Cirrhosis - Chronic Liver Disease

Cirrhosis:

The end-stage of chronic liver diseases. Jessica Magno Medical Terminology Cirrhosis

Overview : Functions of the Liver:

The liver is part of the digestive system, and is considered as the largest organ of the abdominal cavity. Its main function is the secretion of bile. Bile is very important in the digestion and absorption of fat. It also performs a wide variety of functions : Processes nutrients such as carbohydrates , proteins, and lipids Synthesizes plasma proteins, blood clotting proteins, albumin, and cholesterol Stores glycogen, fats, iron, and other vitamins Removes aged red blood cells and bacteria Degrades body wastes and toxins Eliminates wastes such as bilirubin Overview : Functions of the Liver

A Close Look at Cirrhosis:

Cirrhosis is a liver disease characterized by extensive fibrosis with regenerative nodule formation, and distortion of liver structure. It is referred to as the end stage of many chronic liver diseases. The progression of a specific chronic liver disease to cirrhosis can take many years and is dependent upon many factors such as the severity of the liver disease, lifestyle, and overall health of the individual. Cirrhosis is an irreversible condition that also has serious complications. A Close Look at Cirrhosis

Causes::

Chronic Alcoholism Excessive alcohol intake is the leading cause of cirrhosis in the United States. In 2007, 48% of the total cases are associated with alcohol abuse. Chronic alcoholism is the most common cause of steatosis , a condition characterized by fat build up in the liver. Chronic Viral Hepatitis Hepatitis is the inflammation of the liver caused by hepatitis B or C virus. Nonalcoholic steatohepatitis (NASH) This condition exhibits the same characteristics of steatosis that inflames the liver. However, it is not caused by alcohol consumption. This condition often exists in conjunction with other health issues such as obesity, diabetes, and coronary artery disease. Bile Duct Disease Inflammation of the liver caused by the swelling, scarring, obstruction, or destruction of bile ducts. As a result bile backs up in the liver, and is unable to be secreted. Causes:

Symptoms::

In most cases, cirrhosis is asymptomatic until decompensation occurs. Symptoms include: Anorexia Fatigue and weakness Severe body itching Edema Small, red, spider-like blood vessels on the skin Symptoms : Diagnosis : There are no specific diagnostic tests for cirrhosis A physical examination might suggest liver disease. Usually the physician will examine if the patient has: Jaundice Hepatomegaly Palmar erythema Diagnostic tests conducted are: Blood test for certain liver enzymes – amino transferases , gamma glutamyl transpeptidase Bilirubin tests Prothrombine Time Liver biopsy , where a small sample of liver tissue is removed with a long needle or though a very small incision, can be used to confirm cirrhosis.

Comparison Between Healthy and Cirrhotic Liver:

A healthy liver has a smooth surface and a brown color. Comparison Between Healthy and Cirrhotic Liver This picture shows micronodular cirrhosis . The common cause for this type of cirrhosis is chronic alcoholism.

Comparison Between Healthy and Cirrhotic Liver:

Comparison Between Healthy and Cirrhotic Liver Both pictures show macronodular cirrhosis . The common cause for this type of cirrhosis is viral hepatitis. Fat build up Macronodules 3mm or larger

Understanding Pathophysiology:

Normally, hepatocytes are capable of considerable regeneration. However, chronic damage (from viral infection, heavy alcohol consumption, trauma and other factors) can lead to scarring. This scarring is referred to as fibrosis. Formation of scar tissue is a normal bodily response to injury. The injury or death (necrosis) of hepatocytes stimulates inflammatory immune cells to release cytokines, growth factors, and other chemicals. These chemical messengers direct support cells in the liver called hepatic stellate cells to activate and produce collagen, a fibrous connective tissue that gets deposited in the liver. In fibrosis, excessive scar tissue builds up faster than it can be broken down and removed from the liver. If the disease progresses, it can lead to cirrhosis, a condition in which the liver is severely scarred, its blood flow is restricted, and its ability to function is impaired. The nodular regeneration of the liver tissue, permanently alters the structure of the liver. Understanding Pathophysiology

Complications:

The major complications of cirrhosis are similar in both alcoholic and nonalcoholic patients: Portal hypertensive bleeding Increased blood pressure in the blood vessels supplying the liver due to increased in vessel resistance. Portal hypertension leads to the development of new veins called collateral veins, at the end of esophagus and at the upper portion of the stomach. These collateral veins become varicose veins that are prone to bleeding. Ascites Excess fluid in the peritoneal cavity Hepatic encephalopathy Mental confusion , change in the level of consciousness Hepatocellular carcinoma Most common liver cancer Complications

Treatment and Prevention:

Cirrhosis cannot be cured. Treatments are geared to slow the progression of disease. Treatments depend on the underlying cause of the disease, and also on the complications present. For example, if the cause is chronic alcoholism, then the patient must cease consumption of alcohol. In severe cases, liver transplant is necessary. Preventative measures are extremely important. Limit alcohol intake, if possible, abstain Get Hepatitis B vaccination Protect yourself from hazardous bodily fluids that may contain hepatitis virus Yearly physical examinations Treatment and Prevention