Liver Cirrhosis: Symptoms, Causes & Treatement

What is Cirrhosis

Liver Cirrhosis or Cirrhosis denotes a disease condition where the liver fails to function due to extensive damage over 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 due to failure of the liver cells:

• Spider angiomata or spider nevi that are vascular lesions comprising central arteriole, surrounded by many smaller vessels occurring due to increase in estradiol. (The formation suggests the title).
• Palmar erythems denotes the reddening of the palms at the thenar and hypothenar eminences, caused due to increased estrogen.
• Gynecomastia denotes increase in breast gland in males, caused by increased estradiol. However, this is neither related to increased breast fat nor can be called cancerous.
• Hypogonadism denotes 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 denoting fluid accumulation in the peritoneal cavity, giving rise to flank dullness.
• Fetor hepaticus denoting musty breath odor, caused due to increased dimethyl sulfide.
• Jaundice denoting yellowish discoloration of the skin and eyes, caused due to increased biliruben.

Manifestations caused due to portal hypertension

Cirrhosis (liver cirrhosis) enhances resistance to blood flow and higher pressure in the portal venous system that causes portal hypertension, the effects of which are listed below.

• Splenomegaly that denotes 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 though 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 stethoscope) caused due to collateral connections forming between 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, gall stones, as also certain types of medications. Cirrhosis is also typified by substitution of normal liver tissue with scar tissue. These result in loss of liver function.

How Liver Cirrhosis is 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 irregular 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 colchicines (Colcrys) have been extensively tried, but their efficacy is yet to be proved.