Cirrhosis of the Liver
A chronic hepatic disease, cirrhosis is characterized by diffuse destruction and fibrotic regeneration of hepatic cells.As necrotic tissue yields to fibrosis, cirrhosis alters liver structure and normal vasculature, impairs blood and lymph flow and ultimately, causes hepatic insufficiency. Cirrhosis is a serious, irreversible disease that's the 11th largest cause of death in the United 'States. The prognosis is better in noncirrhotic forms of hepatic fibrosis, which cause minimal hepatic dysfunction and don't destroy liver cells.
Cirrhosis can be caused by many things, some known and others unknown:
Signs and symptoms
You may not have signs and symptoms of cirrhosis in the early stages of the disease. But as more scar tissue replaces healthy tissue and liver function declines, you may experience some of the following:
The doctor often can diagnose cirrhosis from the patient's symptoms and from laboratory tests. During a physical exam, for instance, the doctor could notice a change in how your liver feels or how large it is. If the doctor suspects cirrhosis, you will be given blood tests. The purpose of these tests is to find out if liver disease is present. In some cases, other tests that take pictures of the liver are performed such as the computerized axial tomography (CAT) scan, ultrasound, and the radioisotope liver/spleen scan.
TreatmentThe goals of treatment include removing or alleviating the underlying cause of cirrhosis or fibrosis, preventing further liver damage, and preventing or treating complications.
The patient may benefit from a high calorie and moderate- to high-protein diet, but developing hepatic encephalopathy mandates restricted protein intake. In addition, sodium is usually restricted to 400 to 800 mg/day, fluids to 1,000 to 1,500 ml/day.
If the patient's condition continues to deteriorate, he may need tube feedings or hyperalimentation. Other supportive measures include supplemental vitamins - A, B complex, D, and K - to compensate for the liver's inability to store them and vitamin B, folic acid, and thiamine for deficiency anemia. Rest, moderate exercise, and avoidance of exposure to infections and toxic agents are essential.
In cirrhosis, drug therapy requires special caution because the cirrhotic liver can't detoxify harmful substances efficiently. Alcohol is prohibited; sedatives should be avoided or prescribed with great care. Acetaminophen (Tylenol) is especially hepatotoxic, particularly when combined with alcohol.
When absolutely necessary, antiemetics, such as trimethobenzamide or benzquinamide, may be given for nausea; vasopressin, for esophageal varices; and diuretics, such as furosemide or spironolactone, for edema. However, diuretics require careful monitoring; fluid and electrolyte imbalance may precipitate hepatic encephalopathy.
Vitamin K may be given for bleeding tendencies due to hypoprothrombinemia. Transfusion of blood and fresh frozen plasma may also be necessary.
Beta blockers may be given to decrease pressure from varices.
Lactulose may be given orally or rectally for high ammonia levels.
Paracentesis and infusions of salt-poor albumin may alleviate ascites. Surgical procedures include ligation of varices, splenectomy, esophagogastric resection, and splenorenal or portacaval anastomosis to relieve portal hypertension.
CLINICAL TIP Transjugular intrahepatic portosystemic shunt is an alternative to surgical shunting in patients with variceal bleeding refractory to standard therapy. It's helpful in severe ascites. The technique involves insertion of an expandable metal shunt between a branch of the hepatic vein and portal vein over a catheter inserted via the jugular vein. This is usually a bridging mechanism to control variceal bleeding or ascites until liver transplantation can be performed.
Hepatorenal and hepatopulmonary syndromes may occur. Treatment is ineffective except in patients who are acceptable candidates for liver transplantation.
The best way to avoid cirrhosis is to avoid the underlying conditions that cause it.
(c) Health-care-clinic.org All rights reserved
Disclaimer: Health-care-clinic.org website is designed for educational purposes only. It is not intended to treat, diagnose, cure, or prevent any disease. Always take the advice of professional health care for specific medical advice, diagnoses, and treatment. We will not be liable for any complications, or other medical accidents arising from the use of any information on this web site. Please note that medical information is constantly changing. Therefore some information may be out of date.