Cirrhosis: This chronic disorder is marked by
diffuse destruction and fibrotic regeneration of hepatic cells. As
necrotic tissue yields to fibrosis, cirrhosis alters liver structure and
normal vasculature, impairs blood and lymph flow, and ultimately causes
hepatic insufficiency. It is twice as common in men as in women –
particularly among malnourished chronic alcoholic patients over age 50.
Mortality is high; many patients die within 5 years of onset
Portal, nutritional or alcoholic cirrhosis also known as Laennec’s cirrhosis,
is the most common type, results from malnutrition, especially of dietary
protein, and chronic alcohol ingestion.
Biliary cirrhosis results from bile duct diseases.
Postnecrotic (posthepatitic) cirrhosis stems from various types of hepatitis
Pigment cirrhosis may stem from disorders such as hemochromatosis
In 10% of patients, cirrhosis has no known cause.
Symptoms:
Gastrointestinal – usually early and vague – Anorexia, indigestion,
nausea and vomiting, constipation or diarrhea, dull abdominal ache
Respiratory: Pleural effusion, limited thoracic expansion
Central nervous system: progressive symptoms of hepatic encephalopathy,
including lethargy, mental changes, slurred speech, asterixis (flapping
tremor), peripheral neuritis, paranoia, hallucinations, extreme obtundation,
and coma
Hematologic: bleeding tendencies (nosebleeds, easy bruising, bleeding
gums), anemia
Endocrine: testicular atrophy, menstrual irregularities, gynecomastia,
loss of chest and axillary hair
Skin: severe pruritus, extreme dryness, poor tissue turgor, abnormal
pigmentation, spider angiomas, palmar erythema, possibly jaundice
Hepatic: jaundice, hepatomegaly, ascites, edema of the legs
Miscellaneous: musty breath, enlarged superficial abdominal veins,
muscle atrophy, pain in the right upper abdominal quadrant that worsens
when the patient sits up or leans forward, palpable liver or spleen, temperature
of 101 degree to 103 degree F, bleeding from esophageal varices.
Treatment:
Treatment aims to remove or alleviate the underlying cause of cirrhosis,
to prevent further liver damage, and to prevent or treat complications.
High protein diet (but this may be restricted by developing hepatic
encephalopathy.)
Sodium is usually restricted to 200mg to 500mg per day and fluids to
1,000 to 1,500 ml/day
Hospitalization: if the patients condition continues to deteriorate,
he may need tube feeding
Rest, moderate exercise, and avoiding exposure to infections and toxic
agents are essential.
Paracentesis and infusion of salt poor albumin may alleviate ascites.
A LeVeen shunt may be used
Surgical procedures include ligation of varices, splenectomy, esophagogastric
resection, and surgical shunts to relieve portal hypertension
Programs for preventing cirrhosis usually emphasize avoiding alcohol