Cirrhosis: is scarring of the liver tissue and results in decreased liver function. Cirrhosis is the final phase of chronic liver disease and is a result of chronic liver damage




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http://www.3dhealthcare.org/livercirrhosis.html

Causes

Cirrhosis is the end stage of chronic liver disease and can be caused by a variety of other disorders:

Hepatitis C
Hepatitis C is a viral infection that causes inflammation of the liver. It can be spread through contaminated blood, such as through shared needles and sexual intercourse. Mothers may also infect their children with hepatitis C if they have the viris.

Hepatitis B
The hepatitis B virus causes severe infection of the liver that can lead to cirrhosis. It can be spread in the same ways as Hepatitis C, through sexual intercourse, shared needles, and childbirth.

Alcohol
Chronic alcoholism is the most common cause of cirrhosis. Excessive alcohol can cause fatty liver and hepatitis in addition to cirrhosis. 10-20% of heavy drinkers develop alcohol cirrhosis.

Autoimmune liver inflammation
Autoimmune liver inflammation occurs when an individual's own immune system attacks its own cells. Other immune disorders may lead to autoimmune liver inflammation.

Hemochromatosis
Individuals with hemochromatiosis absorb excessive iron from food which accumulates in the body. Cirrhosis results from excessive iron deposits in the liver.

Wilson's disease
In Wilson's disease, copper is not eliminated from the body and is allowed to accumulate in the liver, brain, and other parts of the body. Excessive copper can build up and lead to a dangerous level.

Nonalcoholic fatty liver disease
This disease is similar to alcoholic liver disease. Obese individuals or individuals with type 2 diabetes can develop nonalcoholic fatty liver disease.

The following image shows the normal appearance of the cells of the liver, compared to cells of fatty livers and cirrhotic livers.


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http://www.mayoclinic.com/health/medical/IM03869
http://www.mayoclinic.com/health/medical/IM03869

Symptoms and Signs

Patients with cirrhosis may show no symptoms, or they may show any of the following symptoms:
  • Appetite loss
  • Nausea
  • Vomiting (possibly vomiting of blood)
  • Confusion
  • Weakness
  • Weight loss
  • Jaundice (yellowing of skin, mucous membranes, or eyes)
  • Presence of blood in stools
  • Edema (presence of fluid in the extremities) or ascites (presence of fluid in the abdomen)
  • Bleeding easily

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Testing for Cirrhosis

Doctors may test for cirrhosis using several options.

Liver Biopsy

During a liver biopsy, a small sample of liver tissue is removed. The tissue may be removed by inserting a thin needle through the abdomen and into the liver. This type of biopsy is called a percutaneous liver biopsy and is the most common type. Another type of biopsy is a transjugular biopsy, where a needle is inserted through a vein in the neck, or the laparoscopic biopsy, where needle is inserted through a small incision in the abdomen.

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http://www.mayoclinic.com/health/medical/IM04144
Image 1: Shows the insertion of a needle through the abdominal cavity into the liver during a biopsy.

Blood Tests

A doctor may test for the presence of cirrhosis through a complete blood count test, bilirubin test, or specific tests of liver enzymes.
Specific liver enzyme tests that may be performed include:
  • Albumin
  • Alpha-1 antitrypsin
  • ALP
  • ALT
  • AST
  • Prothrombin time
  • Serum Bilirubin

Imaging Tests

An abdominal magnetic resonance imaging (MRI), abdominal computed tomography (CT), abdominal ultrasound, or endoscopy may be performed to test for cirrhosis.

The following image shows how a CT scan provides cross-section images of the abdominal cavity, giving doctors a change to view images of the liver.
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Medical Treatment

Patients with cirrhosis should avoid drugs that can lead to further liver damage such as alcohol. This includes avoiding anti-inflammatory drugs, as side effects can worsen the damage of the liver.

Diuretics may also be prescribed for edema.

During the early stages of cirrhosis, it may be possible to minimize liver damage by treating the underlying cause of cirrhosis. Drugs to treat hepatitis can help slow the damage caused by hepatitis.

Antibiotics may also be prescribed if infection is present.

Blood pressure medication can help control the pressure in the veins surrounding the liver, which can prevent severe bleeding.
In the advanced stages of cirrhosis, a liver transplant may be needed if liver failure occurs.

Dietary Treatment

Patients with cirrhosis are at risk for malnutrition, so it is important that they consume adequate calories. There energy needs are 120-150% resting energy expenditure (REE), and these increase to 150-175% REE if they exhibit ascites, infection, or malabsorption. Patients with edema should also restrict their sodium intake.

Cirrhosis patients should also not consume raw shellfish because it contains a bacteria that could cause a severe infection.

Patients should not consume any alcohol once they have been diagnosed because of the severe liver damage. They should also consult with their doctor regarding any vitamins or supplements to ensure that they are safe for use. Patients may be recommended to consume a multivitamin and may need extra supplementation of vitamins D and K.

Prevention

Individuals can do the following to reduce their risk of developing cirrhosis:
  • Drink alcohol in moderation to avoid liver damage
  • Eat a heathy diet
  • Maintain a healthy weight
  • Use chemicals sparingly and carefully to reduce the risk of hepatitis
  • Talk to your doctor about ways to prevent cirrhosis


References:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001301/
http://www.mayoclinic.com/health/liver-biopsy/MY00949
http://www.mayoclinic.com/health/hepatitis-b/DS00398
http://www.mayoclinic.com/health/hepatitis-c/DS00097
http://www.mayoclinic.com/health/search/search
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0003909/
http://www.umm.edu/patiented/articles/what_causes_cirrhosis_000075_2.htm
http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis/#cause
http://www.medicinenet.com/cirrhosis/page5.htm
http://www.mayoclinic.com/health/cirrhosis/DS00373/DSECTION=prevention
http://www.medicinenet.com/cirrhosis/page5.htm#toch