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Dictionary The Digestive System


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:

1.       hepatic encephalopathy

2.       portal hypertension and development of ascites

Prognosis  < BACK TO TOP >

  • -

Nutrition < BACK TO TOP >

Nutrition that alleviate or prevent Cirrhosis :-

  • Choline, Glutathione, Lecithin, Methionine, folate acid, Magnesium, Selenium, Vitamin B-complex, Vitamin B1, Vitamin B2, Vitamin B5, Vitamin B6, Vitamin B12, Vitamin C, Vitamin E, Zinc

Herbs < BACK TO TOP >

Herbs that alleviate or prevent Cirrhosis :-
Berberis vulgaris (Barberry), Centella asiatica (Gotu kola), Glycyrrhiza glabra (Licorice), Hydrastis canadensis (Goldenseal), Silybum marianum (Milk thistle), Uncaria gambir (Catechin)

(source : -)

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