Chronic Liver Disease and Cirrhosis

Chronic liver disease is a health problem that results in the progressive destruction and deterioration of the liver. The disease, which develops at a slow process, lasts for a long period of time. There are various types of chronic liver disease. One of them is cirrhosis of the liver.

Cirrhosis of the liver is a disease characterized by the replacement of the liver tissue by a fibrotic scar tissue and regenerative nodules, thus resulting in the progressive deterioration of the liver. Ascites, a condition wherein fluid is retained in the abdominal cavity, is the most common complication of this chronic liver disease. Other complications include bleeding from esophageal varices and hepatic encephalogy (coma and confusion). Once cirrhosis develops, it is generally irreversible and its treatment focuses more on the prevention of the complications and progression of the disease.

What causes Cirrhosis?
There are many possible causes of Cirrhosis. Two of the most common causes of this chronic liver disease are hepatitis C and alcoholism. In some cases, more than one cause can be present in the same patient.

What are the symptoms of Cirrhosis?
The signs and symptoms of cirrhosis include: spider angiomata (vascular lesions); palmar erythema (exaggerations of speckled mottling of the palm due to changes in the metabolism of sex hormones); nail changes (Muehrcke's nails, Terry's nails, and clubbing); hypertrophic osteoarthropathy (chronic and proliferative periostitis of the long bones); dupuytren's contracture (shortening and thickening of the palmar fascia resulting in flexion deformities of the fingers); gynecomastia (benign proliferation of the grandular tissue of the male breasts); hypogonadism (infertility, impotence, testicular atrophy, and loss of sexual drive due to the suppression of the pituitary or hypothalamic function or primary gonadal injury); change of liver size (shrunken, enlarged, or normal); splenomegaly (caused by the congestion of the red pulp resulting from portal hypertension); ascites (retention of fluid in the peritoneal cavity); caput medusa (opening of the umbilical vein in portal hypertension); Cruveilhier-Baumgarten murmur; fetor hepaticus (a sweet pungent smell of breath caused by the increase of dimethyl sulfide); jaundice (yellow discoloring of the eye, skin, and mucus membranes caused by the increase of bilirubin); asterixis (bilateral asynchronous flapping of dorsiflexed and outstretched hands); fatigue; weakness; weight loss; and anorexia.

How is cirrhosis diagnosed?
Cirrhosis, as a form of chronic liver disease, can only be diagnosed by biopsy. The physician may also suspect the existence of the disease, but not confirm it, through several medical tests like full physical examination and X-rays.

How is it treated? 
The liver damage caused by cirrhosis is generally irreversible. But available treatments can help in preventing or reducing the symptoms of the disease and in stopping or delaying its progression. Treatment can be classified as either the elimination of the causes or the prevention of complications.

Elimination of causes. Since alcoholic cirrhosis is caused by alcoholism, the intake of alcohol is discouraged. Meanwhile, the treatment for hepatitis-related cirrhosis includes medications for different kinds of hepatitis like corticosteroids for autoimmune hepatitis and interferon for viral hepatitis. Cirrhosis, which is caused by Wilson's disease (the accumulation of copper in organs), is treated with chelation therapy.

Preventing complications. Diuretics may be used in order to suppress ascites. Antibiotics are prescribed for infections, while other medications to reduce or control itching may be taken. Laxatives like lactulose lessen the risk of constipation. Meanwhile, propranolol is prescribed for portal hypertension. This medication is necessary in order to lower the blood pressure in the portal system.

Severe cases. Transjugular intrahepatic portosystemic shunting may be needed to treat severe complications due to portal hypertension. This treatment is used in order to relieve pressure in the portal vein. But transjugular intrahepatic portosystemic shunting is only administered to patients with a low risk of encephalopathy because this treatment can worsen such health problem. It is also considered only as a palliative measure or a bridge to liver transplantation. A liver transplantation may be needed when the liver ceases to function or when complications can no longer be controlled. Currently, the survival rate of patients undergoing liver transplantation is 90%. The success of the operation depends on the stage of the disease and the health condition of patients.

Prevention of cirrhosis
Observing a healthy lifestyle is the best treatment to any disease, including cirrhosis. In order to avoid the risk of developing cirrhosis or any other chronic liver disease, you must strive to live a healthy lifestyle. As much as possible, avoid practices or the intake of harmful substances that can increase your risk of developing cirrhosis or any chronic liver disease.