Cirrhosis

What is cirrhosis?

Cirrhosis is a condition in which large areas of the liver become very badly scarred due to chronic injury. Scar tissue replaces healthy liver tissue, partially blocking the flow of blood through the liver and prevents it from working correctly. Unfortunately, the scarring is permanent; but treatment can stop or slow down further progression and reduce complications.
Scarring also impairs the liver’s ability to:
- control and fight infections
- remove bacteria and toxins from the blood
- process nutrients, hormones, and drugs
- make proteins that regulate blood clotting
- produce bile to help absorb fats—including cholesterol—and fat-soluble vitamins
- store energy for when you need it

A healthy liver is necessary for survival. It is able to regenerate most of its own cells when they become damaged. With end-stage cirrhosis, the liver can no longer effectively replace damaged cells.

Cirrhosis Causes

Cirrhosis has various causes. Cirrhosis can occur as the result of many long-term liver diseases, such as different types of hepatitis or medical conditions people are born with. However, it can also be caused by things like infections, drug and/or alcohol abuse, or a blocked bile duct. Sometimes the cause of cirrhosis remains unknown, even after a thorough medical examination. Many people with cirrhosis have more than one cause of liver damage.

Main causes of cirrhosis are:

1. Alcohol-related liver disease.
Most people who consume alcohol do not suffer damage to the liver. But heavy alcohol use over several years can cause chronic injury to the liver. Men and women respond differently to alcohol. Most men can safely consume two to five drinks a day, however, one or two drinks a day can cause liver damage in women. Individual tolerance to alcohol varies, but people who drink a lot and drink more often have a higher risk of developing cirrhosis. In some people, liver scarring  can be caused by one drink a day.

2. Chronic hepatitis B,D and particularly C. The hepatitis C virus is a liver infection that is spread by contact with an infected person’s blood. Chronic hepatitis C causes inflammation and damage to the liver over time that can lead to cirrhosis. The hepatitis B virus is a liver infection that is spread by contact with an infected person’s blood, semen, or other body fluid. Hepatitis D is another virus that infects the liver and can lead to cirrhosis, but it occurs only in people who already have hepatitis B.

3. Autoimmune hepatitis. This form of hepatitis is caused by the body’s immune system. It is attacking liver cells and causing inflammation, damage that leads eventually to cirrhosis. Researchers believe genetic factors may make some people more prone to autoimmune diseases (70 % of those are female).

4. Nonalcoholic fatty liver disease (NAFLD). Fat builds up in the liver and eventually causes cirrhosis. This disease is strongly associated with obesity, diabetes, protein malnutrition, coronary artery disease, and corticosteroid medications.

5. Diseases that damage or destroy bile ducts. Several various diseases can damage or destroy the ducts, causing bile to back up in the liver and leading to cirrhosis. It is a biliary cirrhosis (the bile ducts become inflamed and damaged and, in the end disappear or the ducts are mistakenly tied off or injured during gallbladder surgery), sclerosing cholangitis, biliary atresia (In infants, damaged bile ducts due to ducts absence or injury).

6. Inherited diseases. 
- a lack of a specific liver enzyme (alpha-antitrypsin deficiency)
- the absence of a milk-digesting enzyme (galactosemia)
- an inability to convert sugars to energy (glycogen storage disease)
- an absorption deficit in which excess iron is deposited in the liver, pancreas, heart, and other organs (hemochromatosis)
- a disorder characterized by accumulations of copper in the liver, brain, kidneys, and     corneas (Wilson's disease)

7. Drugs, toxins, and infections. Other causes of cirrhosis include drug reactions, exposure to toxic chemicals, parasitic infections, and repeated episodes of heart failure with liver congestion. Usually years of chronic injury are required to cause cirrhosis.

Symptoms of Cirrhosis   

Many people with cirrhosis have no symptoms in the early stages of the disease. If a person with early cirrhosis does have symptoms, they may include:
- weakness
- fatigue
- loss of appetite
- nausea
- vomiting
- weight loss
- abdominal pain and bloating when fluid accumulates in the abdomen
- itching
- spiderlike blood vessels on the skin
- exhaustion

As the liver continues to be damaged and scarred, it may stop performing one or more of its normal functions.
 
When the liver becomes badly damaged with cirrhosis, a number of late symptoms can begin to appear and these are:
- a worsening of jaundice (yellowing of the skin and the whites of the eyes)
- fluid buildup in the stomach area and legs
- a slowing of mental function
- bruising or bleeding easily, including frequent nosebleeds
- intense itching
- personality changes
- stomach bleeding
 
Severe cirrhosis may also develop several complications:
- Diabetes
- Sensitivity to medication
- Gallstones
- Rheumatoid arthritis
- Osteoporosis
- Liver cancer
- Coma or death.

Prevention

What is worth to remember, elimination of alcohol abuse may prevent 75-80% of all cases of cirrhosis.

Other preventive measures are:
- taking precautions such as practicing safe sex and avoiding dirty needles to prevent hepatitis
- getting a vaccine against hepatitis if a person is in a high-risk group
- receiving proper medical treatment quickly when diagnosed with hepatitis
- having blood drawn at regular intervals to clear the body of excess iron from hemochromatosis
- using medicines to relieve the body of excess copper from Wilson's disease
- wearing protective clothing and following product directions when using toxic chemicals at work, at home, or in the garden

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