What does the course of the disease look like?
Cirrhosis of the liver usually progresses over several years. Due to various liver-damaging substances (drugs, alcohol, drugs, fat), the liver initially becomes fatty. In most cases, this can still be reversed if the trigger substances are adequately dispensed with.
If this is not successful, the connective tissue of the liver begins to change, which slowly becomes noticeable in the form of cirrhosis of the liver. Initially, the liver enlarges (usually with the fatty degeneration of the organ).There is a deterioration in the synthesis performance, gradually the coagulation function decreases and the accumulation of blood degradation products occurs. The production of proteins is also reduced, so that over time more and more water retention occurs in the abdomen. In advanced stages, the increased accumulation of toxic metabolic products also leads to brain involvement, known as encephalopathy. In the final stage, the liver is again small and nodularly remodeled, there is little clotting, many bypass circuits of the liver are found and cognitive performance decreases due to brain involvement.
FrequencyEpidemiology
The incidence (occurrence) in the western world is about 250 per 100,000 inhabitants per year, and is about twice as high among men as among women.
The diagnosis of liver cirrhosis
In the blood count, cirrhosis of the liver is shown on the one hand by specific liver values. The so-called transaminases (ALT and AST) are elevated. GLDH, alkaline phosphatase and gamma-GT are also usually elevated.
The bile stasis also prevents the blood dyes from being excreted sufficiently, so that the bilirubin in the blood count is elevated. If the detoxification via the liver is no longer sufficient, the ammonia level in the blood can also rise. In addition, the synthesis disorder of the liver becomes noticeable by reduced coagulation values.
The total protein in the blood, especially albumin, decreases. Ultrasound shows that the liver is bumpy and knotty. In addition, the shape of the organ changes so that the otherwise acute angle of the liver is rounded.
The liver tissue itself shows up with connective tissue changes, which are manifested by inhomogeneities (structures with varying echo density). In cirrhosis, the liver is usually initially enlarged, and later the organ contracts, resulting in a reduction in the size of the liver. In the late stages, ultrasound also reveals complications of cirrhosis of the liver. This results in a reduced number of small liver veins, while the largest liver vessel (portal vein) appears dilated. In addition, water retention in the abdomen (ascites) can be easily diagnosed using ultrasound.
