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Brief overview:
- What is liver cirrhosis? In this disease, the liver tissue shrinks and nodular, scarred connective tissue forms, which means that the liver can no longer fully perform its functions.
- Causes: Chronic alcohol abuse and hepatitis, as well as pre-existing conditions such as fatty liver, diabetes, Wilson's disease or autoimmune hepatitis.
- Risk factors: Certain tropical diseases, certain metabolic diseases, heart failure, medications, toxins.
- Symptoms: Depending on the stage, various symptoms appear, including drowsiness, itching, loss of appetite, nausea. Later, yellowing of the skin, bad breath, tendency to bruise and others.
- Diagnosis: The doctor can already raise suspicions through a physical examination. A blood test and an ultrasound scan help to confirm the diagnosis. A biopsy provides certainty.
- Treatment: The pre-existing conditions must be treated professionally as this is the only way to stop the disease from progressing. The symptoms are treated at the same time as the cause. Accordingly, there is no single golden treatment path.
Article overview
What is liver cirrhosis?
The liver has many vital functions in the body. Its main task is to detoxify the body. For example, it breaks down alcohol, nicotine and drug residues. It also removes dead cells and pathogens from the bloodstream.
The organ produces
- hormones,
- proteins,
- bile and
- cholesterol
and stores vitamins and sugar. It is also involved in fat, sugar and protein metabolism.
In the case of liver cirrhosis, the liver can no longer fulfill these tasks.
If the doctor does not recognize liver cirrhosis in time, the patient's life expectancy is drastically reduced. If left untreated, it always leads to death from acute liver failure.
Approximately 250 out of 100,000 people are diagnosed with liver cirrhosis every year. However, health experts estimate that the number of unreported cases is much higher.
Every patient should therefore have their liver checked at regular intervals by a specialist, usually a gastroenterologist or hepatologist. This also includes a test of the liver values.
Illustration of a liver with cirrhosis © SciePro | AdobeStock
How does liver cirrhosis develop?
The main causes of liver cirrhosis include
- chronic alcohol abuse or
- chronic liver inflammation triggered by viruses (viral hepatitis B, C, D).
Fatty liver inflammation - often with the simultaneous occurrence of diabetes
- diabetes,
- the rare copper storage disease Wilson's disease or
- a so-called autoimmune hepatitis
can also lead to the development of liver cirrhosis. However, this is much less common.
In liver cirrhosis, functional liver cells are transformed into scarred connective tissue that cannot be used by the organism. This scar tissue significantly impairs the functionality of the organ. Ultimately, the liver can no longer fulfill its function as a central storage organ.
Alcohol-induced liver cirrhosis
Long-term alcohol abuse leads to the storage of toxins in the liver. The organ becomes fatty, as it stores a lot of fat over the years.
At this stage, the patient can still be treated well if they stop consuming alcohol. The pathological tissue changes can still be halted.
If this does not happen, the fatty liver cells die and shrink, i.e. they form scar tissue. This leads to liver fibrosis.
In this stage of ethyl-toxic alcohol-induced liver cirrhosis, the disease progresses inexorably.
Women generally tolerate alcohol less well than men. They therefore have a higher risk of developing cirrhosis of the liver than men if they consume the same amount of alcohol every day.
Viral hepatitis
A liver infected with the hepatitis virus type B, C or D can also lead to liver cirrhosis. People are generally at a higher risk of contracting the disease,
- who work in a medical profession,
- frequently spend time abroad or
- whose partner is suffering from liver inflammation.
Other causes of liver cirrhosis
- autoimmune hepatitis (the liver inflammation is caused by an overreaction of the immune system)
- certain tropical diseases
- certain metabolic diseases such as muscular coviscidosis
- heart failure
- medications
- toxins
Symptoms and progression of liver cirrhosis
Cirrhosis of the liver presents with unspecific symptoms in the early stages, depending on the underlying disease. It progresses in several stages (Child 1-3). In the final stage, life expectancy is low.
Signs of liver cirrhosis are
- Drowsiness
- Itching (pruritus)
- loss of appetite
- nausea
- confusion
- weight loss
- constipation
- flatulence
- Feeling of fullness in the upper abdomen
- Yellowing of the skin and eyeball
- bad breath
- Tendency to bruise
- slower blood clotting
- Increased susceptibility to infections
- Milky glass fingernails (milky discoloration)
- in women: irregular menstruation
- in men: potency disorders
- ascites (ascites): The lower abdomen increases greatly in size due to increased fluid leaking from the blood vessels into the abdominal cavity
- Hepatic encephalopathy (brain disease resulting from the inadequate removal of toxins)
- oesophageal varices(varicose veins in the oesophagus that can burst easily)
- hepatocellular carcinoma (HCC)
- Hepatic coma
Diagnosis of liver cirrhosis
As part of the physical examination, the examining doctor will palpate the patient's spleen and liver for any changes in size. He taps the patient's abdomen to determine whether water has already accumulated in the abdominal cavity.
He then checks the skin for so-called liver skin signs: These include spider naevi, for example. These are clearly visible spider-like enlargements of capillary vessels under the surface of the skin. They usually appear on the face or above the chest. The patient also has a yellow coloration of the skin and reddened palms and soles of the feet.
Location of the liver in the human body © yodiyim | Adobe Stock
A clear indication of liver cirrhosis is also a blood test with
- elevated albumin and cholinesterase levels and
- low coagulation factors II, VII, IX and X (Quick test).
Liver cirrhosis also causes increased liver enzyme levels.
The examiner uses imaging techniques such as ultrasound diagnostics to determine how large the patient's liver is and what condition it is in. The progression of the disease is measured using an ultrasound fibroscan. This allows the degree of tissue remodeling to be determined.
Computed tomography or magnetic resonance imaging(MRI) is also used in some cases.
However, the patient only has final certainty once the results of the biopsy are available. This is an examination of a tissue sample taken from the liver.
How is liver cirrhosis treated?
Liver cirrhosis can only be stopped if the disease causing it is treated optimally. Treatment is particularly effective when the disease is still at an early stage of development. However, the damaged organ cannot regenerate liver cells that have already been destroyed.
The treatment of liver cirrhosis is both causal (according to the causes) and symptomatic (based on the signs). The more successfully the underlying disease is treated, the longer the life expectancy of the liver patient. In addition, the remaining life expectancy depends on how advanced the underlying disease is.
First of all, the patient must avoid all causes. Alcohol addicts go into withdrawal, smokers stop smoking so as not to damage the liver even more. The intake of liver-damaging medication should be reduced if necessary.
The disease causing the liver cirrhosis must also be treated professionally. In later stages of liver cirrhosis, a liver transplant is often the only option. However, this does not apply to alcohol-dependent patients.
The symptoms of liver cirrhosis also require appropriate treatment. Dropsy is treated with medication and an abdominal puncture, while viral hepatitis is treated with antiviral medication.
If the patient has autoimmune hepatitis, the doctor administers drugs that dampen the immune system. If the Quick values are too low, the increased risk of bleeding is reduced by administering vitamin K.
Patients suffering from a shrunken liver must also follow a liver diet. It contains a large amount of protein and other important nutrients: those affected consume around 1.5 grams of protein per kilogram of body weight every day - unless they suffer from hepatic encephalopathy.