Cirrhosis of the liver

Content

Introduction

Cirrhosis of the liver is a degenerative disease of the liver, caused by a "chronic inflammation, which determines alterations in its structure and functions (Video).

The factors responsible for inflammation are different and in order to cause the transformation into cirrhosis it is necessary that their action be prolonged over time. The process that leads to cirrhosis, in fact, evolves slowly and as the disease progresses the liver tissue ( liver) is replaced by fibrotic or scar tissue, which makes it no longer able to perform its functions such as the digestion of food and the metabolism of many drugs.

Cirrhosis can be caused by various factors such as alcohol abuse, chronic viral hepatitis, hepatitis associated with metabolic disorders (non-alcoholic hepatic steatohepatitis) and some inherited diseases.

Initially, the disease can develop without causing disturbances (symptoms) and be detected in the course of investigations carried out for various reasons.

Subsequently, various ailments may appear which include:

  • loss of appetite
  • nausea
  • weakness
  • slimming
  • fatigue

In the more advanced stages of the disease, more serious disorders (symptoms) such as jaundice, ascites and edema in the lower limbs may appear.

Cirrhosis is a serious disease and cannot currently be cured. Its evolution over time and treatment depend on the severity of the ailments. For this reason we try to slow it down by identifying the cause that caused it and trying to keep it under control through suitable drugs.

Symptoms

In the early stages, cirrhosis may not cause any disturbances (symptoms) and the liver may function normally, despite being damaged.

Over time, as the severity of liver damage increases, various disorders can arise such as:

  • tiredness and weakness
  • nausea
  • loss of appetite and consequent weight loss

In the more advanced stages of the disease, the liver is no longer able to perform all its functions and all or some of the following disorders (symptoms) may appear:

  • yellowing of the skin and whites of the eyes (jaundice)
  • increase in the volume of the spleen
  • changes in the nails and skin
  • digestive disorders
  • difficulty concentrating
  • memory loss
  • drowsiness, reversal of the sleep-wake rhythm
  • fluid accumulation in the abdomen (ascites) and lower limbs (edema)

Causes

The causes of liver cirrhosis are varied and numerous:

  • hepatitis C
  • hepatitis B and hepatitis D
  • chronic alcohol abuse
  • non-alcoholic fatty liver disease (fatty liver) with inflammation (steatohepatitis)

In Northern Europe chronic alcohol abuse is the most common origin of cirrhosis, while in Italy it is viral hepatitis (hepatitis C, hepatitis B and hepatitis D) that is the most frequent cause. Overall, 58% of cirrhosis cases are attributable to the presence of hepatitis C, 17% to hepatitis B, 16% to chronic alcohol abuse and 7% to fatty liver (steatohepatitis).

The frequency of hepatitis C cirrhosis has decreased in the last 20 years thanks to the "use of disposable syringes, information on risk behaviors (exchange of shaving razors, nail scissors, etc.) and is destined to decrease. further thanks to new antiviral treatments (therapies).The share of cirrhosis linked to chronic alcohol abuse has also decreased in the last 20 years while, on the contrary, the frequency of cirrhosis linked to steatohepatitis, an inflammatory condition of the liver present in about 20% of cases of hepatic steatosis, has increased. non-alcoholic (fatty liver). It is estimated that about ¼ of Italians have non-alcoholic fatty liver disease. The risk factors for its development are represented by obesity, type 2 diabetes, dyslipidemia, excess blood triglycerides, low HDL and metabolic syndrome.

In people with chronic hepatitis, it can take up to 20 years for cirrhosis to develop. However, this process can be accelerated by concomitant alcohol abuse.

Cirrhosis can also be caused by some hereditary diseases such as hemochromatosis, Wilson's disease, glycogen storage diseases, cystic fibrosis. Other causes are represented by autoimmune hepatitis, sclerosing cholangitis, granulomatous diseases (eg sarcoidosis) and certain medications.

Diagnosis

To ascertain (diagnose) whether or not a person has cirrhosis, the doctor initially inquires about his state of health over time (anamnesis) and performs a medical examination. If, after these investigations, he suspects that it may be cirrhosis, he will require a series of blood tests to evaluate the functioning of the liver: transaminases, coagulation factors, bilirubin, albumin and platelet measurements.

Sometimes these tests can be accompanied by ultrasound, computerized axial tomography (CT) and the removal of a small piece of liver (liver biopsy) which can be repeated over time to assess the progression of the disease.

Therapy

Currently, cirrhosis cannot be cured. For this reason we try to slow down its development as much as possible, identifying the cause that caused it and trying to control it through suitable drugs.

For those suffering from alcoholic cirrhosis it is necessary to stop drinking alcohol-containing beverages; if, on the other hand, the disease was caused by hepatitis, it is necessary to take drugs capable of counteracting and treating them.

In its most advanced stage, when the disease is considered irreversible, the only possibility of effective treatment is a liver transplant.

Prevention

Prevention is the best cure (the most effective weapon) to combat liver cirrhosis. For this purpose it is important:

  • don't drink at all, or drink in extreme moderation, alcoholic beverages
  • follow a correct diet (read the buffalo)
  • use some medications with extreme caution
  • undergo vaccination against viral hepatitis
  • refrain from consuming contaminated food or water

Complications

In the early stages, cirrhosis does not cause disturbances (asymptomatic). It is possible that several years may pass before the first signs of its development appear, which include: loss of appetite, nausea, weakness, weight loss, fatigue. In advanced stages of the disease, complications related to the effects of liver changes on others may appear. organs:

  • ascites, accumulation of fluid in the abdomen
  • edema, accumulation of fluid in the legs
  • enlargement of the spleen
  • gastrointestinal bleeding caused by rupture of esophageal varices
  • bacterial peritonitis
  • hepatic encephalopathy

Cirrhosis can also develop into a liver cancer, hepatocellular carcinoma. As a result, regular blood tests and other tests are required to identify and treat this tumor in its early stages.

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