Cirrhosis is a condition where normal liver tissue is damaged and replaced by fibrous tissue. It is an irreversible condition. Small or large nodules form over the surface of the liver. Liver is a vital part of the body responsible for digesting fats, producing proteins and clotting factors and removing toxins from the body. Therefore damage to the liver impairs these functions and has damaging effects on entire body. Alcohol remains one of the most common causes for precipitating cirrhosis of the liver. Fatty infiltration of liver due to diabetes, obesity, inflammation of the bile duct as in cholangitis, viral hepatitis like B and C types, protozoan infections like schistosomiasis, are some of the other conditions that lead to cirrhosis. It can also develop in the late stages of chronic heart failure, due to impaired perfusion of the liver. Pain killer drugs like acetaminophen, NSAIDS(non steroidal anti-inflammatory drugs) also can cause damage to the liver and cirrhosis over a period of time. Certain herbal products used as traditional medicine also cause liver toxicity. Due to destruction of the liver tissue in patches and formation of fibrous tissue, pressure is exerted on the smaller branches of the portal vein. This leads to portal hypertension, which results in accumulation of fluid in the peritoneal cavity, a condition known as ascites. Portal hypertension can lead to increased pressure on the smaller veins at upper end of esophagus or near rectum, resulting in bleeding. In the beginning the patient may have vague symptoms. But as the disease progresses, he develops loss of appetite, weakness, breathlessness, distended abdomen and swollen feet. In case of men, the breasts may become enlarged. He may develop sexual impotence. In advanced disease, one may become disoriented, unconscious or comatosed, a state called hepatic encephalopathy. By this time the kidney function also fails, adding to the sickness. Ultimately the patient succumbs to the illness after being sick for many days. If he survives some days more, he is at risk of developing cancer of the liver, which is equally fatal. Certain events like not eating at all, vomiting, and diarrhea causing electrolyte imbalance in the body, using drugs to reduce swelling manual removal of extra fluid from the abdomen, can precipitate hepatic encephalopathy. Diagnosis is by clinical suspicion, liver function tests and ultrasound of the liver. Biopsy is needed to confirm the diagnosis. There is no available medical treatment for reversing hepatic cirrhosis. Whatever treatment given is only to remove the swelling, improve weakness and treat complications as they come. A definitive treatment is possible only by liver transplant . This is possible in exclusive select centers in the world and is not easy. One has to find a liver which matches with the tissues of the person. The surgery is prolonged and complicated. After that one is exposed to risks of infection and rejection of the tissue implanted. To avoid this one has to take antibiotics and immune suppressive drugs for life, which invariably produce side effects after some time. Even if he survives the transplant, quality of life is altered negatively. One can see, that after developing liver cirrhosis, it becomes a point of no return for a person to normal health. Therefore prudence demands that one takes good care of the liver and avoid substances that may harm it. Alcohol, a fat rich diet, indiscriminate use of painkillers and antibiotics, all these should be avoided. Care while taking pricks, safe sex, can prevent hepatitis B and C. A healthy, disciplined life is necessary to avoid liver damage and its sinister sequel like cirrhosis.
