Progressive Liver Disease (Cirrhosis)

The liver is a large organ that is located in the right upper abdomen, beneath the rib cage. It is able to carry out repair on itself when it has been injured as a result of certain disease processes like hepatitis or chronic use of alcohol. The process of healing involves the creation of scar tissue.

The body is able to tolerate a partially scarred liver without serious consequences. Repeated or continuous injury to the liver (such occurs with heavy alcohol use) can cause significant scarring in the liver. The liver performs many functions that are essential to life including cleansing toxins from the blood, metabolizing medications, and producing blood proteins that are essential for normal blood clotting. Other functions include manufacturing albumin, a protein that is required for maintaining normal fluid balance in the body and producing fluids and enzymes that are required for normal digestion. Liver cirrhosis is the term used to describe a diseased liver that has been severely scarred, usually due to many years of continuous injury.

What are the causes of Cirrhosis?
In most cases, the cause of cirrhosis can be identified. However, in about 5 per cent of cases, it is not possible to identify the cause; such patients are said to have ‘idiopathic’ cirrhosis. The leading common causes of cirrhosis include long standing alcohol abuse and chronic hepatitis virus infection (either Hepatitis B or C).

What are the common signs and symptoms?
Many people with early cirrhosis have few or no symptoms. One common symptom is fatigue. As the condition progresses, symptoms develop because the liver is no longer able to perform its normal functions.

Body fluids accumulate as a result of liver scarring and a decreased ability to manufacture blood proteins. Fluid is typically seen in the legs (edema) and abdomen (ascites) and sometimes in the lung (pleural effusion). ‘Ascites’ causes the tummy to enlarge, which can cause shortness of breath and a feeling of fullness. The ascitic fluid provides an environment where bacteria can grow, increasing the risk of infection. Patients with cirrhosis are at risk of easy bruising and bleeding due to a decrease in the blood cells (platelets) that are essential to form clots and due to a reduced production of certain blood proteins made by the liver (called clotting factors).

‘Encephalopathy’ (pronounced ‘en-ce-fa-lo-pati’), a condition that develops when the liver is unable to break down toxins normally found in the bloodstream, can develop suddenly and may become a medical emergency. In this condition, confusion or even coma results from toxins that build up in the blood. Early stages are associated with symptoms such as difficulty in sleeping or sleeping too much. Advanced encephalopathy causes confusion and may also lead to coma. The condition can also result from bleeding into the gut or infection.

Patients with cirrhosis may have several body changes. These include jaundice (yellow skin and whitening of the eyes), a distended, fluid-filled tummy (ascites), an enlarged liver or spleen and edema (swelling, mostly of the legs). Others include enlarged breast tissue (in men), redness of the palms (‘palmar erythema’), and small, spider-like veins, usually on the chest and back (‘spider telangiectasias’), loss of muscle (due to malnutrition) and atrophy (shrinkage) of the testes. Finally, people with cirrhosis are at increased risk for developing liver cancer.

How is liver cirrhosis diagnosed?
Laboratory tests often reveal abnormal blood chemistries, low protein, low specific blood cell (platelet) count, and increased waste by-product of red blood cells (bilirubin). However, these tests may be normal in people with early cirrhosis. Laboratory testing can often reveal the specific underlying cause of cirrhosis.

Several tests are used to confirm the diagnosis of cirrhosis and determine the underlying cause. A variety of imaging tests, such as ultrasound, CT scan (Computerized Tomography), or MRI (Magnetic Resonance Imaging) can suggest that a person has cirrhosis. The latter two are only available in very few hospitals across the country.

However, they are not used to diagnosing cirrhosis, and cannot replace a liver biopsy. Liver biopsy is the best way to confirm the diagnosis; the procedure is best done within hospitals by specialists called‘Gastroenterologists’.

What are the available treatment options?
No herbal therapies have clearly been proven to be effective, although some continue to be studied in western countries. Importantly, some herbal therapies can be severely dangerous / toxic to the liver.

Patients with cirrhosis need to see their doctors regularly. They should avoid consuming substances that can further damage the liver. The most common of these is alcohol. They should also check with the doctor before taking any new medication (prescription, non-prescription, herbal, vitamins and supplements).

Treatment of accumulated ascites and edema usually involves taking one or more ‘water’ pills and following a low salt diet. Some patients do not get adequate relief with water pills alone. Such patients often require periodic drainage of the fluid (‘paracentesis’). This is done by inserting a needle into the abdomen and withdrawing fluid from the space around the abdominal organs.

It is important to eat a healthy diet with adequate calories and nutrient-rich foods. Salt restriction is usually recommended for patients with early cirrhosis who tend to accumulate fluid.

Finally, one of the biggest advances in cirrhosis treatment is liver transplantation, a procedure in which the diseased liver is replaced with a new healthy liver. This medical procedure is currently not available within the country. Not all patients with cirrhosis will require a liver transplantation, and many are not eligible for one.

The majority of donated livers come from people who have suffered ‘brain death’ for one reason or another. More recently, living donors have been able to donate a portion of their liver.

Some herbal therapies can be severely toxic to the liver and the kidneys. How healthy are your kidneys? Remember to live a healthy ‘kidney life’ this week. Stay healthy, till next weekend. ____________________________________________________________________