Introduction
Cirrhosis of the liver is a highly complex clinical picture, which can be accompanied by numerous secondary diseases, symptoms and difficulties. Ultimately, all chronic diseases of the liver tissue lead to a remodelling of the liver cells and cirrhosis without treatment or elimination of the causes. Over time, cirrhosis of the liver restricts all liver functions and is therefore a life-threatening and, if left untreated, fatal clinical picture. In addition to the clear clinical signs and symptoms, the blood values can provide important information about the presence and severity of liver cirrhosis and its secondary diseases.
Cirrhosis of the liver can be recognized from these blood values
Cirrhosis of the liver is a chronic and incurable disease that progresses over time and results in increasing restriction of liver function. The liver performs vital filtering functions but also the production of essential substances required by the body. Transaminases, colloquially known as “liver values“, are a first indicator of beginning damage to liver tissue.
These are enzymes of the liver that enter the bloodstream when cells are damaged and can be measured there. Furthermore, enzymes of the bile ducts in the blood can also be measured as a result of liver damage, which also non-specifically indicate liver disease. Initially, the liver can compensate for the limited function well, so that no further symptoms and blood values are noticed.
Only when the majority of the liver is affected by cirrhosis do noticeable changes occur, which can be attributed to a limited filtering capacity as well as a limited production of the molecules produced in the liver. The most important and survival-relevant changes occur in the detoxification of substances such as ammonia, the clotting function of the blood, protein production and the production of blood cells and platelets. These dysfunctions can be diagnosed on the basis of the blood values and can be checked over the course of time.
Blood coagulation is a vital and complex system consisting of numerous cells, messenger substances, so-called “coagulation factors” and the blood platelets. Liver function is of great importance for the maintenance of this functioning system. If blood clotting is restricted by cirrhosis of the liver, severe insatiable bleeding can occur.
The additional formation of severe vascular changes in the course of liver cirrhosis can lead to life-threatening bleeding as an important complication. Liver function has a major influence on the production of coagulation factors. However, it can also lead to platelet disorders via an accompanying malfunction of the spleen, thus weakening blood clotting in two ways.
Typical blood values that measure the extent of the coagulation disorder are the so-called “quick value” and the “INR value”. The number of thrombocytes, the blood platelets, can also be recorded as a laboratory value. In emergency therapy for severe bleeding and advanced liver damage, the deficiencies can be treated symptomatically by transfusion of platelets and blood plasma.
The so-called liver values represent an early diagnostic tool for liver damage of all kinds. Liver values are various substances and enzymes that are normally found within the liver cells or cells of the bile ducts and are only released when the tissue is damaged and can be found increased in the blood. However, an increase in these liver values in no way indicates the presence of liver cirrhosis.
Even harmless liver damage can cause abnormal liver values. Typical are repeated alcohol consumption, inflammation of the liver and fatty liver as the cause of high liver values. However, these are in principle curable clinical pictures.
At the same time, the liver values indicate acute damage to the liver cells. Liver values can therefore be within the normal range even in the presence of liver cirrhosis, if the disease is not currently progressing and disease activity is low. Bilirubin is a breakdown product of hemoglobin, which is found in the red blood cells and is responsible for the transport of oxygen in the blood.
Bilirubin accumulates during numerous metabolic processes and an increase in bilirubin can have a variety of causes.Normally, the bilirubin produced during the breakdown of blood cells reaches the liver, where it undergoes various metabolic processes and is then excreted into the intestines with the bile. If there is an extremely high breakdown of red blood cells, liver damage or bile congestion between the liver and intestine, the bilirubin levels in the blood can increase. If the liver is damaged, large amounts of bilirubin can enter the blood and cause the typical jaundice of the eyes or skin.
However, this is by no means a specific blood value, as there may be numerous other causes behind the increase in bilirubin. Albumin is an important protein in the human body, which, together with other proteins in the blood, performs numerous functions. One of its most important tasks is to maintain the so-called “colloid osmotic pressure” in the blood.
It causes certain substances that are difficult to dissolve to become soluble and, through various processes in the blood, ensures that fluid remains within the vessels and does not pass into surrounding tissue through the vessel walls. Albumin is mainly produced in the liver with numerous other important proteins, which is why there are considerable albumin deficiencies in advanced liver damage. As a result, water retention occurs at unusual locations in the body, which can assume serious proportions.
Typical is the formation of abdominal fluid as a result of albumin deficiency. Several liters of water can accumulate within the abdominal cavity and cause subsequent symptoms. Blood platelets, also known as “thrombocytes” in the technical terminology, are an important form of cells in the blood count.
Platelets perform their most important function in blood clotting. They are responsible for the first phase of hemostasis by attaching the cells to each other with first closure of the wound. A lack of platelets can therefore lead to heavy and unstoppable bleeding.
However, a deficiency is often first noticed by small punctiform bleedings under the skin, so-called “petechiae“. Even though platelets are produced in the bone marrow, they are dependent on liver function. Due to an increased function of the spleen in the context of liver cirrhosis, the thrombocytes are increasingly broken down, causing their value in the blood to drop.
This is also a typical, but very unspecific symptom of liver cirrhosis, since reduced platelets can be attributed to numerous causes. The white blood cells comprise a number of cells of the blood which are significantly involved in the function of the immune system. The most important representatives are granulocytes and lymphocytes.
With the help of a so-called “differential blood count” it can be further distinguished which of the white blood cells are relatively elevated or decreased, which allows further conclusions to be drawn about the cause. In the context of liver cirrhosis, the deficiency of white blood cells is also caused by an overactive spleen. The hyperactivity is a direct consequence of liver damage and causes the breakdown of various cells in the blood.
In the long term, the progressive immunodeficiency leads to a considerably increased susceptibility to bacterial, viral and all other infectious agents. This results in an enormous risk for cirrhhotics to fall ill with a life-threatening infection. Many metabolic processes in the body produce nitrogen in the form of ammonia as a by-product.
This is a toxic substance which the body can normally break down and excrete without difficulty in the liver via the so-called “urea cycle”, a chain of chemical reactions. In advanced cirrhosis of the liver, these detoxification and filtration functions of the liver fail, which can lead to an accumulation of numerous other toxins in the body in addition to ammonia. Elevated ammonia levels are also found in the blood. A severe complication of liver cirrhosis is a strong increase in ammonia with damage to brain structures. This damage can manifest itself as poor concentration, trembling, loss of consciousness and ultimately coma.
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