Liver Cirrhosis: The Thief Of Liver (Know More About It)

Liver cirrhosis is the histological development of regenerative nodules surrounds by fibrous band in response to chronic liver injury that leads to portal hypertension and at the result, end stage liver disease.

Liver Cirrhosis


Its progression from liver injury that leads to cirrhosis may occur over weeks to years, sometimes patients with hepatitis C may develop chronic hepatitis for as long as 40 years before its progresses to cirrhosis.

READ ALSO: Use me well, am your liver

 It is also known as a slowly progressing disease in which healthy liver tissue is replaced with scar tissues, eventually preventing the liver from functioning properly. Most affected are between age 40-60 years and twice in men than women.

What are  the types of liver cirrhosis?

There are 3 types of liver cirrhosis which are:
Alcoholic cirrhosis: The scar tissue surrounds the portal areas of the liver, it is most frequently caused by chronic alcoholism and the most common type of liver cirrhosis.

Biliary cirrhosis: The scarring in the liver occurs around the bile ducts, it result from chronic biliary obstruction and infection (cholangitis) but it is less common.

Post-necrosis cirrhosis: There are broad bands of scar tissue. It is as a result of previous bout of acute viral hepatitis.

What are the causes of liver cirrhosis?

Causes of liver cirrhosis has been linked to variation in prevalence of risk factors such as:

Alcoholic liver diseases: Heavy or severe alcohol consumption over several years makes an individual more prone to develop alcohol-related liver disease. Drinking more than the recommended alcohol consumption (men and women) are advised not to drink more than 14 units a week. This can leads to fat and inflammation in the liver which over 10-12 years resulting to alcoholic cirrhosis.

Non-alcoholic fatty liver disease (NAFLD): In this case, the fat builds up in the liver which is accompanied by inflammation and sacrring (damage) causing fibrosis and which later results liver cirrhosis.

Chronic hepatitis B, C and  E: A viral infection that leads to inflammation,damage, fibrosis and cirrhosis to the liver over the years.

Autoimmune hepatitis: The body immunes system attacks the liver cells and causes inflammation,damage,scarring and cirrhosis.

Primary biliary cirrhosis: There is a damage of the bile duct which leads to secondary liver damage. It may be symptomatic or complain of fatigue,pruritus(itching) and non-jaundice skin with hepatomegally(liver enlargement).

Cystic fibrosis: An inherited disease of the lungs,intestines,pancreas and bile ducts in which the body does not produce enough fluid and mucus becomes thick and block small bile ducts which leads to cirrhosis.

Other causes are:

  1. Chronic heart failure with liver congestion
  2. Hepatotoxic (drugs or toxins)
  3. Galactosemia
  4. Nutritional deficiency with reduced protein intake
  5. Cryptogenic: Unknown cause


What are the signs and symptoms of liver cirrhosis?

Most individuals with liver cirrhosis are asymptomatic (without symptom) because cirrhosis is frequently indolent until complications of liver disease present, as a result the chance of survival is limited.

The signs and symptoms are grouped into the following categories:

Compensated

  • Intermittent fever
  • Abdominal pain
  • Ankle oedema (swollen)
  • Reddened palms
  • Vascular spiders
  • Firm enlarged liver

Decompensated


  • Ascites : Accumulation of fluid in the abdomen
  • Jaundice: Yellowish discoloration of the skin , eyes and mucus membrane
  • Weakness
  • Muscle weakness
  • Weight loss
  • Continous mild fever
  • pruritus (itching)
  • Spontaneous bruising
  • Cocacola urine
  • Loss of appetite.
  • Clubbing:
  • Nail changes
  • Terry's nail (double nails)
  • Advanced disease:
  • Bruising
  • Bleeding
  • Enlarged liver

How is liver cirrhosis diagnosed?


Liver cirrhosis can be diagnosed through the following means:
Ultrasound scan: This measure the difference in density of parenchymal cells and the scar tissue.

Liver biopsy: A small amount of the liver tissue is removed through needle aspiration,it evaluate diffuse disorders of the parenchand yma and space-occupying lesion's.

Bilirubin tests: Used to measure bile excretion and retention.

Enzyme tests: Indicates liver cell cell damage, serum alkaline phopsphate.

Radiostope liver scan: This maybe done to assess the liver size, blood flow and obstruction.
How is liver cirrhosis managed?

Generally, the damage done by liver cirrhosis can not be reversed but treatment could stop or delay further progression and reduce complications. It can be managed through the following measures:

  • Adequate rest
  • Improved nutritional status :Foods rich in fat soluble vitamins A,D,E,K and vitamin B complex.
  • Food high in calories
  • Reduction of salt in diet
  • Adequate fluid intake
  • Ceassation of alcoholic consumption
  • Use of antibiotics
  • laxative agents e.g lactutose
  • Diuretics e.g Aldactone
  • Immune suppressive agents
  • Phebotomy
  • Liver transplantation
  • Complications
  • Portal hypertension
  • Esophageal varices
  • Ascites
  • Coma
  • Hepatocellular (carcinoma liver)
  • Hepatorenal syndrome.
  • Infection
  • Spontaneous bacterial peritonitis

How can liver cirrhosis be prevented?

An individual can reduce the chance of developing cirrhosis by adhering to the following precautions:

Limit alcohol consumption: Keep within recommended limits (men and women are advised not to drink more than 14 units in a week).

Protection from Hepatitis through:
  • Using a condom when having sexual intercourse
  • Avoid resusing needles
  • Vaccinations against hepatitis A and B
  • Hepatitis infection screening
  • Blood donors should be screened for viral hepatitis before transfusion.


For Further Reading:

  1. Brunner and Suddath(2015) Textbook of Medical-Surgical Nursing (13th edition).
  2. Johnson,A,(2009),interventions for patient with liver problems,In D.Ignatavicus &M.Workman,(eDs.)Medical-Surgical nursing;Critical thinking for collaborative care (4th edition).Philadelphia;W.B.Saunders,pp,1463-1369.
  3. LeMone,P.&Pagana ,T.(2005);Manual of diagnostics and laboratory tests(7th edition).St.Louis,Mosby,p.109.



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