Cirrhosis

Cirrhosis of the liver: liver disease not to be underestimated. Here are causes, prevention and treatment.
Cirrhosis of the liver is a degenerative disease of the liver that causes alterations in its structure and functionality. It is one of the most important causes of death and involves high direct (treatment, possible hospitalization, transplantation, etc.) and indirect (loss of working days, early retirement, etc.) social costs. Cirrhosis mortality increased sharply between 1960 and the second half of the 70s. In the last 30 years the situation has improved and mortality has practically halved, thanks to the reduction in the number of people infected with hepatitis B (Hbv) and C (HCV), the most common causes of the disease.

What is it

It is a disease characterized by chronic inflammation of the liver, of various origins, which causes lesions with the consequent formation of fibrous tissues (scars) and “nodules” of regeneration of liver tissue that, little by little, subvert the normal architecture of the liver.

Scar tissue alters blood flow through the liver, while regeneration nodules induce the formation of a disordered system of new blood vessels that on the one hand leads to an increase in pressure in the veins affecting the organ (portal vein system, resulting in hypertension called portal hypertension) and on the other to compression of the vessels that supply other areas of the liver, with possible further damage.

In case of cirrhosis, the body is also weaker against infections, it can undergo malnutrition due to the inability to adequately process nutrients and there are difficulties in disposing of toxins.

The disease is chronic and generally irreversible.

Find out what measures you can take to prevent the appearance of cirrhosis in this article.

Causes

The main cause of cirrhosis is represented by infections with hepatitis C, B and, to a lesser extent, D. Frequent is the development of cirrhosis even in heavy drinkers because in metabolizing alcohol the liver produces toxic compounds that damage liver cells (in this case we speak of alcoholic cirrhosis). In particular, it has been seen that the continuous intake of excessive doses of alcohol for at least ten years can lead to cirrhosis.

If in Northern Europe the most common cause of cirrhosis is represented by chronic alcohol abuse, in Italy the main culprits are viral hepatitis. In people with chronic hepatitis, however, it can take up to 20 years for cirrhosis to develop, a process that can be accelerated by concomitant alcohol abuse.

Even exposure to toxic substances, both natural (poisonous mushrooms) and industrial, can cause liver damage that evolves into cirrhosis.

There are also a number of potentially hepatotoxic drugs, which are harmful especially when taken at high dosages.

Cirrhosis can sometimes be the complication of:

  • a non-alcoholic fatty liver disease (also called “fatty liver”)
  • biliary pathologies such as prolonged obstruction of the biliary tract, primary biliary cirrhosis (characterized by progressive destruction of the bile ducts), primary sclerosing cholangitis
  • a chronic obstruction of venous outflow from the liver and some hereditary diseases, such as hemochromatosis, Wilson’s disease, alpha-1-antitrypsin deficiency, galactosemia.

As for non-alcoholic fatty liver disease, there has been a surge in cases over the past decade. This condition is closely related to diabetes and obesity. In itself, non-alcoholic fatty liver disease is a benign condition that is not serious; however, in a minority of cases, about 5% of the total, it can evolve into a progressive form, non-alcoholic steatohepatitis or Nash (non-alcoholic steatohepatitis), which seriously compromises health with inflammation and formation of fibrous tissue in the liver, as well as increased risk of developing cirrhosis and liver cancer. In some countries, starting from the United States, steatohepatitis is now among the most common causes of terminal liver disease, whose only solution is liver transplantation. But also in Europe and Italy it represents an emerging threat.

Most common symptoms

Cirrhosis can remain asymptomatic for many years. When it begins to manifest itself is observed loss of appetite, fatigue (asthenia), nausea, weight loss; Sometimes the formation of small plaques of fat in the eyelids and erythema in the palms of the hands is noted.

It can also be found a certain ease to manifest hematomas even for slight bruises.

Subsequently, jaundice (yellowish color of the skin and sclerae of the eyes), itching and, in the most advanced stages, ascites (collection of fluids in the peritoneum with swelling of the abdomen) and states of mental confusion may intervene.

Complications

When cirrhosis is at an advanced stage (decompensated liver cirrhosis), signs and symptoms begin to become important and a number of complications may appear. Among these, in addition to the enlargement of the spleen (splenomegaly), there is the formation of varicose veins in the blood vessels that supply the esophagus and stomach, which risk rupturing giving rise to bleeding and bleeding, sometimes even imposing.

Esophageal varices are formed by increased venous pressure in the portal circulation; This condition causes a swelling of the venous network of the cardia and esophagus.

Esophageal varices do not give symptoms, generally the patient with cirrhosis does not know he has this problem until he performs a control gastroscopy or presents, as just mentioned, the rupture of these vessels resulting in digestive bleeding, which can be very serious.

Another complication is the lowering of oxygen levels in the blood (hypoxemia) with progressive dyspnea (difficult breathing). Chronic obstructive pulmonary disease and other lung diseases may also occur as a result of autoimmune reactions to the disease.

Especially when the origin of cirrhosis is hepatitis B or C, the risk of developing liver cancer increases. In these cases, it is recommended that blood tests and other investigations be regularly tested in order to identify and treat hepatocellular carcinoma from its onset.

Diagnosis

If liver cirrhosis is suspected, diagnostic confirmation can be obtained by some investigations, starting with some blood tests to check the levels of bilirubin, liver enzymes (transaminases and gamma-GT), liver synthesis indices such as albumin, platelets and prothrombin time, which provides a measure of clotting time . Ultrasound, CT scan, magnetic resonance imaging and sometimes liver biopsy can also be used.

Treatment

The most suitable treatment varies depending on the causes of cirrhosis and essentially aims to stop or slow down the progression of the disease, avoiding further liver damage and possible complications. Dietary prescriptions and even more so the absolute elimination of alcoholic beverages are of particular importance. If, on the other hand, the disease has been caused by chronic viral hepatitis, it is advisable to take the drugs that can counteract and treat them.

Until a few years ago, the therapy of choice for hepatitis C was based on the association between pegylated interferon and the antiviral ribavirin, a treatment with limited efficacy, important side effects and not indicated for all patients. The introduction of new direct-acting antivirals has revolutionized therapy, allowing not only to eradicate the infection in almost all patients, but also to treat individuals with advanced disease with excellent results. Thanks to these new drugs, which act on the enzymes that allow the virus to replicate, patients who need liver transplants due to hepatitis C have also decreased considerably.

In case of hepatic steatosis, to reduce the risk of progression to more aggressive forms, it is recommended to lose weight and practice regular physical activity. A correct and balanced diet is equally important to reduce cholesterol and triglyceride levels in the blood and, if it is not enough, you can intervene with targeted drugs. Obviously it is better to avoid the intake of alcohol that can further impact the liver.

Any drug therapy is intended to prevent complications or relieve symptoms, such as the use of diuretics to reduce the accumulation of fluid in the abdominal cavity (i.e. ascites) or antihypertensive drugs or surgery to reduce blood pressure in the liver or to stop any bleeding.

It is good that the patient with cirrhosis also consult the doctor for taking over-the-counter drugs and herbal products.

In cases where the disease worsens considerably and the prognosis is not good, liver transplantation may be necessary.

When to consult your doctor

It is appropriate when mild symptoms persist for a certain time (loss of appetite, tiredness, weight loss) and always in the presence of more worrying symptoms such as jaundice. The doctor will provide the appropriate diagnostic tests.

Prevention

The prevention of liver cirrhosis is based on a series of measures that help to keep away the diseases that can cause it and to counteract risk factors. The first recommendation is not to drink or limit alcohol consumption a lot. Unfortunately, it is not possible to define a quantity of alcohol consumption that can be recommended or “safe” for health. At most we can speak of “low risk” amounts, or a daily amount of alcohol not to be exceeded: 20 grams for men (about two glasses) and 10 grams for women and over 65 years. Any quantity is risky for young people who are advised not to consume alcohol until the age of 18-21.

Other good rules are:

  • follow a diet rich in fruits and vegetables and low in animal fats
  • undergo vaccination against hepatitis B (for C there is no vaccine)
  • reduce the risk of contracting hepatitis B or C by having protected sex
  • Do not abuse medications in general.

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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