Cirrhosis of the liver

He was a young boy barely 20, who started complaining of loss of appetite and nausea. His family thought this to be the result of stress at school. After some weeks, they were alarmed to notice that his feet and abdomen had started swelling. The weakness had increased to the extent that he found it difficult to walk even short distances comfortably without getting breathless. When he was taken to hospital, he was informed after examination and tests that he was suffering from cirrhosis of the liver.Cirrhosis is a condition where normal liver tissue is damaged and replaced by fibrous tissue. Small or large nodules form over the surface of the liver. The 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 the entire body. Moreover once cirrhosis has started, the situation becomes irreversible. 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 particularly B&C, 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 the upper end of esophagus or near the rectum, resulting in bleeding. In the beginning the patient may have only vague symptoms. But as the disease progresses, he may have 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 kidneys also fail, 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, diuretic use(drugs used 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 hepatic cirrhosis. Whatever treatment given is only to remove the swelling, improve weakness and treat complications as they come. A definitive treatment is by liver transplant only. This is possible only in select centers in the world and there also lies a difficult problem. 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 sometime. Even if he survives the transplant, there remains no quality of life. In short 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. Daily exercise helps to avoid obesity and keeps the liver also free from fats. A healthy, disciplined life is necessary to avoid liver damage and its sinister sequel like cirrhosis. rachna212002@yahoo.co.uk