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Liver Cirrhosis

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LIVER CIRRHOSIShttp://www.mydr.com.au/default.asp?article=3425What

is cirrhosis?In cirrhosis of the liver, progressive scarring (fibrosis) of the livercauses scar tissue to replace normal liver tissue. The scar tissuedamages the normal structure of the liver which affects the normal flowof blood through the liver. The liver itself becomes distorted, hardenedand lumpy. Without a good blood flow the liver can't work as it shouldand its normal functions are impaired. The liver is the largest organ in the body and is a very important organto keep the body functioning properly. It is involved

in the processingof nutrients and fats, poisons or toxins that find

their way into thebody, hormones and medications. It controls blood

clotting and producesproteins. So, cirrhosis of the liver can affect the functioning of theentire body. What happens in cirrhosis?Cirrhosis happens when the cells of the liver are damaged by toxins, orby inflammation and disorders of the body's normal metabolic processes.Although many people associate liver cirrhosis with alcoholism, it canhave other origins, all of which cause the same characteristic damage. What causes it?Cirrhosis of the liver has a number of different causes. * Long-term heavy drinking of alcohol. It usually takes about 10years of heavy drinking of alcohol for cirrhosis to develop. Women candevelop cirrhosis with a daily intake of 2-3 alcoholic drinks a day,which might not be considered by some to be 'heavy'. Similarly, men whohave

3-4 alcoholic drinks a day can also develop cirrhosis. * Chronic

viral hepatitis types B, C & D. These hepatitis virusescause inflammation of the liver and liver damage that after a fewdecades can cause cirrhosis. * 's disease. This is an inherited disorder where excessiveamounts of copper are absorbed in body tissues, particularly the liver. * Haemochromatosis. Another inherited disorder, this time one inwhich too much iron is absorbed by the body and the excess is depositedin the liver. * Other inherited metabolic disorders, such as cystic fibrosis.Certain disorders that interfere with the body's metabolism and how theliver

stores substances can result in cirrhosis. * Autoimmune hepatitis. This is hepatitis caused by a problem inthe body's immune

system. The immune system doesn't recognise its owncells and tissues as 'self' and attacks them thinking they are'foreign', like invading bacteria. * Blocked bile ducts. Bile is made in the liver and then the bileducts carry the bile out of the liver to the gallbladder where it isstored. If the bile ducts become blocked due to scarring orinflammation, bile backs up in the liver and damages the liver tissuescausing cirrhosis. Primary biliary cirrhosis is a disease of adultswhere the bile ducts become damaged. Biliary atresia is a condition ofbabies in which they are born without bile ducts or the bile ducts aredamaged causing build-up of bile in the liver. * Toxic hepatitis. This is rare and is caused by severe reactionsto medications or environmental toxins. * Chronic congestive heart failure with liver congestion. Repeatedepisodes of congestive heart failure with liver congestion can causecirrhosis of

the liver.What are the initial symptoms of cirrhosis?Often, especially in the early stages of liver cirrhosis, there may beno symptoms at all or some people may notice only minor changes in theirbody.

Symptoms of early cirrhosis include: * loss of appetite; *

weight loss; * tiredness and weakness; and * nausea. Later

symptoms and problemsLater on, as the cirrhosis progresses and liver function gets poorer,other symptoms can develop including the following. * Ascites. Ascites is a build-up of fluid in the abdominal cavity.This occurs in cirrhosis of the liver because less protein than normalis made by the cirrhosed liver, which leads to water building up. Thefluid can also build up in the legs when it is

known as oedema. * Bruising and bleeding. You may bruise more easily (due to adecrease in proteins needed for blood clotting). *

Intense itching. You may experience intense itching. This is dueto bile products being deposited in the skin. * Jaundice. Because bilirubin is not secreted so easily from theliver cells in cirrhosed

livers, it builds up in the blood, leading tojaundice, with its typical yellow colour of the skin and whites of theeyes. * Gallstones. Gallstones can occur in cirrhosis because not enoughbile

is being secreted from the liver and so not enough bile reaches thegallbladder.

* Reddening of the palms of the hands. * Enlarged breast tissue in men (doctors call this gynaecomastia).This is because oestrogen is not broken down as normal in the livercells and so builds up. * Mental disturbances. If your liver is cirrhosed it no longerfilters out toxins effectively. This causes the toxins to build up inthe blood, which can cause mental impairment. At first this may be mild,such as poor concentration, forgetfulness or not being able to completesimple tasks, but may progress to personality changes, even coma. * Sensitivity to medicines. Most medicines that are taken by mouthare absorbed in the digestive tract and then into the bloodstream. Theythen pass through the liver. When the liver is cirrhosed, it does notfilter medications as effectively as normal, which may lead to thebuild-up of medications in the body which may increase the side effectsof the medication. * Varices. These are enlarged veins that can form in theoesophagus (gullet) due to high venous blood pressure in the liver.Blood from the intestines and spleen is normally pumped to the liver inthe portal vein. If cirrhosis has damaged the liver, reducing venousblood

flow through the liver, then the pressure in the portal vein risesand

causes the blood to flow through other veins to return to the heart.The

new blood vessels can become large and they have thin walls. Becausethe

blood pressure inside them is high, if they break there will be aserious

bleeding problem. Swelling of the spleen and haemorrhoids are 2other

consequences of raised portal venous pressure. How is cirrhosis diagnosed?Your doctor can usually diagnose cirrhosis quite easily by

physicallyexamining you and taking a history of any symptoms you may have. Thedoctor will be able to feel whether your liver is enlarged by gentlypushing on your abdomen. Usually if cirrhosis is suspected, other testssuch as blood tests or a liver biopsy are done

to confirm the diagnosisand identify the cause. What is the treatment for cirrhosis?Because cirrhosis is irreversible, treatment

aims to stop the diseasefrom getting any worse. The treatment you are offered will depend on thecause of your cirrhosis. If you are a heavy drinker, you must stop consuming alcohol. Your doctorwill

be able to provide you with a comprehensive plan to help you to doso.

The outlook for your disease is not good if you continue to drink -whereas

the benefits of stopping are enormous. You will halt theprogression

of the disease from day one and will also feel much better.Talk to your doctor today. There are many methods available to help you.If

your cirrhosis is caused by viral hepatitis, you may be treated withanti-viral

drugs to reduce permanent damage. Autoimmune hepatitis may betreated

with steroids. Cirrhosis caused by 's disease is treated with

medications toremove the excess copper from the body. Similarly, cirrhosis caused byhaemochromatosis is treated by letting blood every so often to use upthe excess iron in the body. Some symptoms of cirrhosis can be helped by medications. Ascites andfluid

retention can be treated with medicines known as diuretics thathelp

remove excess fluid. A low-sodium diet can also help with theseproblems.

Medications may be given to help reduced mental functioning and herealso your doctor may advise making changes to your diet to assist thisprocess. Also, if itching is a symptom, your doctor will probably beable to prescribe something to help stop or reduce the itching. If cirrhosis is very severe and the liver stops working, livertransplantation is the only option. It is often recommended whensymptoms become difficult to control by other methods. Transplants arenot usually given to people with cirrhosis who are actively usingalcohol or drugs, although people who have cirrhosis as a result ofheavy drinking, and who can show that they have stopped, may be goodcandidates for transplantation. In all cases

of cirrhosis of the liver a healthy balanced diet andavoidance of alcohol are essential. The problem with the gene pool? No lifeguards!

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