The liver is an important organ in the human body, and it can lose its vital functions during the pathological stages. These stages may be severe and asymptomatic. 60% of patients may have clear symptoms, while 20% develop cirrhosis invisibly, and they are not diagnosed. Cirrhosis of the liver except after death.
Knowing what happens at each stage of the disease and recognizing its symptoms can prevent cirrhosis from developing. End-stage chronic liver disease leads to cirrhosis and death. This article will explain the link between cirrhosis and death, what are its causes, how to treat it, and how to prevent this chronic disease.
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What is cirrhosis?
Cirrhosis is a late stage of scarring (or cirrhosis) of the liver, caused by many liver diseases, such as hepatitis and chronic alcoholism.
Every time the liver becomes injured, whether it is due to disease, excessive alcohol consumption, or some other reason, it tries to repair itself, forming scar tissue in the process.
As cirrhosis progresses, more and more scar tissue forms, which over time can replace normal, functioning tissue, causing impaired liver function that can be life-threatening. Usually, liver damage caused by cirrhosis cannot be cured, but if cirrhosis is diagnosed early and the cause is treated, the progression of the damage can be reduced and rarely treated.
What is the function of the liver?
The liver has an incredible number of functions, most of which are essential to sustain life:
- The liver helps the body metabolize nutrients (protein, fats, and carbohydrates) and stores energy in the form of glycogen .
- The liver removes toxins and foreign substances from the blood, such as alcohol and drugs.
- The liver produces a large number of proteins needed for blood to clot during bleeding.
- In the case of infections, the liver becomes active in producing proteins that help the body and the immune system to fight infection.
- The liver produces bile, which is a substance necessary for the intestine to absorb fats.
When a person develops cirrhosis, the liver cannot do these things the same as it is for healthy people.
What are the causes of cirrhosis?
There are a variety of causes and diseases that can damage the liver and lead to cirrhosis.
The most common reasons are the following:
- Chronic alcohol abuse leads to chronic viral hepatitis.
- Fat accumulation in the liver, leading to non-alcoholic fatty liver disease.
- Steroid medicines including (methotrexate) or (isoniazid).
There are less common reasons:
1. Metabolic diseases (hemochromatosis):
This genetic disease occurs predominantly in men of old age and is characterized by an increased storage of iron in the body. Excess iron builds up in various organs and damages the liver as well.
2. Antitrypsin deficiency (alpha 1 deficiency):
A hereditary disease in which the elastic tissues are increasingly destroyed by proteins. This disease in which the protein antigen is formed in the liver cells, and it cannot be expelled, and this leads to the destruction of these cells, and thus to cirrhosis.
3. Cystic Fibrosis:
The most common inherited metabolic disorder is characterized by an abnormality in the mucus-producing glands, the glands in the lungs and digestive system producing more and more sticky secretions. This secretion is difficult to remove from the body and thus damages liver tissue.
4. Wilson’s disease:
In this hereditary disease, copper cannot be excreted sufficiently from the body, the mineral accumulates in various organs, the result can be cirrhosis and memory disorders.
5. Chronic heart failure on the right side:
The right ventricle’s pumping capacity becomes very weak, causing congestion in the liver. This increased pressure damages liver tissue and can lead to cirrhosis.
6. Bud-Chiari syndrome:
If there has been a blockage in the veins of the liver from birth, or later in life due to clots or tumors, cirrhosis can occur.
In tropical countries, infection with flukes is one of the main causes of cirrhosis. Larvae enter the blood or lymphatic system through contaminated water through the skin, and develop into adult worms in the liver. Additionally, the worm eggs can block the portal vein and thus damage liver tissue.
8. Primary cholangitis (known as primary biliary cirrhosis):
The bile ducts are damaged due to the autoimmune process, resulting in secondary liver damage. Patients may be asymptomatic or experience fatigue, itching, and hyperpigmentation.
What are the common symptoms of cirrhosis?
Cirrhosis can take a long time to develop, and symptoms may be slow to appear. Early symptoms may include:
- Fatigue and severe weakness.
- Dark urine.
- memory loss.
- Swelling in the legs, feet, or ankles (edema).
- Weight loss.
- Itchy skin.
- Yellowing of the skin and eyes (jaundice).
- Fluid accumulation in the abdomen (ascites).
- The appearance of spider web-shaped blood vessels in the skin.
- Redness on the palms of the hands.
- Absence or loss of menstruation in women, loss of sex drive, breast enlargement (gynecomastia), or testicular atrophy, and male infertility.
- Confusion, drowsiness and slurred speech (hepatic encephalopathy).
- A marked change in the personality and character of the patient.
- 16. The appearance of painful cracks at the corners of the mouth.
Cirrhosis and death
Doctors have classified cirrhosis into three categories to assess the severity of cirrhosis: A, B, and C.
Cirrhosis that does not cause any serious complications is called compensatory cirrhosis, that is, Class A and B cirrhosis, at this stage there are no major concerns about life expectancy.
But if the cirrhosis is very advanced, i.e. category C, the liver will not be able to compensate for the large loss of functional cells, and it can cause various life-threatening complications most often, and these complications include:
Ascites often occurs in advanced stages of liver cirrhosis, an abnormal accumulation of fluid in the abdominal cavity occurs around the internal organs, fluid accumulation increases the volume of the abdomen and makes the abdomen swell. When lying down, the fluid in the abdomen expands sideways. If fluid presses on the diaphragm, lung and heart problems can arise and may cost the patient’s life.
2. Bleeding from varicose veins in the esophagus:
Cirrhosis causes an increase in blood flow through the liver, which causes swelling of the blood vessels and veins, and here the risk lies if these veins burst, and this is called life-threatening bleeding from esophageal varices because of its serious complications, such as coughing up blood (hemoptysis), and if The patient inhaled this blood that entered the airways, and thus there is a risk of suffocation or severe pneumonia. In addition, blood can enter the intestine through the stomach and turn the stool black. Bleeding from varicose veins in the esophagus, if not treated in a timely manner, is definitely life-threatening.
3. Hepatic encephalopathy:
Hepatic encephalopathy is the most important complication of cirrhosis. About 70% of sufferers show signs of a metabolic disorder in the brain. The main reason is an increase in toxins such as ammonia in the blood, at a time when the liver is completely unable to filter these toxins from the blood. Depending on the symptoms that occur, hepatic encephalopathy is divided into four stages:
- Stage one: mood swings, lack of focus.
- The second stage: the shaky hands.
- Stage III: aggressiveness, changes in the electrical activity of the brain.
- The fourth stage: coma (hepatic coma), here the patient no longer reacts to painful stimuli, and does not feel anything at all, and it is likely that he will remain in this state from 3 months to two years, and then he dies.
4. Hepatocyte cancer:
HCC is the most common cause of death in people with cirrhosis. HCC can feel pain in the right upper abdomen. However, symptoms do not always occur in the early stages.
Screening for early signs of cancer is often done as a preventive measure, and unfortunately the diagnosis is often made late.
Cirrhosis is associated with a significantly poor lifestyle and an increase in the death rate, and expert doctors were able to determine the approximate average age for each stage of cirrhosis, which is as follows:
- The average life expectancy of Class A cirrhosis is approximately 15-20 years.
- The average life expectancy of category B cirrhosis is approximately 6 to 10 years.
- The average life expectancy of category C cirrhosis is only 1 to 3 years.
Studies show that people with severe cirrhosis are about 30 times more likely to die if they contract Covid 19 compared to people with only chronic cirrhosis.
The results of this study were reported by 14 experts from the United States, Spain and the United Kingdom.
How is cirrhosis diagnosed?
Usually the doctor will ask the patient about symptoms and individual medical history, then the doctor will make a diagnosis based on examining the patient and discovering the typical complications of cirrhosis.
Through a physical examination, the doctor may discover stiffness and enlargement of the liver upon palpation of the abdomen, which will significantly diminish in size in its later stages, and then resort to the following procedures:
When the liver does not perform the detoxification task, waste products are found in the blood that no longer break down. They also include the biliary pigment bilirubin , which is responsible for jaundice. A blood test can also reveal whether the liver is inflamed, or that the cells have already died. Bile).
With the help of an ultrasound scan, the structure and size of the liver can be shown. Liver cirrhosis complications such as: ascites, an enlarged spleen, or newly formed blood vessels (varicose veins) can also be detected.
Ultrasound may also check for hepatocellular carcinoma, portal hypertension, and portal vein pulse for Bud-Chiari syndrome (by assessing the flow in the hepatic vein).
And some doctors resort to examination of flexibility, which is also an ultrasound examination, ultrasound is sent through the liver to reveal the extent of the distortion of the liver tissue. If the patient is significantly overweight, has a build-up of water in the abdomen or has severe hepatitis, flexible imaging is not reliable.
The most sensitive and accurate is the MRI scan of the liver and bile ducts.
Cirrhosis can be diagnosed clearly by removing a portion of liver tissue (biopsy). Samples taken from the liver provide information on how many cells have already been converted into connective tissue, and how inflamed the tissue is.
Gastroscopy (endoscopic examination of the esophagus, stomach, and duodenum) is performed in patients with cirrhosis to exclude the possibility of developing esophageal varices.
Is there a cure for cirrhosis?
Treatment depends entirely on the cause of the disease, in general, it can be said that it is a matter of removing the cause that led to the cirrhosis, but any damage that has occurred to the liver can no longer be cured.
The following measures can treat and reduce disease progression:
- The patient should avoid substances harmful to the liver, and this primarily includes alcohol. If alcohol is the cause of cirrhosis, the patient should be strictly prohibited from consuming it, otherwise the disease will inevitably develop. Abstaining from alcohol not only applies to patients with alcohol-related cirrhosis, it also applies to everyone else, so that they do not develop cirrhosis.
- Some medicines damage the liver, so they should not be taken in the case of cirrhosis unless it is medically necessary. In addition, patients should always consult a doctor first before using any type of medication on their own, including over-the-counter medicines.
- Treating the underlying disease that caused the cirrhosis, for example, in the case of chronic viral hepatitis ,
- The doctor prescribes certain medications for hepatitis, in order to eliminate or control the viral infection. Patients should also seek advice from their doctor about appropriate vaccinations for them.
- In cases of ascites, water tablets (diuretics) help to flush out accumulated fluid. In addition, patients must follow a low-sodium diet, and in severe cases of ascites, a so-called perforation or paracentesis may be necessary: the doctor pierces the abdomen with a fine needle To drain the fluid through a tube.
- Liver and brain failure is treated with lactulose, antibiotics (rifaximin), and protein-free supplements.
- In severe and advanced cirrhosis, a liver transplant is often the patient’s last chance. If complications cannot be controlled or when the liver stops functioning, a liver transplant is necessary. The survival rate with liver transplantation has increased to about 80%.
Survival depends largely on disease severity and other medical risk factors in the recipient.
There is no cure for cirrhosis, but some improvement may be seen when the main cause of cirrhosis is treated or controlled.
Ways to prevent cirrhosis?
By following some steps, each person can greatly reduce the chances of developing cirrhosis, and these steps include:
- Not drinking alcohol.
- Preventing weight gain.
- Eat a low-fat diet, eat foods that contain lots of fruits and vegetables, and eat whole grains and protein sources.
- Exercising, as it greatly reduces the risk of developing liver disease.
- Drink two or more cups of coffee per day, because coffee improves liver enzymes, even in people with cirrhosis, it is effective as a type of treatment due to polyphenols , which have an antioxidant and anti-inflammatory effect.
- Liver tests every six months to a year help diagnose the disease and prevent its progression.
- Not having multiple intimate relationships without protection (condoms) because they contribute to cirrhosis.
This article contains general information only and should not be taken by the patient for self-diagnosis or self-medication.
Everyone who feels the symptoms mentioned above should see a specialist doctor as soon as possible, and conduct the required examinations and analyzes, in order to avoid life-threatening complications of cirrhosis.