Cirrhosis Of Liver | Liver Cirrhosis Diagnosis | Causes Of Liver Cirrhosis

Cirrhosis of liver

Cirrhosis of liver is derived from a Greek word named ’scirrhus’, which means orange or tawny.

Cirrhosis id defined as a diffuse process of fibrosis which converts liver architecture into structurally abnormal nodules.

Classification: morphologically classified as-

1. Micro-nodular: in which nodules are less than 3mm in diameter.
2. Macro-nodular: in which nodules are more than 3mm.
3. Mixed nodular: in which micro and macro nodules are present in almost equal numbers.

Causes of liver cirrhosis

1. Viral hepatitis e.g. hepatitis B and C.
2. Alcohol.
3. Metabolic disorders like Wilson’s disease, haemochromatosis, alpha-1-antitrypsin deficiency, cystic fibrosis, glycogen storage diseases.
4. Venous outflow obstruction as in-

i.         Budd-chiari syndrome.

ii.       Cardiac failure and

iii.      Veno-occlusive disorders.

1. Biliary  obstruction as in-

i.         Primary biliary cirrhosis.

ii.       Extra-hepatic biliary obstruction.

1. Drugs like methotrexate.
2. Unknown causes-

i.         Childhood cirrhosis and

ii.       Cryptogenic cirrhosis.

Clinical features of Cirrhosis of liver

About 1/3^rd of patients with cirrhosis are asymptomatic.

Weakness and fatigue is common in de-compensated cirrhosis.

Spider angioma (naevus) and palmar erythema are seen in alcoholics.

The naevi consists of a central arteriole with radiating capillaries.

Palmar erythema appears as reddening of the finger pulp, with sparing of rest of the palm.

Gynaecomastia (enlarged breasts) is seen in men and is due to increased conversion of androgens into estrogens in peripheral tissues.

Use of spironolactone therapy can also cause gynaecomastia.

Hypogonadism manifests in men by testicular atrophy and loss of libido especially in alcoholics.

Anemia is seen in cirrhosis and may be due to blood loss, iron or folate deficiency, bone marrow hypo-function and haemolysis.

Impaired coagulation due to decrease in coagulation factors synthesized in liver.

Low fever, white opaque nails, clubbing of nails, cyanosis and ‘faetor hepaticus’ are infrequent features.

Examination of abdomen may reveal a palpable liver which is firm and nodular.

Spleen may be enlarged.

Dilated veins radiating from umbilicus are seen.

Other manifestations are features of hepato-cellular failure and portal hypertension which include jaundice, ascites and gastrointestinal bleeding.

Read this to know: What is Ascites?

Diagnosis of liver cirrhosis

1.      Bio-chemical investigations reveal (LFT)-

i.         Decreased serum albumin levels.

ii.       Increased serum globulin levels.

iii.      Serum bilirubin and amino-trasnferase may be elevated in presence of histologic activity.

iv.     Elevated gamma glutamyl transferase is suggestive of alcohol abuse.

v.       Tests for hepatitis auto-antibodies, serum copper, serum iron and alpha-1-antitrypsin levels should be done on clinical suspicion of etiology of the disease.

2.      Radiology-

a.       Barium swallow.

b.      Ultrasound

c.       CT-scan and MRI are helpful in diagnosis.

3.      Endoscopy-

It is done to detect esophageal varies (micro bleeding); a reliable sign of portal hypertension.

4.      Ascitic fluid paracentesis is done to determine the characteristics of the fluid.

5.      Final diagnosis of cirrhosis is based on liver biopsy.

Management of Cirrhosis of liver

There is no specific line of management and the treatment is only palliative.

1. Bed rest.
2. Correction of any etiological factor-

1. Abstinence from alcohol.
2. Penicillamine for Wilson’s disease.
3. Anti-viral agents for viral hepatitis.
4. Desferrioxamine for haemochromatosis.

1. Diet- low salt diet. Total daily intake of 2000cal with protein intake of 120gm. Vitamin B complex supplementation.
2. Drugs- corticosteroids may help patients with active post-hepatitis cirrhosis.
3. Symptomatic treatment-

1. Anemia- oral iron, B12 and folic acid supplementation.
2. Restlessness- all sedatives are potentially harmful but if needed small doses of diazepam can be given to patient.

1. Ascites- low sodium diet, decrease fluid intake to 1lit/day and minimum use of milk and dairy products. Diuretics like spironolactone or amiodarone or frusemide are the drugs used. Over diuresis is to be avoided as may lead to electrolyte imbalance.
2. Gastrointestinal bleed should be managed with active hospitalization, fresh blood transfusion.

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