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The Digestive SystemCirrhosis Synonyms : Hepatic cirrhosis Clinical features, Diagnosis, Management, Prognosis, Nutrition, Herbs, In the Western world cirrhosis is the third leading cause of death in patients aged 45-65 years after cancer and cardiovascular disease. Most cases of cirrhosis are due to chronic alcohol abuse, followed by chronic hepatitis C and B. Cirrhosis (the Greek word for tawny-yellow) is the end stage of various chronic liver diseases, characterised by:
Deposition
of connective tissue
in the form of delicate bands or broad scars replacing necrotic functional
liver tissue, which is an irreversible change.
Regeneration
of remaining hepatocytes in form of nodules
that vary from very small (< 3 mm in diameter, micronodules) to large
(several cm in diameter, macronodules).
Disruption
of the architecture
of the entire liver leading to impaired blood flow through the liver and
consequent portal hypertension as well as cholestasis. Clinical features: < BACK TO TOP >
They
vary greatly in different cases; cirrhosis may even run a long asymptomatic
course.
Usually
there is enlargement of the
liver initially, but eventually the liver shrinks and becomes firm and fibrotic.
Jaundice
of various grades is observed in majority of patients, and when obstruction to
bile flow is marked pruritus and xanthelasmas are common.
Ascites (accumulation of fluid in the peritoneal cavity in the abdomen) is a
consequence of portal hypertension.
Bleeding (haemorrhagic) tendency
presenting as easy bruising, epistaxis (nose bleeds), menorrhagia is due to
decreased synthesis of clotting factors in the liver.
Enlargement
of the spleen (splenomegaly) is due
to portal hypertension and spleen congestion.
Prominent
enlarged veins on the abdominal skin
may be noted and they serve as a bypass route for blood to reach the vena cava
inferior and then the systemic circulation.
Spider-like
blood vessel formations in the skin (spider telangiectasia) usually on the
upper body and pigmentation of the skin are sometimes observed; they are
characterised by a central elevated red dot the size of a pinhead from which
small blood vessels radiate.
There
is predisposition to bacterial infection due to hypersplenism-induced
leukopenia.
Bleeding from the oesophageal varices (enlarged veins in the oesophagus that also
divert blood into the system of superior vena cava) is common in advanced
cirrhosis and can be life-threatening. A bleeding episode may be caused by
increase in the abdominal venous pressure due to physical exertion, coughing,
sneezing, vomiting or straining at stool; it is abrupt and without pain.
Endocrine
changes develop in some patients presumably due to deranged metabolism of sex
hormones in the liver
loss of libido, hair loss in both sexes in men there is gynaecomastia (enlargement of
breasts), testicular atrophy, erectile dysfunction in women breast atrophy, irregular periods,
amenorrhoea (absence of menstruation) Diagnosis: < BACK TO TOP >
Biochemical
investigations are used to assess the activity and severity of liver disease.
The
plasma transaminase reflects the activity of the disease which is usually low
in established cirrhosis.
Transaminase
levels can be much higher during the evolution of cirrhosis, particularly that
caused by chronic active hepatitis.
The
plasma alkaline phosphatase reflects the severity of cholestasis and is
highest in biliary forms of cirrhosis.
The
plasma bilirubin and albumin concentrations and the prothrombin time reflect
the severity of liver damage.
Imaging,
especially ultrasound and CT can often clearly show the structural changes of
cirrhosis. Liver biopsy establishes the diagnosis of cirrhosis and may show the cause. Management < BACK TO TOP >
No
treatment can reverse cirrhosis or even ensure that no further progression
occurs, but medical therapy can alleviate symptoms.
Treatable
conditions (e.g., chronic hepatitis, alcohol abuse, hepatotoxic medications,
haemochromatosis and Wilson’s disease) should always be sought and
appropriately treated.
Correct
diet is important, and should be adjusted in case hepatic encephalopathy
occurs.
Liver
transplantation is now an established treatment for liver failure in patients
with chronic liver disease. The overall prognosis in cirrhosis is poor and without transplantation only 25% of patients survive 5 years from diagnosis. Complications of hepatic cirrhosis: 2.
portal
hypertension and development of ascites Prognosis < BACK TO TOP >
Nutrition < BACK TO TOP > Nutrition that alleviate or prevent Cirrhosis :-
Herbs < BACK TO TOP > Herbs that alleviate or prevent Cirrhosis :- (source : -) |
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7 April 2010 
10 December 2004 - International Human Rights Day
World No-Tobacco Day
World Health Day |
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speaker Mr NgThian Watt the Principal Trainer from
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