Chronic disease or inflammatory processes in the liver can lead to fatty liver and, as it progresses, destroy the tissue. Liver cells are then replaced by functionless connective tissue. As a result, the liver can no longer perform its metabolic and detoxification tasks, or can do so only to a limited extent. Such cirrhosis of the liver is irreversible and, in its final stages, life-threatening. Liver cirrhosis affects more than twice as many men as women.
Causes of cirrhosis of the liver
Almost any chronic disease of the liver can progress to cirrhosis. In about half of cases, chronic abuse of alcohol is the cause. In a good third of those affected, chronic viral hepatitis is the underlying cause. Rarer causes are, for example, autoimmune diseases in the area of the bile ducts located in the liver, which lead to constant inflammatory reactions, and metabolic diseases such as Wilson’s disease or hemochromatosis, in which copper and iron, respectively, are stored in the liver and lead to cell death there.
Liver cirrhosis: symptoms and consequences
Liver cirrhosis itself usually causes symptoms relatively late; depending on the condition, symptoms of the underlying disease are initially in the foreground. The symptoms of liver cirrhosis result from the impaired performance of the liver. The main consequences are an altered protein and hormone balance, the accumulation of toxic substances such as ammonia in the blood, which also reach the brain and damage it (hepatic encephalopathy), and an increase in pressure in the portal vein. Since the scarred shrinkage of the liver makes it difficult for the blood to flow through it, it creates bypass circuits, which in turn can lead to life-threatening bleeding in the esophagus. In addition, liver cirrhosis increases the risk of liver cancer. The corresponding leading symptoms of cirrhosis of the liver include:
- General symptoms: decreased performance, fatigue, weight loss.
- Skin abnormalities: Vascular asterisks (spider naevi), lacquer lips and tongue, reddened palms, white nails, vein dilatation under the abdominal skin (signs of bypass circulation).
- Bleeding tendency, but also a tendency to clotting is possible.
- Abdominal dropsy (ascites): distended abdomen, possibly with a feeling of pressure and upper abdominal pain.
- Hormonal disturbances: Loss of libido, in men breast formation and belly baldness (loss of male hair on the abdomen), in women menstrual disorders.
- Jaundice (icterus) with yellow discoloration of the skin and eye conjunctiva and severe itching.
- Signs of brain disorders: Orientation disorder, memory problems, mental upset or mood swings, inappropriate behavior, later disturbances of consciousness until unconsciousness (liver failure coma).
On examination, such as palpation or by ultrasound, the liver shows enlarged at the beginning as a result of the disease processes. If the liver cirrhosis progresses, the liver shrinks as a result of the scarring changes and it becomes small, firm and bumpy.
Diagnosis of cirrhosis of the liver
To make a diagnosis of cirrhosis of the liver, typical symptoms and findings on physical examination are often enough. Laboratory tests, ultrasound, and abdominal ultrasonography or liver biopsy are performed to search for causes, assess the stage of cirrhosis, and plan treatment. A gastroscopy is performed to check whether there are already – potentially life-threatening – bypassing blood vessels called esophageal varices on the esophagus.
Treatment of cirrhosis of the liver
Once liver tissue has been altered, it cannot be converted back into functional liver cells. Therefore, the primary goal of therapy is to reduce progression of cirrhosis. The first priority is therefore to treat the underlying disease. In addition, it is imperative to avoid substances that can further damage the liver – especially alcohol, but also drugs, which are often detoxified via the liver. In addition, a diet adapted to cirrhosis of the liver is also advisable. In addition, the symptoms and possible complications of liver cirrhosis are treated. For example, ascites is reduced by means of medication or abdominal puncture, or bleeding from esophageal varices is stopped by means of endoscopy.In some cases, a not harmless shunt operation is also performed, in which an artificial bypass of the portal vein system is created. This portosystemic shunt protects against variceal bleeding, but increases the risk of hepatic coma. In some cases, liver transplantation can restore liver function. However, due to some exclusion criteria, such as alcohol dependence, many affected individuals are not eligible for this.
Liver cirrhosis: progression and life expectancy.
Life expectancy in liver cirrhosis depends partly on the cause, and partly on how far the cirrhosis has progressed and how well it can be prevented from worsening. If nothing is done or if, for example, the liver is further damaged with alcohol, cirrhosis will end fatally in months to a few years. The most common cause of death is hemorrhage from esophageal varices, followed by hepatic coma and combined liver and kidney failure (hepatorenal syndrome). To estimate prognosis, doctors use the Child-Pugh score. This is used to classify liver cirrhosis into stages (Child 1 to Child 3). Five criteria are relevant (three laboratory values plus ascites and the extent of brain disorders), for each of which a score of 1 to 3 is assigned. The higher the score obtained (maximum 15), the lower the life expectancy.
