Liver Cirrhosis: Symptoms, Causes & Treatment
What is Cirrhosis Liver cirrhosis, or cirrhosis, denotes a disease condition where the liver fails to function due to extensive damage over a long period of time, involving loss of liver cells, as well as irreversible scarring of the liver. Even though at the initial stage, symptoms are negligible or nil, manifestations appear in rapid succession as the disease progresses. These include fluid buildup in the abdomen, spider-like blood vessels on the skin, swelling in lower legs, and many more that are being discussed in detail next, while the patient becomes weak, loses appetite, and develops yellowish skin (Jaundice). Likely to prove fatal if not treated early. What are the symptoms of Cirrhosis? Cirrhosis symptoms may be grouped under two heads: symptoms that have resulted from failure of the liver cells and those that have occurred due to portal hypertension (secondary). Manifestations caused by the failure of the liver cells: ■ Spider angiomata or spider nevi are vascular lesions comprising a central arteriole, surrounded by many smaller vessels, occurring due to an increase in estradiol. (The formation suggests the title). ■ Palmar erythema denotes the reddening of the palms at the thenar and hypothenar eminences, caused by increased estrogen. ■ Gynecomastia denotes an increase in the breast gland in males, caused by increased estradiol. However, this is neither related to increased breast fat nor can it be called cancerous. ■ Hypogonadism denotes a decrease in sex hormones, leading to loss of libido, impotence, and testicular atrophy, resulting from suppression of hypothalamic/pituitary functions. However, this is associated with cirrhosis on account of alcoholism and hemochromatosis. ■ Abnormal liver dimensions – Enlarged as well as shrunken. ■ Ascites denotes fluid accumulation in the peritoneal cavity, giving rise to flank dullness. ■ Fetor hepaticus, denoting musty breath odor, is caused by increased dimethyl sulfide. ■ Jaundice, denoting yellowish discoloration of the skin and eyes, is caused by increased bilirubin. Manifestations caused by portal hypertension Cirrhosis (liver cirrhosis) enhances resistance to blood flow and higher pressure in the portal venous system, which causes portal hypertension, the effects of which are listed below. ■ Splenomegaly denotes an enlarged spleen. 35% to 50% patients present this picture. ■ Esophageal varices result from collateral portal blood flow through vessels in the stomach and esophagus. However, when these blood vessels become enlarged (known as varices) they are prone to rupture. This often leads to copious bleeding, which can be fatal unless immediate medical aid is made available. ■ Caput medusa relates to dilated periumbilical collateral veins associated with portal hypertension. Blood from the portal veins may be moved through these veins, and eventually to the abdominal wall veins, manifesting a model that somehow resembles the head of MEDUSA, a Greek mythological monster. ■ Cruveilhier-Baumgarten Murmur denotes venous hum that can be heard in the epigastric region (through a stethoscope) caused by collateral connections forming between the portal system and the periumbilical veins (due to portal hypertension). What causes Liver Cirrhosis? Cirrhosis is mostly caused by excessive alcohol consumption, hepatitis B, hepatitis C, as also non-alcoholic fatty liver disorders. However, the latter is again associated with obesity, high blood pressure, high body fat, and diabetes. Some of the less common causes include autoimmune hepatitis, primary biliary cirrhosis, hemochromatosis, gallstones, and certain types of medications. Cirrhosis is also typified by the substitution of normal liver tissue with scar tissue. These result in loss of liver function. How is Liver Cirrhosis diagnosed? Even though the gold standard for diagnosis of cirrhosis is liver biopsy through a percutaneous, transjugular, laparoscopic, or fine-needle method, doctors currently insist on imaging as the best diagnostic approach. However, some of these approaches are outlined below. Ultrasound is customarily used in the evaluation of cirrhosis. It may show a small and nodular liver in advanced cirrhosis, along with increased echogenicity with irregularly appearing areas. Other findings suggestive of cirrhosis in imaging are an enlarged caudate lobe, widening of the liver fissures, and enlargement of the spleen. An enlarged spleen, which normally measures less than 11–12 cm in adults, is suggestive of cirrhosis with portal hypertension in the right clinical setting. Ultrasound may also screen for hepatocellular carcinoma, portal hypertension, and Budd-Chiari syndrome (by assessing flow in the hepatic vein). Other tests performed in particular circumstances include abdominal CT and liver/bile duct MRI (MRCP). Gastroscopy (endoscopic examination of the esophagus, stomach, and duodenum) is performed in patients with established cirrhosis to exclude the possibility of esophageal varices. If these are found, prophylactic local therapy may be applied (sclerotherapy or banding), and beta-blocker treatment may be commenced. What are the lines of treatment for Cirrhosis? Since no cure exists for biliary cirrhosis, treatment generally focuses on slowing down the progress of the disease, relieving symptoms as much as possible, and preventing further complications. However, researchers are continuing to explore new drugs for treating primary biliary cirrhosis. Immunosuppressant drugs, especially methotrexate (Trexall, Rheumatrex) and colchicine (Colcrys) have been extensively tried, but their efficacy is yet to be proved.
Liver Function Test: Purpose & Procedure
Liver function tests (LFTs/LFs) conducted at LivGastro primarily consist of Blood Tests that provide vital information about the condition of a patient’s liver. Some of these tests comprise Prothrombin Time (PT/INR), aPTT, albumin, Bilirubin (both direct and indirect), and a few others. Liver transaminases (AST or SGOT and ALT/SGPT ) provide helpful biomarkers in terms of the types of liver injury a patient has suffered. Thanks to the high-tech medical equipment from the manufacturer, Hisky Med, for equipping this digestive hospital in the City of Joy with state-of-the-art medical instruments! Without them, it could not have offered accurate, convenient, and standard services to the locals approaching this diagnostic centre to diagnose chronic liver diseases. As luck would have it, call it ill luck, most liver disorders cause not so intense initial symptoms, while ninety percent of hepatic disease conditions have a poor prognosis. However, tests are essential to ascertain the extent of damage caused to the person’s liver and to determine the right course of treatment. While some tests are associated with functionality, such as albumen, there are others that relate to cellular integrity, such as transaminase, while some others are linked to the biliary tract (gamma-glutamyl transferase and alkaline phosphate). Some biochemical tests are also conducted for the evaluation and management of patients with hepatic dysfunction, especially in terms of ascertaining the extent of damage caused to the liver, as well as the line of treatment that would best suit such patients. Other tests commonly conducted at LivGastro include the following: ■ 5’ Nucleotidase (5’NTD), which is specific for cholestasis that refers to damage to the intra- or extrahepatic biliary system, is often used as a substitute for GGT in ascertaining if the elevated ALP is of biliary or extrabiliary origin. ■ Coagulation Test – The liver is responsible for the production of the vast majority of coagulation factors. In patients with liver disease, INR can be used as a marker of liver synthetic function, as it includes factor VII, which has the shortest half-life (2-6 hours) of all coagulation factors measured in INR. An elevated INR in patients with liver disease, however, does not necessarily mean the patient tends to bleed, as it only measures procoagulants and not anticoagulants. In liver disease, the synthesis of both is decreased, and some patients are even found to be hypercoagulable (increased tendency to clot) despite an elevated INR. In liver patients, coagulation is better determined by more modern tests such as thromboelastogram (TEG) or thromboelastrometry (ROTEM). ■ Serum glucose Test, also called ‘BG’ or ‘Glu,’ is conducted to measure the liver’s ability to produce glucose (gluconeogenesis). In fact, it is the terminal function to be lost in the setting of ‘fulminant liver failure’. ■ Lactate dehydrogenase Test – Lactate dehydrogenase or LDH is observed in most body tissues, including the liver. However, elevated LDH levels often indicate liver damage. However, LDH isotype-1 (or cardiac) is often used for estimating damage caused to cardiac tissues, even though troponin and creatine kinase tests are found to be better alternatives.
Fatty Liver Disease: Symptoms, Diagnosis & Treatment
Fatty Liver, as the name suggests, is the excessive build-up of fat in the liver of about 5-10% of the liver’s weight. Most of the time, it’s not a serious concern, but in some cases, it is something to fret about, as it leads to liver damage. It starts with inflammation, causing the tissues to damage. The medical term for this first stage is steatohepatitis. In the second stage, scar tissue begins to form, which in turn damages the liver. Doctors call it fibrosis. In the third and final stage, the healthy tissues get replaced by extensive scar tissue. This is when cirrhosis of the liver occurs. It is a final blow to the liver, whereby liver functioning starts slowing down. Sooner or later, the liver function gets blocked entirely. According to the Cleveland Clinic, this cirrhosis transpires into liver cancer or liver failure in patients. Do you now get why fatty liver disease is a thing to panic about? Forms of Fatty Liver Disease Fatty liver disease has two primary forms: Alcohol-induced – As hinted, it is caused by heavy drinking. Non-alcoholic – Alternatively called NAFLD or Non-Alcoholic Fatty Liver Disease, the cause is still unknown, but diabetes and obesity have been said to increase the risk of occurrence. Symptoms to Pay Attention The symptoms of fatty liver are often silent unless the disease progresses to liver cirrhosis. The signs to watch out for are: ■ Weight loss, appetite loss, and nausea ■ Extreme weakness, exhaustion, and mental confusion ■ Jaundice ■ Abdominal pain, especially in the upper right side of the abdomen ■ Edema or swollen legs and abdomen If you ever feel any of the symptoms above, be prompt and book an appointment with a hepatologist for diagnostic services. The next section covers the Liver function tests, or a diagnosis that a doctor may order. Diagnosis Fatty liver silently creeps in, and for a layperson, it is challenging to spot the same. However, a doctor can easily determine the condition by noticing the elevation in liver enzymes from blood tests done for other ailments. To map the liver injury, a doctor often orders the tests mentioned below: ■ A liver biopsy to check the stage the liver disease has reached ■ Ultrasound or a CT Scan to examine the liver condition ■ FibroScan to determine the fat content in the liver Treatment for Fatty Liver Disease Unfortunately, there is no medication for treating fatty liver disease. Doctors primarily advise altering lifestyles to improve health conditions. Therefore, the treatment mostly comprises the following: ■ Reducing weight ■ Intake of thiazolidinediones or vitamin E ■ Avoiding alcohol consumption ■ Intake of medications to control cholesterol, diabetes, and triglycerides How to Prevent Fatty Liver Disease? If you have not been hit by fatty liver disease, you can do the following to maintain your overall health: ■ Get yourself involved in regular exercise ■ Maintain a healthy weight ■ Take prescribed medications ■ Put a check on alcohol consumption Reverse Your Fatty Liver Disease! Yes, you read it right. It can be either through a weight loss program or by avoiding alcohol. A Mediterranean diet, where one needs to consume lots of vegetables, fruits, and good fats, can lead to steady weight loss. So, if you are living with the ailment, don’t worry! Just make sure it never progresses into liver cirrhosis, and even if it does, go for immediate treatment to prevent liver failure or cancer.