Hepatic cirrhosis

The Cirrhosis is a chronic, diffuse and irreversible disease of the liver which is characterized by the existence of areas of fibrosis, ie areas where proliferation appears fibrous along tissue areas nodules composed of liver cells they have regenerated, but are isolated by the areas of fibrosis and, therefore, their function is altered. The mere existence of liver fibrosis does not imply that we can diagnose cirrhosis, since it also appears in other liver diseases.

The prognosis of the disease is serious, since it means the final stage of the pathology that produces it. Patients can die from gastrointestinal bleeding, liver failure, liver cancer, or infections.

Causes of liver cirrhosis

Liver cirrhosis can be caused by multiple causes. The most frequent in Spain are alcohol, hepatitis B virus and hepatitis C virus.

Alcohol : it is the most frequent cause in Spain, causing up to 60% of cirrhosis. It is estimated that excessive alcohol consumption for at least ten years is necessary for it to develop, however, not all alcoholics suffer from it.

Hepatitis B virus : can be transmitted through sexual, blood, or mother-to-child contact during pregnancy.

Hepatitis C virus : transmitted exclusively via the blood.

Primary biliary cirrhosis : it is a chronic liver disease, the cause of which is probably an immune disorder.

Secondary biliary cirrhosis : it can be caused by any process that produces an obstruction of the hepatic ducts, such as: prolonged gallstones .

Obstruction of the venous drainage of the liver, as occurs in congestive heart failure.

Drugs , for example methotrexate, which is used to treat certain types of cancer.

Cryptogenic cirrhosis : is one whose cause is unknown, which occurs in 30-40% of the cases.

The process by which alcohol triggers cirrhosis is unknown, although it is believed to be due to successive outbreaks of acute hepatitis or a direct stimulation of fiber production by alcohol. In the case of primary biliary cirrhosis, it is an abnormal immune response that destroys the bile ducts.

The consequences of cirrhosis arise from the poor liver function that this pathology entails. On the one hand, there is a decrease in protein synthesis, especially albumin, which implies an increase in the oncotic pressure of the plasma, causing fluid retention and ascites .

The alteration of the synthesis of coagulation factors leads to the appearance of hemorrhages, especially digestive ones.

Due to the destruction of liver cells, the blood concentration of certain enzymes found inside the hepatocyte, such as transaminases , rises .

Due to the deficit of folic acid, there is an alteration in the synthesis of red blood cells, which appear larger than normal, leading to anemia.

What symptoms appear?

On many occasions liver cirrhosis does not produce any symptoms, being discovered by chance when performing an analysis or when the doctor palpates a liver that is larger than normal. Other times, very characteristic alterations develop, called liver stigmata, of which we can highlight:

• Spider veins, which are lesions in which a pulsatile central arteriole appears, from which spider-legged vessels emerge.
• Palmar erythema, which consists of the redness of the palms of the hands.
• Nail disorders, which appear brittle and opaque.
• Enlargement of the liver and spleen, seen when exploring the abdomen. On palpation, the liver appears as a painless, irregular mass.
• Gynecomastia, which is the enlargement of the breasts in men.
• Jaundice , which consists of the yellow coloration of the skin and mucous membranes caused by an excess of circulating bilirubin in the blood, which in turn is due to the destruction of red blood cells by toxins such as alcohol, or by obstruction of bile flow.
• Ascites or accumulation of free fluid in the abdominal cavity.
• Hepatic encephalopathy , which is characterized by the appearance of neurological alterations, due to the accumulation of toxic substances that have not been able to be metabolized by the liver.

Diagnosis of cirrhosis

To guide the diagnosis, it is necessary to perform a good physical examination, so that we can find some liver stigma. The diagnostic tests that can help us the most in the diagnosis of liver cirrhosis are: liver scintigraphy with technetium 99, abdominal ultrasound and liver biopsy.

In the liver scintigraphy with technetium 99, it can be seen that the uptake of the isotope by the liver is irregular.

The ultrasound allows to observe the enlargement of the liver and spleen, as well as the presence of ascites.

The liver biopsy establishes the diagnosis with certainty, when observing areas of fibrosis together with regeneration nodules.

It would also be convenient to perform a fibrogastroscopy to detect the existence of esophageal varices.

Treatment of liver cirrhosis

As for the general measures to be taken, certain taboos must be banished. On the one hand, the diet should not prohibit the intake of any type of food, although it should be balanced and eliminate alcohol intake. On the other hand, you should not keep bed rest, recommending, on the contrary, the realization of moderate activity. Yes, the administration of certain drugs, such as aspirin, due to its danger of bleeding, or barbiturates, which can trigger hepatic encephalopathy, should be prohibited.

The feeling of tiredness and anorexia can be fought with small doses of anabolics.

Chronic autoimmune hepatitis can benefit from treatment with corticosteroids and azathioprine, which are drugs that suppress the immune system .

The last resort would be a liver transplant. This would be indicated in case of hepatic encephalopathy, severe ascites, kidney failure, gastrointestinal bleeding due to esophageal varices that does not yield to treatment, or serious bacterial infections.

You should see a doctor before the first manifestations of cirrhosis appear, because, as already described, this condition is the final stage of various liver diseases; which, initially, can manifest as abdominal pain of a few days of evolution, jaundice, fever , feeling of fatigue, lack of appetite, and so on.

How to avoid it?

Liver cirrhosis caused by toxins such as alcohol can be easily prevented with moderate consumption of it.

In the case of using drugs that are potentially toxic to the liver, it is recommended to carry out tests for the detection of liver enzymes and abdominal ultrasounds, in order to detect liver damage early.

For the prevention of hepatitis B and C, you should avoid sharing sharp objects and, in the case of hepatitis B, avoid contagion through sexual intercourse, by using condoms in the case of risky sex.