Cirrhosis is a condition in which the liver becomes extensively scarred and shrunken. Most diseases of the liver end up as cirrhosis. Although any disease that affects the liver can lead to cirrhosis, alcoholism is the cause for 60-70% cases.
The next most common culprit is viral hepatitis. Initially, there is death of cells in the liver because of injury caused by alcohol or viruses. The remaining cells later multiply to form small nodules within the liver. The formation of such nodules is a very characteristic feature of cirrhosis. The liver cells within these nodules do not get proper blood supply. Hence, they are unable to purify the blood which comes from the intestines. So, the toxins are not removed effectively by liver.
The blood containing toxins reaches the heart, from where it circulates in the body reaching all vital organs. In severe cases of cirrhosis, there is injury to the brain, leading to a condition known as hepatic encephalopathy or hepatic coma. As liver is damaged in cirrhosis, proteins are not synthesized and their level in blood is reduced. This leads to an accumulation of fluid in the body, which leads to the swelling of limbs. Fluid accumulates in the abdomen as well, leading to a condition known as ascites. The failure of the liver to function properly also leads to accumulation of bilirubin in the body, which in turn, can cause jaundice.
Many of the substances required for the clotting of blood are produced by the liver. So, in cirrhosis, the level of these substances decrease, causing the patient to have an increased bleeding tendency. Because of the abnormality of blood circulation, the blood vessels in the lower end of the esophagus are dilated; these may rupture and bleed, resulting in vomiting out of blood.
Blood tests to estimate the levels of bilirubin, proteins and clotting factors help in the diagnosis of this disease. Ultrasonography is performed to note the amount of liver shrinkage. Liver biopsy, which is performed using a wide bore needle, often confirms the diagnosis.
Cirrhosis is an irreversible condition. So, treatment is directed only to reduce the symptoms of the patient. Such treatment includes measures such as removal of fluid from abdominal cavity, giving proteins and clotting factors in saline, banding of dilated blood vessels in esophagus etc. Some of the advanced medical centers perform liver transplantation. This procedure, though expensive, may be life saving for a patient who is at the final stages of cirrhosis.
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—About our writer:
Dr. Girish Kamat has done his MBBS and MD(Pathology) from RGUHS, Bangalore. He has authored Review Notes, PG Digest, Question Bank for MD(Pathology) and other medical websites. He is an editorial board member of Receptor, and Medicoz Lemon. He is interested in writing about diseases (both for general public and professionals), diagnostic algorithms, pathology reports, SOPs, editorial work, preparing power points, writing/rewriting textbooks, typing, proofreading and indexing of manuscripts, writing web content, preparing syllabus/ curriculum and preparing MCQs.
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