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LIVER CIRRHOSIS

What is liver cirrhosis?

Cirrhosis is a chronic disease of the liver in which fibrous tissue replaces the functioning hepatic cells. Cirrhosis is the most serious or final stage of liver injury and degeneration. In contrast to enlarged fatty liver, the cirrhotic liver is contracted and has lost most of its function.  The liver carries out many important functions such as detoxifying chemicals, metabolizes drugs, synthesis of plasma proteins, lipoproteins, phospholipids, cholesterol, glycogen and storage of glycogen, iron and copper. Conversion of blood coagulation factors to prothrombin in the presence of Vitamin K, B carotene to retinol and Vitamin D to its active metabolites.

 

CAUSES :

  • Chronic alcoholism is considered to be the most common cause since alcohol and its metabolic products disturb liver metabolism and damage liver cell directly.
  • Metabolic disorders such as haemochromatosis ( a defect in iron absorption) or Wilson’s disease ( a disorder of copper metabolism) may lead to cirrhosis.
  • Hepatitis B and Hepatitis C infection
  • Destruction of liver cells may occur due to various infective and toxic agents such as aflatoxin.
  • Non-alcoholic fatty liver disease (NAFLD) &   Nonalcoholic steatohepatitis (NASH)

 

 

SYMPTOMS :

The onset of the disease is gradual with initial symptoms of -

  • Nausea
  • Vomiting
  • Anorexia
  • Distention
  • Epigastric pain
  • Steatorrhea (excretion of abnormal quantities of fat with the faeces)
  • Macrocytic anaemia due to folic acid deficiency
  • Jaundice appears with increasing weakness, oedema, ascites, oesophageal varices and tendencies of gastrointestinal bleeding.

 

COMPLICATIONS:

 

  • Ascites- Accumulation of abnormal amounts of fluids, serum protein and electrolytes in the peritoneal cavity.
  • Portal hypertension-Elevated blood pressure in the portal venous system caused by obstruction of blood flow through the liver.
  • Oesophageal Varices (Enlarged veins) – The impaired portal circulation with increasing venous pressure may lead to oesophageal varices with a danger of rupture and haemorrhage.
  • Blood clotting mechanisms are impaired because factors such as prothrombin and fibrinogen are not adequately produced.
  • If untreated, cirrhosis can lead to complications such as alterations in glucose and fat metabolism, renal insufficiency, osteopenia and hepatic encephalopathy.

 

TREATMENT:

  • Prognosis of cirrhosis depends on abstinence from alcohol and degree of complications already developed. Ethanol ingestion creates specific and severe nutritional abnormalities.
  • It is important for the patient to stop drinking if cirrhosis was caused by regular heavy consumption of alcohol.
  • Malnutrition is the common complication of the advanced liver disease. When appropriate nutrition therapy is provided to patients with liver disease, malnutrition can be reversed.
  • The aim should be to maintain adequate energy and protein intake and correct other nutritional deficiencies. Hence, if patients are not able to consume food orally, enteral feed and parenteral support should be provided.
  • Studies have shown positive outcomes with oral and enteral nutrition in the malnourished patient with cirrhosis with improvement in nutrition status and complications such as ascites, encephalopathy and infection.

 

 This is Copyright Content by Gadge's Diabetes Care Edited and written by Madiha Khan

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