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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Article Home Adult and Senior Health Cirrhosis of liver

Cirrhosis of liver

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Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrous tissue and regenerative nodules. This results in progressive loss of liver function.

  

Causes of liver cirrhosis

  • Alcoholic liver disease
  • Hepatitis B and C infection
  • Cryptogenic cirrhosis
  • Non alcoholic fatty liver/steatohepatitis
  • Autoimmune hepatitis
  • Primary biliary cirrhosis
  • Hemochromatosis
  • Wilson disease
  • Alpha 1 antitrypsin deficiency
  • Granulomatous disease (sarcoidosis)
  • Type IV glycogen storage disease
  • Drug induced liver disease
  • Budd-chiari syndrome
  • Chronic right sided heart failure
  • Tricuspid regurgitation
  • Cardiac cirrhosis 

Signs and symptoms

Symptoms in cirrhosis are due to gradual failure of the liver and distortion of the liver architecture by scarring. 

  • Tiredness or exhaustion
  • Weakness or fatigue
  • Nausea/Vomiting
  • Loss of appetite leading to wt loss
  • Loss of sex drive
  • Jaundice
  • Fever
  • Diarrhea
  • Itching
  • Abdominal pain and swelling
  • Swelling of ankles and legs
  • Confusion, delusions, personality changes (hepatic encephalopathy)
  • Extreme sleepiness, difficulty in awakening, or coma (encephalopathy)
  • Easy bruising
  • Blood in vomit and feces
  • Bleeding from gums or nose
  • Hemorrhoids
  • Gynecomastia
  • Scrotal swelling and small testis
  • Abnormal menstrual period 

 

Specific signs in liver cirrhosis


  • Spider angiomata or spider nevi
  • Palmar erythema
  • Muehrcke's nails (due to hypoalbuminemia)
  • Hypertrophic osteoarthropathy
  • Dupuytren's contracture
  • Gynecomastia
  • Hypogonadism
  • Hepatomegaly
  • Splenomegaly
  • Ascites
  • Caput medusa
  • Fetor hepaticus
  • Cruveilhier-Baumgarten murmur
  • Asterixis 

Complications

  • Bruising and bleeding
  • Hepatic encephalopathy
  • Hepatocellular carcinoma
  • Portal hypertension
  • Spontaneous bacterial peritonitis
  • Hepatorenal syndrome
  • Hepatopulmonary syndrome
  • Portopulmonary hypertension  

Tests and diagnosis

  • Liver function test (LFT)
  • Serum electrolytes
  • Complete blood count
  • Renal function test
  • Coagulation profile
  • Ultrasound abdomen
  • Liver biopsy 

Medical treatment

  • Most treatment of cirrhosis is directed toward relief of complications.
  • Medicines like steroids, D-penicillamine, Colchine
  • Portal hypertension is treated with beta- blockers (Propranalol) to reduce the pressure in the blood vessels.
  • Ascites- Diuretics (potassium sparing diuretic), IV antibiotics, and ascitic tap.
  • Hepatic encephalopathy- Lactulose, hepamerz granules IV
  • In alcoholic cirrhosis: Abstinence from alcohol intake and adequate balanced diet is required.
  • In cirrhosis caused by viral hepatitis: Antivirals and interferon’s are given. 

 

General measures  

 

 

  • Avoid alcohol
  • Healthy diet
  • Low sodium diet
  • Low fat diet
  • High protein diet
  • Iron supplements
  • Vitamin B12 supplements
  • Treatment of underlying cause