What is Liver cirrhosis
Liver cirrhosis is a disease that occurs when there is an irreversible scarring of the liver and a permanent loss of liver cells. It is becoming more and more common with about 10 lakh new patients being diagnosed with liver cirrhosis every year in India alone!
The primary causes of the disease included Hepatitis B and C till some time ago but now it is primarily due to alcohol abuse and non-alcoholic fatty liver disease. We are witnessing a paradigmatic shift in the dynamics of this disease as it is now on the verge of becoming one of the most common lifestyle diseases in the country. The more common causes, that are alcohol abuse and non-alcoholic fatty liver disease, are easily preventable by modifications in one’s lifestyle.
The symptoms of the disease include loss of appetite, weakness, easy bruising, yellowing of skin, fatigue and itching. The patient’s body may also face complications such as ascites (fluid build-up in the abdominal cavity), spontaneous bacterial peritonitis, hepatic encephalopathy, increased chances of variceal bleeding and other infections. However, one in every three patients may not show any symptoms.
A liver biopsy can show the condition of one’s liver and if they need treatment. The treatment for liver cirrhosis basically includes preventing further damage to the liver, treating the complications that are associated with the occurrence of the disease and detecting or preventing liver cancer.
Patients whose liver has undergone a lot of damage may need a liver transplantation. But the situation of liver demand and supply in our country is very grim. In north India, close to 97 per cent of liver transplants are Living Donor Liver transplants. Only the remaining 3 per cent transplants are cadaver (after brain death) transplants. Our country needs to develop a more radical outlook towards organ donation to help people suffering from liver cirrhosis and other diseases that need transplant.
Liver cirrhosis can develop due to other liver conditions that you have. Many a times, a cirrhotic liver is also a cause of an unidentified cause. The causes of liver cirrhosis are explained below:
Excessive alcohol consumption
If one consumes alcohol every day and over the prescribed quantity, their chances of developing a liver disease increase by at least 30 per cent. The amount of alcohol that one should consume is different for different people. However, studies have shown that women shouldn’t drink more than a drink a day and men (below the age of 65) shouldn’t drink more than two drinks a day. Chronic alcohol consumption can lead to liver disorders such as fatty liver disease, fatty liver with inflammation or to cirrhosis.
Non-alcoholic fatty liver disease (NAFLD)
This refers to a range of liver related diseases that have one thing in common: the accumulation of fat in the liver. Non-alcoholic here refers to the fact that it occurs in individuals who do not consume excessive alcohol but the disease’s symptoms are very similar to the liver disease that occurs due to excessive alcohol. NAFLD is associated with conditions such as insulin resistance, diabetes type 2 and obesity. It is also associated with high cholesterol levels and triglycerides in your blood, high blood pressure and metabolic syndrome.
Hepatitis refers to the inflammation of liver which is caused by excessive alcohol consumption, some specific medications or medical conditions. However, most of the patients who are affected with viral hepatitis do not develop cirrhosis. Hepatitis A is easily curable and most of its patients recover easily within weeks. However, Hepatitis B can be comparatively more severe and some of its patients may develop liver cirrhosis. Hepatitis C is the most severe and many of its patients can develop other serious liver diseases such as cirrhosis or liver cancer.
Certain inherited disorders
In some inherited disorders, such as hemachromatosis or Wilson’s disease, patients inherit the tendency to absorb more iron from their food. This iron accumulation can prove harmful for many organs in your body and can lead to liver cirrhosis, arthritis, heart failure, loss of sexual drive, among other diseases.
Bile duct disease
The function of the bile duct is to carry bile (a digestive fluid) from the liver to the small intestine. If, for any reason, the bile duct gets damaged or blocked, the bile accumulates in the liver only and can lead to cirrhosis.
Diseases such as gallstones or cystic fibrosis can lead to damage of the bile duct.
In some cases, infants are born without a bile duct and ultimately develop cirrhosis.
This is a disease that is found more commonly in women than in men. In autoimmune hepatitis, an abnormal immune activity can cause progressive inflammation in the liver and can lead to destruction of the liver cells, causing cirrhosis.
MYTH: Liver disease can be detected by a simple blood test.
FACT: Liver disease cannot be detected by a simple blood test. There are specific blood tests that are needed to diagnose liver impairment but they are hardly prescribed by doctors. Transaminase levels cannot tell whether you have a liver problem. Patients need to be tested for their ASAT and ALAT markers as they show the extent of damage in liver.
MYTH: All patients of liver cirrhosis show symptoms.
FACT: This is not true as in many cases, the patients do not show any symptoms for many years of the occurrence of the disease. Liver is often called ‘silent’ for this very reason.
MYTH: Liver cirrhosis can be cured.
FACT: A further damage of the liver is the only aspect of cirrhosis that is controllable but curing cirrhosis is not possible yet.
MYTH: If you don’t drink alcohol, you can’t get liver cirrhosis.
FACT: There are many other causes of liver cirrhosis other than alcohol. Factors such as obesity, presence of diabetes, metabolic syndrome and even heredity and autoimmune processes of the body can lead to the development of cirrhosis in your liver.
There can also occur many complications within liver cirrhosis. These include the following:
Edema and ascites
When the liver is damaged, your kidneys retain more salt and water in the body. As a result of this, there is an accumulation of this salt and water beneath the skin around your legs and ankles. This happens due to the pulling force of gravity. The accumulation of this fluid is what is referred to as peripheral or pitting edema. The accumulation of the fluid increases as the day progresses and is maximum at night. This is because you stand, sit or walk during the day, pulling the fluid downwards due to gravity. As you sleep, it gets lessened because of the low effect of gravity while lying down.
When this fluid retention gets worsened, it also begins to get accumulated around your abdominal cavity. The accumulation of fluid in this cavity is what is referred to as ascites. It causes discomfort in the abdomen and may lead to weight gain.
Spontaneous Bacterial Peritonitis (SBP)
When the fluid gets retained in the abdomen, bacteria can grow there very easily. When the liver is damaged, the fluid in the abdomen can get very easily affected by infections and this infection can find its way from the intestines to the ascites. Therefore, SBP can even be life threatening.
Bleeding in the esophageal varices
When cirrhosis develops in the liver, the blood flow that is returning to the heart from the intestines raises pressure in the portal vein. When the pressure in the portal vein gets very high, the veins in the lower esophagus and upper stomach expand. This condition is referred to as esophageal and gastric varices. Varices may increase in size and the larger they get, the higher the chances are of a patient to bleed from the varices. This bleeding is severe and if an immediate treatment is not administered, it may even prove fatal.
Some protein that is not digested is carried to the bacteria in the intestine, which in the process of ingesting it produce certain substances and toxins. These toxins, which include ammonia, are carried to the liver, which in normal conditions removes it and detoxifies the blood. But when the liver is damaged and there is cirrhosis present in it, it cannot function normally and hence, the toxic substances remain in the blood stream. When the level of this toxin rises in the blood, it will begin affecting the brain. This is the condition which is known as hepatic encephalopathy. This condition can lead to reversal of the normal sleep pattern, loss of memory, a confused state of mind, irritability, among other symptoms. If hepatic encephalopathy gets severe, it may even cause coma and death.
In this condition, the kidneys start getting affected by a failing liver function. This occurs because the kidneys are not able to detoxify the impurities that blood has and hence, cannot produce adequate amount of urine. However, kidneys still continue to remove salt from the blood, which is one of their primary functions. This could be because when the liver doesn’t function properly, there is a high presence of toxins in the blood which the kidneys cannot purify alone.
Hepatopulmonary syndrome is a complication that occurs when the lungs of the patient start getting affected by a failing liver. This adversely affects the breathing ability of the patient and makes it difficult for him to breathe properly, particularly when he is exerting. This happens because when liver cirrhosis reaches its advanced stages, certain hormones are produced in the body that make the lungs function abnormally.
Liver cancer (hepatocellular carcinoma)
A liver that is cirrhotic can increase the chances of primary liver cancer manifold. This is because the chances of a tumor developing in the liver are very high when it is cirrhotic.
If you are already a patient of the disease, you must take the following precautions to prevent the liver from damaging further.
– You must ensure that your diet is balanced and you take multivitamins.
– All patients who are suffering from cirrhosis should abstain from drinking alcohol. If your condition developed due to excessive alcohol consumption only, you must experience an improvement in your health as soon as you start abstaining. For patients in whom the causes are not related to alcohol, abstinence can still help slow the progression of the disease.
– Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs). These can adversely impact the condition of your liver.
– Take a diet that is low in sodium because salt can make your body retain fluids, causing swelling in your abdomen and legs. Replace salt with natural herbs.
– Avoid getting infected as liver cirrhosis can make it difficult for you to fight infections. This will include maintaining proper hygiene, washing hands frequently, getting vaccinated for hepatitis, influenza and pneumonia.