Liver Cirrhosis - Terminal Stage Of Liver Damage

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-08-25 11:04

Cirrhosis of the liver

Cirrhosis of the liver is the end stage of liver damage. It begins with a progressive increase in connective tissue (fibrosis), from which larger cirrhosis nodes (diameter: three millimeters to three centimeters) develop in the course of the disease. By converting liver tissue into connective tissue, the liver can gradually no longer adequately fulfill its tasks - e.g. metabolic and detoxification functions. Chronic liver failure develops. The speed and extent of this development can vary from person to person.

In Austria, alcohol abuse and chronic virus-induced liver inflammation, hepatitis B and C, are the top causes. Early treatment of the underlying diseases (e.g. alcohol abuse) can usually prevent further progression of the liver damage.

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How is the diagnosis made? "> How is cirrhosis of the liver treated? ">How is cirrhosis of the liver treated?

How is cirrhosis of the liver treated? >

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How is cirrhosis of the liver treated? >

What are the causes of cirrhosis of the liver?

Liver cirrhosis often results from the interaction of several liver-damaging factors. In addition to chronic viral hepatitis B and C, chronic alcohol abuse or alcohol dependence is mainly responsible for the development of liver cirrhosis. In recent years, however, non-alcoholic fatty liver (NASH) has become increasingly important in the development of cirrhosis of the liver.

Numerous metabolic diseases can lead to cirrhosis of the liver. Examples are hemochromatosis (genetic iron storage disease) or Wilson's disease (genetic reduced copper excretion in the bile). The metabolic syndrome and type II diabetes mellitus are also risk factors. In addition, heart failure or certain drugs (eg amiodarone or methotrexate) can promote the development of liver cirrhosis.

Rare causes include autoimmune liver diseases such as autoimmune hepatitis or inflammation of the biliary tract. These include primary biliary cholangitis and primary sclerosing cholangitis. Primary biliary cholangitis is a relatively rare autoimmune disease of the liver that begins in the small bile ducts and affects women in around 90 percent of cases. Primary sclerosing cholangitis is a chronic inflammation of the biliary tract inside and / or outside the liver.

What are the symptoms?

Since the liver is responsible for many metabolic and detoxification processes, liver dysfunction due to liver cirrhosis can have dangerous consequences. However, people with cirrhosis of the liver can remain symptom-free for years at the beginning of their illness.

The first unspecific symptoms are usually:

• easy exhaustion,
• Flatulence,
• Loss of appetite,
• general feeling of illness and
• Weight loss.

Symptoms of advanced liver cirrhosis

The loss of appetite often leads to malnutrition, the reduced bile secretion (release of bile into the intestine) to an inadequate absorption of fat and fat-soluble vitamins. Bile congestion (cholestasis) causes jaundice (jaundice), itching (pruritus) and xanthelasma. Xanthelasma are yellowish plaques caused by the deposition of cholesterol in the tissues of the upper and lower eyelids.

After tissue damage to the liver, connective tissue regenerated nodes are formed. New blood vessels form around the nodes to maintain blood flow within the liver. However, the delivery volume of this “liver circulatory system” is reduced and the pressure in the vein that carries blood to the liver (portal vein) increases. This leads to the formation of "bypass circuits" by the liver. Unsuitable veins now have to carry more blood. The high blood pressure in the portal vein system (portal hypertension) can lead to various symptoms due to secondary diseases.

Symptoms of portal hypertension

• Varicose veins in the esophagus (esophageal varices) and in the stomach as well as associated bleeding (usually recognizable by pitch-black stools - so-called tarry stools - or vomiting of red or black clotted blood),
• portal hypertensive gastropathy (special stomach disease),
• Varicose veins in the rectum and around the anus (hemorrhoids),
• Edema of the legs,
• Enlargement of the spleen (splenomegaly) with increased breakdown of blood cells,
• Enlargement of the abdominal circumference and possibly shortness of breath due to abdominal fluid (ascites); possibly with the development of peritonitis caused by bacteria (bacterial peritonitis),
• Movement, behavior and consciousness disorders with a disorder of brain functions (hepatic encephalopathy),
• Shortness of breath and decreased performance with pulmonary hypertension (portal hypertension)
• Kidney dysfunction (hepatorenal syndrome).

Other symptoms of chronic liver damage

The following symptoms are not specific to cirrhosis, but indicate chronic liver damage. They must be taken seriously as a warning sign of possible cirrhosis or liver damage that can lead to liver cirrhosis:

• Skin changes: Spider nevi (small skin vessels like spider webs), reddening of the palms of the hands (palmar erythema), shiny and hairless abdominal skin,
• white nails,
• Breakdown of muscles,
• progressive shrinkage and thickening of the connective tissue plate, usually of the hand (Dupuytren's contracture),
• Reduction in size of the testicles (testicular atrophy), erectile dysfunction and growth of the mammary glands (gynecomastia) in men,
• Menstrual cycle disorders up to the absence of menstrual bleeding (amenorrhea) in women,
• Ascites (ascites),
• Edema in the legs or position-dependent edema (possible anywhere on the body - anasarca),
• Shortness of breath and rapid pulse due to lack of oxygen due to a disorder of the lung function (hepatopulmonary syndrome),
• Symptoms of kidney failure due to a dysfunction of the kidneys (hepatorenal syndrome),
• Symptoms of heart failure when the heart muscle is damaged (hepatic cardiomyopathy),
• Bone fractures due to a decrease in bone quality (hepatic osteodystrophy),
• Symptoms of hepatic encephalopathy.

Changes in the blood

Often there is also a reduction in red and white blood cells and platelets. This can have several causes. Increased portal vein pressure creates a backlog of blood in the spleen, where more blood cells are then broken down (hypersplenism).

A decrease in red blood cells results in a reduced uptake of oxygen, a reduction in white blood cells a weakening of the defense system against pathogens. A decrease in the number of blood platelets causes an increased tendency to bleed (coagulopathy).

If alcohol abuse is the cause of liver cirrhosis, a diet-related vitamin B-12 or folic acid deficiency as well as direct damage to the blood-forming bone marrow from alcohol can be the cause.

Note A reduced formation of vitamin K-dependent coagulation factors (factor II, VII, IX, X) in the liver due to a liver dysfunction additionally increases the risk of bleeding.

How does cirrhosis of the liver work?

The course of the disease is difficult to predict in individual cases and depends on numerous factors, such as

• Cause of liver change,
• Severity of the clinical picture,
• Accompanying complications,
• Concomitant diseases,
• Alcohol consumption, even in the smallest amounts (significantly worsens the prognosis).

An acute stress on the liver (e.g. from a viral infection or a drug) can suddenly and drastically worsen decreased liver function due to liver cirrhosis.

How is the diagnosis made?

For the diagnosis, the doctor collects the risk factors (e.g. alcohol abuse, metabolic syndrome, liver-damaging substances - e.g. medication) and existing symptoms.

During the physical examination, the doctor can palpate a liver with a relatively firm consistency and blunt edge in the early stages. If the liver continues to shrink due to the nodular remodeling, it is often no longer palpable. In addition, she / he may see an enlarged spleen and signs of ascites. He / she may also be able to detect other signs of liver disease (e.g. spider nevi, jaundice).

A blood test will then be carried out. The liver values GOT and GPT are usually normal to slightly increased, Gamma-GT is usually moderately increased. Bilirubin is often in the normal range at the beginning and increases with increasing connective tissue conversion of the liver tissue and the resulting biliary backlog. The alkaline phosphatase can also be increased. The blood count may show a lack of red and white blood cells and platelets. In addition to the lack of blood platelets, a reduced formation of vitamin K-dependent coagulation factors (factor II, VII, IX, X) in the liver leads to a change in coagulation values. These include, for example, the aPTT, the Quick value / the PTZ or the INR. Reduced serum albumin (protein in the blood) can be observed if the liver function is already impaired.

Further blood tests can identify the causes of liver cirrhosis. In addition, the extent of liver damage and the associated effects on the body can be estimated.

With the help of imaging methods such as ultrasound or computed tomography (CT) of the abdomen, a more precise diagnosis is made (representation of the nodular architecture or changes in the liver vessels). As part of a so-called elastography, the elasticity of the liver tissue can be examined using ultrasound. Decreased elasticity is a sign of an increase in connective tissue in the liver. A tissue sample from the liver (liver biopsy) is occasionally useful to confirm the diagnosis.

How is cirrhosis of the liver treated?

An important goal of therapy is to avoid further liver damage and to prevent the progression of liver damage, which can lead to hepatic coma and death. The gradual destruction of the liver can be stopped if the causes of the cirrhosis of the liver can be eliminated in a timely manner. In the initial stage, if the triggering cause is treated effectively, a regression of the fibrosis (formation of connective tissue) is possible. In the further course of the disease, the liver damage can be prevented from progressing or, often, slowly regressed.

Complications such as blood clotting disorders, bleeding, portal hypertension, ascites or hepatic encephalopathy must also be treated. The attending doctor adjusts the necessary medication to the liver dysfunction and, if necessary, discontinues stressful medication.

A drug treatment of cirrhosis of the liver, independent of the cause, is hardly possible and has primarily a supportive character.

Any alcohol consumption should be strictly avoided, as it significantly worsens the course of the disease. Patients can also make an important contribution through a healthy, high-energy and protein-rich diet. A mineral and vitamin supplement (supplements) is also useful if there is a corresponding deficiency. Diet can also affect some complications. In the case of ascites, for example, a reduction in salt consumption and reduced fluid intake may be necessary. The doctor can provide precise information on this, or he / she will refer you to a dietician.

In the end-stage of liver disease, liver transplantation is the only treatment option for suitable candidates.

Note Bleeding from varicose veins in the esophagus or stomach is a life-threatening complication that requires immediate hospitalization. A gastroscopy is used to try to stop the bleeding and, if necessary, blood is administered.

How is long-term care provided for liver cirrhosis?

If you have known cirrhosis of the liver, certain examinations are carried out at regular intervals. The attending physicians make regular appointments for check-ups, which should be strictly observed.

It is important to repeatedly check the progression of the liver damage and to detect possible complications early by means of blood tests and imaging tests. For example, regular early diagnosis tests for liver cell carcinoma (AFP in the blood, liver ultrasound) are of particular importance.

Control gastroscopy (gastroscopy) is often necessary to detect the formation of varicose veins in the esophagus or stomach and, if necessary, to treat them.

Vaccination against hepatitis A and B is urgently recommended for patients with liver cirrhosis in order to avoid further liver damage from a virus infection.

How can cirrhosis of the liver be prevented?

The early detection of liver diseases and their consistent treatment is particularly important in order to avoid liver cirrhosis.

Excessive alcohol consumption over a long period of time damages the liver permanently and can lead to liver cirrhosis. Therefore, alcohol consumption should not exceed certain limits. See "Alcoholic Liver Disease" for more information.

A vaccination against hepatitis B is recommended to prevent liver cirrhosis.

Overweight people can reduce the risk of developing fatty liver by changing their diet and exercising regularly.

People with liver disease should avoid drugs that could potentially damage the liver if possible. The treating physicians try to select “liver-sparing” medication as much as possible for patients with liver disease. If there is an indication of drug-related liver damage, the treating doctor will reduce the dose of certain drugs or - if possible - stop them. Self-treatment without prior consultation with the treating doctor should be avoided. In people without previous liver damage, regular liver tests should be carried out if they are taking such medication for a long time.

Note In the information leaflet for medication, you can find out whether a medication can cause liver damage under the side effects / undesirable effects.

Whom can I ask?

The diagnosis and treatment of liver cirrhosis are possible in the following facilities:

• special hospital outpatient department, e.g. hepatological outpatient department,
• Cash outpatient clinics with special hepatology clinics,
• at a department for internal medicine (focus on gastroenterology and hepatology),
• In the private practice area: Specialist in internal medicine with in-depth hepatological knowledge.

How will the costs be reimbursed?

All necessary and appropriate diagnostic and therapeutic measures are taken over by the health insurance carriers. You can find more information under What does a hospital stay cost? Your resident doctor or outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (treatment contribution) (BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (ie doctor without a health insurance contract). For more information, see What does a hospital stay cost, a doctor's visit: Costs and deductibles.

For certain non-drug treatments (e.g. physical therapy) - in some cases only when a certain level has been reached - approval from the health insurance provider may be required.

For certain services (e.g. medical aids and medical aids) - depending on the health insurance provider - patient co-payments are provided. Most health insurance providers provide for a permit, sometimes depending on the type of medical aid. The prescription fee has to be paid for medication on a “prescription”. For more information about the respective provisions, please contact your health insurance provider, which you can find on the social security website, for example.