hepatic encephalopathy, and spider-like vessels on the skin. The excessive bleeding and bruising is a result of the decreased production of blood clotting factors by the diseased liver, and the yellowing of the skin, or jaundice, is due to the accumulation of bilirubin in the blood. Weight loss is often a result of the loss of appetite associated with the disease. Individuals may experience few or no symptoms, and these symptoms may be nonspecific. This means symptoms may not suggest that liver failure is necessarily the problem. These symptoms may also not be directly linked to cirrhosis but be developed because of the complication associated with the disease. The symptoms vary with the stage of the disease. For example, fluid retention, or edema, in the ankles, legs, and abdomen is often the earliest sign of cirrhosis. On the other hand, confused thinking and mental changes (hepatic encephalopathy) usually occur when cirrhosis is present for a long time. This happens because the toxins produced in our intestines, which are normally detoxified by the liver, cannot be detoxified. This results in toxins getting in the blood stream and cause confusion and even coma.

Cirrhosis Patient Picture

As pictured below, jaundice is evident in the patient as well as a distended abdomen.
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Risk Factors

Cirrhosis of the liver has many causes and risk factors. The most general causes of this disease include poisons, long-standing inflammation, heart disease, and infections. There are four main causes that we will go into more depth about. These main causes include chronic alcoholism, hepatitis, biliary cirrhosis, and autoimmune cirrhosis.

  • Chronic alcoholism:

    • Alcohol poisons all living cells: This causes liver cells to become inflamed and die.

    • This is the most common cause of cirrhosis in the United States.

    • The severity of the scarring is in relation to how much, and how often you drink alcohol.

    • This is also influenced greatly by genetics. Some people are much more susceptible to obtaining cirrhosis than others.

  • Hepatitis:

    • Usually resultant of a viral infection of the liver.

    • Hepatitis D, Hepatitis C, and Hepatitis B are all the forms of hepatitis that cause cirrhosis. Hepatitis C being the most common cause of cirrhosis in the United States.

  • Biliary Cirrhosis:

    • Bile ducts become blocked backing nile up into the liver.

    • The liver becomes inflamed and eventually leads to a long process of cell damage and eventually cirrhosis.

    • Gallstones are a common cause of the blockage, or children can be born with the ducts already blocked.

    • Women are generally the subject for this disease, aging from 35-60 years old.

  • Autoimmune cirrhosis:

    • Immune system attacks healthy liver tissue instead of the normal foreign invaders.

Cirrhosis of the liver is often not associated with a cause. It has been statistically shown that 30-50% of cirrhosis cases have no known cause.


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Treatments

Treatment for cirrhosis depends on the cause and extent of a person’s liver damage. These treatments aim to slow the growth of scar tissue in the liver and also to treat the various symptoms. In the early stages of this disease there are a few treatment options. First, you can treat a person’s alcohol dependency, if they suffer from this disease because of alcohol abuse. If the person cannot stop drinking by themselves, a doctor might recommend a treatment program for them. Next, if the patient is suffering from this disease without having an alcohol addition, weight loss would be the next treatment step. If they watch their weight and control their blood sugar levels this will help them. There are also a few medications that can help stop the growth of cirrhosis. These medications include controlling damage to liver cells caused by hepatitis B or C, medications to slow the progression of certain types of liver cirrhosis, and other medications to relieve symptoms such as itching, fatigue, and pain.


Treatment for complications of cirrhosis vary depending on the type of complication an individual may be having. When a person has excess fluid in their body this may be managed with a low-sodium diet and medication to prevent fluid buildup in the body. More severe fluid buildup may require procedures to drain the fluid or surgery to relieve pressure. If a patient is experiencing portal hypertension they may be given blood pressure medications that control increased pressure in the veins that supply the liver (portal hypertension) and prevent severe bleeding. Their doctor then can perform an upper endoscopy at regular intervals to look for enlarged veins in the esophagus or stomach that may bleed. If a person is having a reaction they may receive antibiotics or other treatments for infections. Their doctor also is likely to recommend vaccinations for influenza, pneumonia and hepatitis.


Lastly, in the most severe cases of cirrhosis, when the liver stops functioning, a liver transplant may be the patient’s only treatment option. A liver transplant is a procedure to replace the patient’s liver with a healthy liver from a deceased donor or with part of a liver from a living donor. Cirrhosis is the most commonreason for a liver transplant.

References

Cirrhosis. (2015, January 14). Retrieved December 2, 2015, from http://www.liverfoundation.org/abouttheliver/info/cirrhosis/


Gunter, J., & Barton, E. (2015, August 4). Cirrhosis Causes, Symptoms, Treatment - Cirrhosis Causes - eMedicineHealth. Retrieved December 1, 2015, from http://www.emedicinehealth.com/cirrhosis/page2_em.htm


Heidelbaugh, J., & Bruderly, M. (2006, September 1). Cirrhosis and Chronic Liver Failure: Part I. Diagnosis and Evaluation. Retrieved December 1, 2015, from http://www.aafp.org/afp/2006/0901/p756.html


Mayo Clinic Staff. (2014, August 16). Cirrhosis. Retrieved December 1, 2015, from http://www.mayoclinic.org/diseases-conditions/cirrhosis/basics/tests-diagnosis/con-20031617


The Progression of Liver Disease. (2015, July 2). Retrieved December 1, 2015, from http://www.liverfoundation.org/abouttheliver/info/progression/