25/05/2016
Symptoms of cirrhosis
A symptom is something the patient feels and reports, while a sign is something other people, including a doctor or a nurse may detect. For example, pain may be a symptom while a rash may be a sign.
Symptoms are not common during the early stages of cirrhosis. However, as scar tissue accumulates the liver's ability to function properly is undermined. The following signs and symptoms may occur:
Blood capillaries become visible on the skin on the upper abdomen
Fatigue
Insomnia
Itchy skin
Loss of appetite
Loss of bodyweight
Nausea
Pain or tenderness in the area where the liver is located
Red or blotchy palms
Weakness.
The following signs and symptoms may appear as liver cirrhosis progresses:
Abdomen fills up with fluid, giving the patient a large tummy (ascites)
Accelerated heartbeat
Altered personality (as blood toxins build up and affect the brain)
Bleeding gums
Body and upper arms lose mass
Body finds it harder to process alcohol
Body finds it harder to process drugs
Confusion
Dizziness
Fluid buildup on ankles, feet and legs (edema)
Hair loss
Higher susceptibility to bruising
Jaundice (yellowing of the skin, whites of the eyes, and tongue)
Loss of libido (s*x drive)
Memory problems
More frequent fevers (susceptibility to infections)
Muscle cramps
Nosebleeds
Pain on the right shoulder
Panting (breathlessness)
Stools become black and tarry, or very pale
Urine becomes darker
Vomiting blood
Walking problems (staggering).
irrhosis is an abnormal liver condition in which there is irreversible scarring of the liver. The main causes are sustained excessive alcohol consumption, viral hepatitis B and C, and fatty liver disease - however, there are many possible causes.
People with cirrhosis may develop jaundice (yellowing of the skin, eyes and tongue), itching and extreme tiredness.
For cirrhosis to develop long-term, continuous damage to the liver needs to occur. When healthy liver tissue is destroyed and replaced by scar tissue the condition becomes serious, as it can start blocking the flow of blood through the liver.
Cirrhosis is a progressive disease, developing slowly over many years, until eventually it can stop liver function (liver failure).
The liver carries out several essential functions, including the detoxification of harmful substances in the body. It also purifies the blood and manufactures vital nutrients.
If cirrhosis is mild the liver can make repairs and continue functioning properly. If the cirrhosis is advanced and more and more scar tissue forms in the liver, the damage is irreparable. The liver tissue is replaced by fibrous scar tissue as well as regenerative nodules (lumps that appear as a consequence of a process in which damaged tissue is regenerated).
Diagram of liver cirrhosis
Diagnosis of cirrhosis
Cirrhosis in its early stages is often diagnosed when the patient is being tested for some other condition or disease because symptoms are not present.
Anybody who has the following symptoms should see their doctor immediately:
Fever with shivering
Panting (shortness of breath)
Vomiting blood
Dark stools, or tarry stools (as if covered with tar)
Episodes of drowsiness or confusion.
Location of the liver in the body
The liver is located in the upper-right section of the abdominal cavity, underneath the diaphragm.
A GP (general practitioner, primary care physician) will examine the patient and feel around the liver area to determine whether it is enlarged. The patient will be asked about his/her medical history and lifestyle (drinking, etc).
The following tests may also be ordered:
A blood test - to measure how well the liver is functioning and determine whether there is any damage. If levels of ALT (alanine transaminase) are high the patient may have hepatitis.
Imaging tests - this may involve an ultrasound, CT (computerized tomography), or MRI (magnetic resonance imaging) scan of the liver. Apart from seeing whether the liver is enlarged, the doctor will also be able to detect any scarring.
A biopsy - a small sample of liver cells are extracted and examined under a microscope. The doctor inserts a fine needle in between the ribs and into the liver. The patient will receive a local anesthetic. The biopsy not only confirms or rules out cirrhosis, but may also reveal its cause (if it is cirrhosis).
Endoscopy - an endoscope, a long, thin tube with a light and video camera at the end goes down the patient's windpipe (esophagus) and into their stomach. The doctor sees the inside of the stomach on a screen, and looks out for swollen blood vessels (varices); a hallmark sign of cirrhosis.
Child-Pugh Score
Also known as the Child-Turcotte-Pugh score, assesses the prognosis (outlook) of chronic liver disease, mainly cirrhosis. Originally, it was used to predict mortality during surgery, but is now used to determine prognosis, as well as the required treatment strength, and whether or not the patient needs a liver transplant. It is a combination of numbered points and the letters A, B, C (see below):
Class Points One year survival Two year survival
A 5-6 100% 85%
B 7-9 81% 57%
C 10-15 45% 35%
Recent developments on diagnosing cirrhosis from MNT news
Breath test for early-stage liver disease steps closer
Scientists have identified a biomarker that could form the basis of a breath test for the detection of early-stage liver disease. The study suggests that high levels of a natural compound called limonene in the breath could be a sign of early-stage cirrhosis of the liver.
Treatments for cirrhosis
If the cirrhosis is diagnosed early enough, damage may be minimized by treating its underlying cause.
Alcohol dependency (alcoholism) treatment - it is important for the patient to stop drinking if their cirrhosis was caused by long-term, regular heavy alcohol consumption. In many cases the doctor will recommend a treatment program for alcoholism.
Medications - the patient may be prescribed drugs to control liver cell damage caused by hepatitis B or C.
Treating cirrhosis complications
Ascites or edema - ascites (accumulation of fluid in the abdomen) or edema (fluid retention in the legs) can be treated with a low-sodium (salt) diet and water pills. In severe cases the fluid may have to be drained. Sometimes surgery is required.
Pressure in the portal vein and collateral smaller veins - hypertension (high blood pressure) drugs are usually prescribed to control the increasing pressure in the blood vessels around the liver; the aim is to prevent severe bleeding. In some cases a stent may be surgically placed in the portal vein to hold it open. Signs of bleeding can be detected via an endoscopy.
Treatment of swollen varices - if the patient vomits blood or passes bloody stools they probably have esophageal varices (in the food pipe). Urgent medical attention is required. The following procedures may help:
Banding - a small band is placed around the base of the varices to control bleeding. An endoscope goes down the patient's throat and esophagus during the procedure.
Injection sclerotherapy - after an endoscopy a substance is injected into the varices which triggers a blood clot and scar tissue to form; this helps stem the bleeding.
A Sengstaken tube with a balloon - the balloon is at the end of the tube. If endoscopy does not stop the bleeding a tube goes down the patient's throat and into their stomach. The balloon is inflated; this places pressure on the varices and stops the bleeding.
TIPSS (transjugular intrahepatic portosystemic stent shunt) - if the above-mentioned therapies do not stem the bleeding, a stent (metal tube) is passed across the liver to join the portal and hepatic veins, creating a new route for the blood to flow through. This reduces pressure - pressure which was causing the varices.
Infections - the patient will be given antibiotics, and some other treatments.
Screening for liver cancer - patients with cirrhosis have a much higher risk of developing liver cancer. The doctor may recommend regular blood tests and imaging scans.
Hepatic encephalopathy (high blood toxin levels) - drugs can help treat excessive blood toxin levels. The signs and symptoms need to be explained to the patient so that they know what to look out for.
Liver transplant - if the cirrhosis is advanced and there is liver failure (liver does not function) the patient may need a liver transplant.
