Cirrhosis is a late stage liver disease in which healthy liver tissue is replaced with scar tissue and the liver is permanently damaged.Many types of liver diseases and conditions injure healthy liver cells, causing cell death and inflammation. This is followed by cell repair, the process where scar tissue forms.As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function and finally life threatening tissue scarring reaches as a result of the repair process.
It affects about 1 in 200 adults age 45 to 54, the age group most commonly affected by cirrhosis.
The scar tissue blocks the flow of blood through the liver and slows the liver’s ability to process nutrients, hormones, drugs and natural toxins. It also reduces the production of proteins and other substances made by the liver. Cirrhosis eventually keeps the liver from working properly. Later stage cirrhosis is life-threatening.
The liver damage done by cirrhosis generally can’t be undone. But if liver cirrhosis is diagnosed early and the cause is treated, fruther damage can be limited and rarely reversed.
Cirrhosis often has no signs or symptoms until liver damage is extensive. Some of the symptoms may be nonspecific and don’t suggest the liver is their cause.
When sign and symptoms do occur, they may include –
• Yellowing of the skin (jaundice) due to the accumulation of bilirubin in the blood.
• Loss of appetite
• Loss of bodyweight
• Easy bruising from decreased production of blood clotting factors by the diseased liver
• Pain or tenderness in the area where the liver is located
• Itchy skin
• Red or blotchy palms
• Swelling (edema) on ankles, feet and legs
• Accelerated heartbeat
• Bleeding gums
• Hair loss
• For men, loss of sex drive, breast enlargement (Gynecomastia) or testicular atrophy
• For women, absent or loss of periods not related to menopause
• More frequent fever and increased risk of infection
• Bleeding through nose
• Blood in vomitting
• Stool becomes black and tarry, or very pale
• Urine becomes darker
• Memory problems
• Muscle cramps
• Problems with walking and mobility
• Dizziness and confusion
Cirrhosis of liver goes with 4 stages which are as follows –
• Stage 1 cirrhosis
It involves some scarring of the liver, but few symptoms. This stage is considered compensated cirrhosis, where there are no complications.
• Stage 2 cirrhosis
It includes worsening portal hypertension and the development of varices.
• Stage 3 cirrhosis
It involves the development of swelling in the abdomen and advanced liver scarring. This stage marks decompensated cirrhosis, with serious complications and possible liver failure.
• Stage 4 cirrhosis
It can be life threatening and people have develop end-stage liver disease (ESLD), Which is fatal without a transplant.
A wide range of diseases and conditions can damage the liver and lead to cirrhosis.
Some of the causes include –
• Chronic alcohol abuse
• Chronic viral hepatitis ( Hepatitis B, C and D)
• Fat accumulation in the liver (nonalcoholic fatty liver disease)
• Copper accumulation in the liver (Wilson’s disease)
• Iron buildup in the body (Hemochromatosis)
• Cystic fibrosis
• Poorly formed bile ducts (Biliary atresia)
• Inherited disorder of sugar metabolism (Galactosemia)
• Destruction of the bile ducts
• Hardening and scarring of the bile ducts
• Genetic digestive disorder (Alagille syndrome)
• Alpha-1 antitrypsin deficiency (buildup of an abnormal protein in the liver)
• Liver disease caused by your body’s immune system (Autoimmune hepatitis)
• Infection, such as syphilis or brucellosis
• Medications, including methotrexate or isoniazid
Risk Factors –
• Drinking too much alcohol
• Being overweight
• Have diabetes
• Inject drugs using shared needles
• Have a history of liver disease
• Having viral hepatitis – Not everyone with chronic hepatitis will develop cirrhosis, but it’s one of the world’s leading causes of liver disease
• Have unprotected sex
• High blood pressure in the veins that supply the liver (Portal Hypertension)
• Swelling in the legs and abdomen due to increased pressure in the portal vein
• Enlargement of the spleen (Splenomegaly) due to posted hypertension
• Portal hypertension can cause blood to be redirected to smaller veins.
Strained by the extra pressure, these smaller veins can burst, causing serious bleeding.
• If you have cirrhosis, your body may have difficulty fighting infections. Ascites can lead to bacterial peritonitis, a serious infection.
• Buildup of toxins in the brain called hepatic encephalopathy which can progress to unresponsiveness or coma.
• Jaundice occurs when the diseased liver doesn’t remove enough bilirubin from your blood.
• Some people with cirrhosis lose bone strength and are at greater risk of fractures.
• Failure of kidney function as a result of having portal hypertension.
• A large proportion of people who develop liver cancer have pre-existing cirrhosis.
• Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weightloss.
Your healthcare provider will first ask about your medical history and over-the-counter and prescription drug use.
To diagnosis cirrhosis, your provider will perform a physical exam and may order one or more of the following tests –
• Physical Exam
Your doctor will examine you. looking for the signs and symptoms of cirrhosis.
• Blood Tests
If your doctor suspects cirrhosis, your blood will be checked for signs of liver disease. Signs of liver damage include –
• Lower than normal levels of albumin and blood clotting factors ( lower levels means your liver has lost its ability do make these proteins)
• Raised leveIs of liver enzymes (suggests inflammation)
• Higher level of iron (may indicate haemochromatosis)
• Presence of auto antibodies (may indicate autoimmune hepatitis)
• Raised bilirubin level (suggests liver isn’t working properly to remove bilirubin from the blood)
• High white blood cell count (indicates an infection)
• High creatinine level (a sign of kidney disease suggests late stage cirrhosis)
• Lower levels of sodium (is an indicator of cirrhosis)
• Raised level of alpha-fetoprotein (indicates presence of liver cancer)
• Imaging Tests
Imaging test show the size, shape and texture of the liver. These tests can also determine the amount of scarring, the amount of fat you have in your liver and fluid in your abdomen. Imaging tests of your liver that could be ordered includes –
• Abdominal ultrasound
• Magnetic resonance imaging (MRI)
A sample of liver tissue is removed from your liver and examined under the microscope.
Your treatment depends on how badly your liver is injured. The goal is to protect the healthy tissue you have left.
The first step is to treat the condition that’s causing your cirrhosis to prevent any more damage. Some things you may need to do include –
• Stop drinking alcohol right away.
• Lose weight if you are obese.
• Eat enough protein.
• Practice good hygeine.
• Drink enough fluids, even if you have ascites, so you don’t get dehydrated.
• Do not take over-the-counter medicines like acetaminophen, aspirin or ibuprofen, if you have ascites.
• Eat a low salt diet if you have ascites. It can help control swelling.
• Eat a high protein, high calorie diet.
• Blood pressure medications can lessen bleeding inside your body that’s caused by swollen and burst blood vessels.
• Antibiotics and vaccinations can treat and prevent other infections.
If your cirrhosis is severe, you may need a liver transplant. It’s a major operation. You will likely need to get on a waiting list for a new liver from an organ donor who has died. Sometimes people with cirrhosis can get part of a liver that is donated from someone who is living.
Ayurvedic Perspective –
From Ayurvedic Perspective, liver cirrhosis is caused due to extreme aggravation of pitta dosha and can be interpreted as Yakrit vriddhi and Kumbhkamla. Liver function is affected by aggravated kitty which later vitiates other doshas as well. There is intoxication of Rasa and rakta dhatus as well as dhatus too become weak.
Beneficial Herbs –
Effective Medications –
• Aarogyavardhini Vati
• Punarnava Mandur
• Bhoonimbadi Kadha
• Chandraprabha Vati
• Guduchi satwa
• Avipattikar churna
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