Do you know ? Alcohol abuse and viral hepatitis are two major causes of cirrhosis in Indian sub-continent.
By : Dr Anil Jangir
OVERVIEW
The liver plays a vital role in synthesis of proteins (albumin, clotting factors and complements), detoxification and storage of nutrients. In addition, it participates in the metabolism of lipids and carbohydrates. Liver cirrhosis is a pathologic entity defined as diffuse hepatic fibrosis with the replacement of the normal liver architecture by nodules which causes the liver to shrink and harden progressively. This results in metabolicsynthetic dysfunction and makes it difficult for nutrient-rich blood to flow into the liver from the portal vein (which carries blood from the digestive organs to the liver) leading to development of Portal hypertension and its related serious complications.
CAUSES
Alcohol abuse and viral hepatitis are two major causes of cirrhosis in Indian sub-continent. Excessive consumption of alcohol over long term results in damage to liver parenchyma resulting in alcoholic hepatitis leading finally to cirrhosis and liver cancer.HBV and HCV are two major viral causes leading to viral hepatitis which may progress to cirrhosis if not treated properly. Other causes of cirrhosis in our community are metabolic liver diseases (NAFLD NASH, Wilson disease, Galactosemia, Glycogen storage disease), autoimmune hepatitis, Biliary atreisa, BuudChiari Syndrome, Iatrogenic biliary injury, Untreated Biliary stones and tumors.
SYMPTOMS
Cirrhosis of the liver is usually slow and gradual in its development. It is usually well advanced before its symptoms are notice able enough. Weakness, easy fatigability, loss of appetite and weight loss are usual early symptoms. Other common manifestations are ascites (collection of fluid in abdomen), jaundice, splenomegaly, blood in vomiting, pedal swelling and some skin changes. Change in sleep pattern, disorientation, irrelevant talks, irritability gradually pro gressing to alteration of sensorium and even coma denotes development of hepatic encephalopathy because of adverse effects of toxic substances (like ammonia) on to the brain.
DIAGNOSIS
Routine blood investigations including blood counts, LFT (Liver function test), routine viral markers (HBV,HCV), blood sugar should be done initially. Other liver specific blood tests may fail to detect cirrhosis especially in the early stages. Ultrasonography is an excellent easily available modality to assess liver architecture and portal hypertension.Liver biopsy is the definitive test to detect cirrhosis.
TREATMENT
Depends largely upon underlying cause. Treatment of chronic viral hepatitis with newer antiviral agents certainly prevents development and progression of cirrhosis with a survival benefit. Other cause specific treatments include steroids for autoimmune hepatitis, alcohol abstinence for alcoholic cirrhosis and strict control of blood sugar for NAFLD related cirrhosis. Cirrhotic patients should follow a high protein diet with salt restriction in those who have ascites.
LIVER TRANSPLANTATION
Liver transplantation is the ultimate potentially curative treatment option with excellent results. Cadaveric or live donor grafts are used with proper donor screening protocols.With increasing techniques and experience with surgery, liver trans plantation is the best available management of cirrhotic patients.
PROGNOSIS
Depends largely upon stage at which diagnosed and underlying cause. Compensated cirrhosis has good survival but onset of decompensation has poor prognosis. Prompt recognition and man agement of complications definitely prolongs life. Patient needs to be under expert care.
CIRRHOSIS & LIVER CANCER
Cirrhosis is a definitive predisposing condition for development of primary liver cancer and the patients need to be under periodic surveillance programmes. Antiviral treatment for virus related cirrhosis and other cause specific treatments have been shown to reduce the cancer related mortality.
Article By Dr. Anil Jangir, Published in Times Of India, Jaipur Edition : http://epaperbeta.timesofindia.com/Article.aspx?eid=31810&articlexml=All-about-Liver-Cirrhosis-10122015103011
