Cirrhosis of the Liver




Disease definition

Cirrhosis, a chronic liver disease that is characterized by scarring of the liver with noticeable fibrous tissue formation resulting in decreased functioning. Since the liver is responsible for many important functions such as: storing excess nutrients and ridding the body of harmful substances, its function becomes impaired when scar tissue blocks the flow of blood to the liver. When this occurs, the liver is not at optimal productivity and the processing of nutrients, hormones, and drugs is inevitably slowed.


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Causes

According to the National Institute of Health, cirrhosis is the 12th leading cause of death by disease. Although there are many causes of cirrhosis, alcoholism, fatty liver, and hepatitis B, C, and D are the three most common causes in the United States. Most people who consume alcohol do some sort of damage to their liver with varying severities, but not all these individuals acquire cirrhosis of the liver.

Heavy alcohol consumption over several years can lead to chronic injury to the liver. As it turns out, women are more susceptible to developing cirrhosis of the liver. Individuals who suffer from hepatitis B & C are more likely to develop cirrhosis of the liver.

In nonalcoholic fatty liver disease, fat builds up in the liver and eventually leads to cirrhosis. This specific type of liver disease is shown to be associated with obesity, diabetes, protein malnutrition, coronary artery disease, and corticosteroid medications.

Hepatitis can be contracted in many different ways. In individuals with Hepatitis C, the liver infection is obtained through contact with an infected person's blood. In hepatitis B individuals, this disease is contracted through contact of an infected person’s blood, semen, or other body fluids. Hepatitis D is rare, and can only occur in individuals who already have hepatitis B. Chronic hepatitis causes inflammation of the liver and damage that over time, will lead to cirrhosis of the liver.

Some of the less common causes of cirrhosis include:
  • Obstruction of the bile duct that carries bile from the liver to the intestine for fat digestion.
  • Inherited disorders such as cystic fibrosis
  • Medications
  • Diseases such as Wilson’s disease that is characterized by abnormal storage of copper in the liver

Signs and Symptoms



Cirrhosis is a disease that may present differently in every individual. Symptoms may develop slowly or not at all. When symptoms do occur, they can include:
  • Confusion or problems thinking
  • Impotence, loss of interest in sex, and breast development in men
  • Loss of appetite
  • Nausea and vomiting
  • Nosebleeds or bleeding gums
  • Pale or clay-colored stools
  • Small, red spider-like blood vessels on the skin
  • Swelling or fluid buildup of the legs (edema) and abdomen (ascites)
  • Vomiting blood or blood in stools
  • Weakness
  • Weight loss
  • Yellow color in the skin, mucous membranes, or eyes (jaundice)
  • Lack of energy
  • Bruises
  • Itchy skin
  • Fever

Other signs may be identified by a physician during a physical exam. These can include:
  • An enlarged liver or spleen
  • Excess breast tissue
  • Edema or ascites
  • Reddened palms
  • Small, red spider-like blood vessels on the skin
  • Small testicles
  • Widened veins in the abdomen wall
  • Jaundice

If any of the above signs or symptoms is identified, a physician may order further tests. The tests may show:
  • Anemia
  • Clotting problems
  • Low blood albumin

Medical Treatment

After a physical exam and lab testing, cirrhosis is diagnosed by a liver biopsy. Once a patient has a confirmed diagnosis, treatment can begin. There is no cure for cirrhosis since it causes permanent scarring of the liver. However, measures may be taken to prevent further damage. A doctor can also help treat some of the symptoms of cirrhosis.

All patients can benefit from lifestyle changes which are covered in the next section. A doctor may recommend getting vaccines such as influenza, hepatitis A, hepatitis B, and pneumococcal pneumonia.

Other treatments are available so help treat the side effects (listed above) of cirrhosis.
  • Bleeding varicies- upper endoscopy with banding and sclerosis
  • Ascites: take diuretics, fluid removal, and diet changes
  • Coagulopathy: blood products or vitamin K
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    transjugular intrahepatic portosystemic shunt
  • Confusion or encephalopathy: lactulose medication and antibiotics
  • Infections: antibiotics

With bleeding or ascites, a procedure called transjugular intrahepatic portosystemic shunt may be necessary. This is used to correct bleeding issues. It creates new connections between two blood vessels in the liver.

If cirrhosis progresses to end stage liver disease, the patient may be a candidate for a liver transplant.

Dietary treatment


Eating a healthy diet is an important part of treatment for cirrhosis. Malnutrition is often a complication with this disease because adequate nutrition is difficult to achieve. Complications that follow liver disease such as; maldigestion or malabsorbtion, restricted diet, altered metabolism, nausea and vomiting, early, and anorexia all contribute to poor dietary intake. For these reasons, a well-balanced diet with plenty of fruits, vegetables, whole grains, along with proper protein balance, and limiting fluid and salt intake is very important to maintain the highest quality of life possible
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Energy
Calorie needs of individuals can be 120 - 175 % more than those without cirrhosis. This can be very difficult to achieve taking into account all the complications with food intake. Therefore all foods eating need to be nutrient dense in calories and the much needed vitamins and minerals.

Carbohydrates
Liver failure reduces glucose production, so main energy intake needs to come from lipids and amino acids.

Fat
The body prefers fat as an energy source, since lipid metabolism is increased in patients with liver disease, so a diet consisting of 25-40% is recommended

Protein
Protein is very important in the treatment of all diseases since it helps to repair muscle mass. In cases of Cirrhosis, the quality of the dietary protein may be equally if not more important than the quantity. High quality protein, mostly found in animal sources is needed if edema is present in the abdomen, feet, legs, or back. The high quantity of protein, however, can raise ammonia levels and trigger hepatic encephalopathy. The amount of protein that is right is determined for each individual by their doctor, it is recommended for everyone with liver disease to consume protein from vegetables, such as soy, and only get a the minimal amount from the protein that comes from animals.

DO'S and DO NOT's
Do get smaller; more frequent meals they are better tolerated than three traditional meals
Do Not eat raw shellfish (it can carry a bacteria called Vibrio vulnificus that can be dangerous to people with cirrhosis)
Do drink lots of clear liquids
Do Not drink alcohol
Do eat good amounts of fresh foods because they contain very little sodium
Do Not consume processed and prepared foods- canned meats, soups, and vegetables, crackers, and cold cuts (instead of adding salt, try lemon juice or black pepper to add taste.)
Do get lots of unsaturated fats - olive oil and the fats from fish
Do Not consume large amounts of cholesterol or saturated Fat

Read more: http://www.umm.edu/altmed/articles/cirrhosis-000037.htm#ixzz1s9Y2FJ00

A number of factors are reported to directly or indirectly affect brain function in a patient with Cirrhosis.
Ammonia and glutamine are neurotoxins that most often have negative implications in this syndrome.
Other dietary factors include inflammatory mediators, certain amino acids, and manganese

References
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001301/
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004476/
http://www.webmd.com/digestive-disorders/cirrhosis-liver?page=2
http://www.medicinenet.com/cirrhosis/article.htm
http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis/#cause
"Hepatic Encephalopathy: Suspect It Early in Patients with Cirrhosis." Cleveland Clinic Journal of Medicine. Web. 15 Apr. 2012. <http://www.ccjm.org/content/78/9/597.full