Cirrhosis occurs due to death of the cells of liver with fibrosis and formation of nodules. The diffuse abnormality of liver architecture affects blood flow of liver and impairs its function.
It is important to identify cirrhosis and treat it adequately because it can lead to chronic liver failure, which manifests when liver becomes incapable of maintaining normal physiology.
Causes of Cirrhosis
Cirrhosis can affect any age group but is more common in younger adults, leading to premature death. The commonest causes are alcohol in the West and viral infection (particularly hepatitis C) world-wide.
Other less common causes are anything causing chronic hepatitis, Wilson’s disease, hemochromatosis, deficiency of alpha-1 antitrypsin, cystic fibrosis, hepatotoxic drugs and toxins like methotrexate, galactosemia, glycogen storage disease, autoimmune hepatitis, cardiac cirrhosis, Budd-Chiari syndrome. The abnormal liver architecture in cirrhosis affects its blood flow and interferes with function and also causes portal hypertension.
How to Identify Symptoms of Cirrhosis
These can vary greatly. Cirrhosis could be asymptomatic and found incidentally upon surgery, or associated with only isolated hepatomegaly (enlargement of liver). The common symptoms are fatigue, weakness, muscle cramps, loss of weight, and nonspecific gastrointestinal symptoms like anorexia, nausea and vomiting, or abdominal discomfort and distention. Other symptoms are due to impaired liver function and portal hypertension.
Initially there is hepatomegaly but later as the disease progresses, liver can shrink in size due to destruction of liver cells and fibrosis. Liver is felt to be hard and irregular but painless. Mild jaundice can be present due to impaired excretion of bilirubin.
Palmar erythema (redness of palms), spider telangiectasia (central blood vessel marking with radiating smaller vessels) of 1-2 mm or cm in size usually above the nipples are found. Gynecomastia (male breast enlargement) and enlargement of parotid gland (swelling on the lateral part of cheek below the ear) are common in alcoholic cirrhosis. Central cyanosis (bluish discoloration of lips) is a late feature.
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Mild fever and clubbing (swollen nails) are nonspecific symptoms. Other changes that could be present on nails are horizontal bands interspersed with normal color, and white and red bands. Easy bruising and epistaxis (bleeding from nose) are common.
Pigmentation can occur in cirrhosis due to hemochromatosis. There could be loss of male hair pattern and atrophy of testes in males. In women irregular menses, absence of menses (amenorrhea) and breast atrophy can be present.
Spleen can be enlarged (splenomegaly). Abdomen could be swollen due to fluid collection (ascites). Breath could be musty in odor (fetor hepaticus). Other symptoms and signs depend upon the underlying cause leading to cirrhosis.
History and signs and symptoms can lead to a strong suspicion of cirrhosis. It can be confirmed by liver function tests, ultrasonography, CT scan, MRI, liver biopsy and other specific tests depending on the suspected underlying cause.
Maintenance of nutrition, treatment of any identified cause and attending to alleviation of complications form the cornerstones of treatment of cirrhosis. Patient should abstain from alcohol.
Salt intake should be restricted. Aspirin and other such analgesics are best avoided. A careful watch should be kept for symptoms and signs of impending liver failure. If liver failure supervenes, liver transplantation is indicated.
Prognosis is good when the underlying cause is correctable like in alcoholic cirrhosis, Wilson’s disease, and hemochromatosis. Otherwise, the overall prognosis is poor with only 25% survival rate 5 yr from diagnosis in case of advanced presentation.
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