Cirrhosis of the Liver: Causes, Clinical Features, Complications, and Management

Cirrhosis of the Liver: Causes, Clinical Features, Complications, and Management

Define cirrhosis of the liver. Discuss in detail its causes, clinical features, complications, and management.

Answer. The term cirrhosis is applied to chronic diffuse liver disease of varied etiology and is characterized by hepatic cell necrosis, proliferation of connective tissue, and nodular regeneration.

Causes of Cirrhosis of the Liver

1. Common causes of Cirrhosis of the Liver

1. Alcohol
2. Viruses: Hepatitis B virus, hepatitis C virus.

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2. Other causes: Cirrhosis of the Liver

• Hepatic venous congestion
• Veno­occlusive disease
• Budd­Chairi syndrome
• Wilson’s disease
• Galactosemia
• Glycogen storage diseases
• *Hemochromatosis
• Drugs such as isoniazid, oral contraceptives, etc.

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3. Clinical Features Cirrhosis of Liver

• Hepatomegaly
• Jaundice
• Ascites
• Circulatory changes
• Spider angioma
• Palmar erythema
• Cyanosis
• Endocrine changes.
  Loss of libido
  Hair loss of chest.
  Men: Gynecomastia, testicular atrophy, impotence
  Women: Breast atrophy, irregular menstrual cycle, amenorrhea
• Hemorrhage tendency: Bruises, purpura, epistaxis, menorrhagia
• Portal hypertension: Splenomegaly, collateral vessels, variceal bleeding
• Hepatic encephalopathy
• Miscellaneous: Pigmentation, clubbing, low grade fever.

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Complications Cirrhosis of Liver

• Posthepatic vein obstruction “Budd­Chiari syndrome” or extrahepatic and postsinusoidal.
• Intra-hepatic postsinusoidal / cirrhosis
• Esophageal varices causes severe hemorrhage
• Development of hepatocellular failure due to hepatocellular carcinoma.
• Renal failure
• Hypersplenism
• Due to infection, spontaneous bacterial peritonitis and secondary bacterial peritonitis occur.

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Investigations Cirrhosis of Liver

1. Blood examination:

• Anemia can be present secondary to bleeding, folate defiiency, marrow suppression or hypersplenism.
  Leukopenia and thrombocytopenia.
• Aminotransferases (ALT, AST) get frequently elevated whereas a rise in the serum bilirubin and ALP may occur later. Serum albumin is low and Prothrombin time is frequently prolonged.

2. Imaging: Ultrasonography is done to assess the liver size and texture, ascites, portal hypertension and splenomegaly.

3. Endoscopy: Upper gastrointestinal endoscopy is being carried out to detect esophageal varices and to exclude other causes of upper gastrointestinal bleeding in the stomach and duodenum.

4. Liver biopsy: It is done for the assessment of severity of the cirrhotic changes and also confims the specifi cause of the cirrhosis.

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Management Cirrhosis of Liver Cirrhosis of Liver

No treatment can reverse cirrhosis or even ensure that no further progression occurs, but medical therapy can improve general health and treat the symptom of disease effctively.

The main objectives are:

• Detect treatable causes
• Prevent and correct malnutrition
• Manage chronic cholestasis
• Treat the complication.
• Treatable causes: The treatable causes are alcohol abuse, drug ingestion, *hemochromatosis and Wilson’s disease, relief of biliary obstruction will prevent secondary biliary cirrhosis.
• Nutrition: In absence of ascites, a high energy 3000 kcal / day, protein rich (80–100 gm / day) diet should be advised.
  Salt restriction is required if ascites are present.
  Fat intake is not restricted unless cholestasis is a feature.
  Complete absence of alcohol.
  Vitamin and other supplements are not required when good diet is taken.
• Drug treatment: Any drug should be avoided because as most of the drugs are metabolized in the liver which are liable to develop toxic reaction because they will unable to get metabolize.
• Liver transplantation: It is considered in all patients with chronic liver disease who develop  liver failure.

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Cirrhosis