Overview
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism.
Each time your liver is injured — whether by disease, excessive alcohol consumption or another cause — it tries to repair itself. In the process, scar tissue forms. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function (decompensated cirrhosis). Advanced cirrhosis is life-threatening.
The liver damage done by cirrhosis generally can’t be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited and, rarely, reversed.
Symptoms
Cirrhosis often has no signs or symptoms until liver damage is extensive. When signs and symptoms do occur, they may include:
- Fatigue
- Easily bleeding or bruising
- Loss of appetite
- Nausea
- Swelling in your legs, feet or ankles (edema)
- Weight loss
- Itchy skin
- Yellow discoloration in the skin and eyes (jaundice)
- Fluid accumulation in your abdomen (ascites)
- Spiderlike blood vessels on your skin
- Redness in the palms of the hands
- For women, absent or loss of periods not related to menopause
- For men, loss of sex drive, breast enlargement (gynecomastia) or testicular atrophy
- Confusion, drowsiness and slurred speech (hepatic encephalopathy)
When to see a doctor
Make an appointment with your doctor if you have any of the signs or symptoms listed above.
Causes
A wide range of diseases and conditions can damage the liver and lead to cirrhosis.
Some of the causes include:
- Chronic alcohol abuse
- Chronic viral hepatitis (hepatitis B, C and D)
- Fat accumulating in the liver (nonalcoholic fatty liver disease)
- Iron buildup in the body (hemochromatosis)
- Cystic fibrosis
- Copper accumulated in the liver (Wilson’s disease)
- Poorly formed bile ducts (biliary atresia)
- Alpha-1 antitrypsin deficiency
- Inherited disorders of sugar metabolism (galactosemia or glycogen storage disease)
- Genetic digestive disorder (Alagille syndrome)
- Liver disease caused by your body’s immune system (autoimmune hepatitis)
- Destruction of the bile ducts (primary biliary cirrhosis)
- Hardening and scarring of the bile ducts (primary sclerosing cholangitis
- Infection, such as syphilis or brucellosis
- Medications, including methotrexate or isoniazid.
Risk factors
- Drinking too much alcohol. Excessive alcohol consumption is a risk factor for cirrhosis.
- Being overweight. Being obese increases your risk of conditions that may lead to cirrhosis, such as nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.
- Having viral hepatitis. Not everyone with chronic hepatitis will develop cirrhosis, but it’s one of the world’s leading causes of liver disease.
Complications
Complications of cirrhosis can include:
- High blood pressure in the veins that supply the liver (portal hypertension).Cirrhosis slows the normal flow of blood through the liver, thus increasing pressure in the vein that brings blood to the liver from the intestines and spleen.
- Swelling in the legs and abdomen. The increased pressure in the portal vein can cause fluid to accumulate in the legs (edema) and in the abdomen (ascites). Edema and ascites also may result from the inability of the liver to make enough of certain blood proteins, such as albumin.
- Enlargement of the spleen (splenomegaly). Portal hypertension can also cause changes to and swelling of the spleen, and trapping of white blood cells and platelets. Decreased white blood cells and platelets in your blood can be the first sign of cirrhosis.
- Bleeding. Portal hypertension can cause blood to be redirected to smaller veins. Strained by the extra pressure, these smaller veins can burst, causing serious bleeding. Portal hypertension may cause enlarged veins (varices) in the esophagus (esophageal varices) or the stomach (gastric varices) and lead to life-threatening bleeding. If the liver can’t make enough clotting factors, this also can contribute to continued bleeding.
- Infections. If you have cirrhosis, your body may have difficulty fighting infections. Ascites can lead to bacterial peritonitis, a serious infection.
- Malnutrition. Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss.
- Buildup of toxins in the brain (hepatic encephalopathy). A liver damaged by cirrhosis isn’t able to clear toxins from the blood as well as a healthy liver can. These toxins can then build up in the brain and cause mental confusion and difficulty concentrating. With time, hepatic encephalopathy can progress to unresponsiveness or coma.
- Jaundice. Jaundice occurs when the diseased liver doesn’t remove enough bilirubin, a blood waste product, from your blood. Jaundice causes yellowing of the skin and whites of the eyes and darkening of urine.
- Bone disease. Some people with cirrhosis lose bone strength and are at greater risk of fractures.
- Increased risk of liver cancer. A large proportion of people who develop liver cancer have pre-existing cirrhosis.
- Acute-on-chronic cirrhosis. Some people end up experiencing multiorgan failure. Researchers now believe this is a distinct complication in some people who have cirrhosis, but they don’t fully understand its causes.
Prevention
Reduce your risk of cirrhosis by taking these steps to care for your liver:
- Do not drink alcohol if you have cirrhosis.If you have liver disease, you should avoid alcohol.
- Eat a healthy diet. Choose a plant-based diet that’s full of fruits and vegetables. Select whole grains and lean sources of protein. Reduce the amount of fatty and fried foods you eat.
- Maintain a healthy weight. An excess amount of body fat can damage your liver. Talk to your doctor about a weight-loss plan if you are obese or overweight.
- Reduce your risk of hepatitis. Sharing needles and having unprotected sex can increase your risk of hepatitis B and C. Ask your doctor about hepatitis vaccinations.
Dr Rela Institute and Medical center is among the top most hospitals in India for Liver Transplant.But here the documantation required for Liver transplans is very strict and lengthy,which require a lot of time.In between patient condition may become critical and he or she may have bleeding in any parts of body especially brain which could possibly hamper the future prospect of patient to undergo liver transplant.
That’s exactly happened with my patient here.We had given all the required documents but lacked one.Since our patient doner was her own sister whose husband was in Dubai.
The Dr Rela Institute and Medical center demanded the affidavit of her husband from Executive Magistrate stating that her husband doesn’t have any problem for his wife donating her liver to her brother.Since Doner Husband was in Dubai it was almost impossible to make this affudavit just a day before operation.The councelling department of Rela Institute and Medical center could not make us understand about all documents requirement and thus delayed the patient liver transplant further.
We called her husband to give a written letter with his signature giving consent to her wife for her liver donation to her brother.But courier could still take 6 to 7 days to reach chennai from dubai.
Though Doner was the sister of patient and her father who was also the father of Patient and doner son had made an affidavit stating that they had no objection for her daughter and mother respectively donating her liver to her brother.
But hospital did not accept this affidavit of father and son stating that husband affidavit is also required.
We pleaded before the councellor to some how fascilitate operation as we had already submitted or deposited Rs.25 lakhs for liver transplant fee in the hispital.But they hadn’t shown mercy and same day the patient in the night had a huge bleeding deep inside the brain and hospital said that the patient is under comma and now liver transplantation operation is not possible as his huge bleed in the brain is a further insult to liver which liver couldn’t bear and further deteriorated.
We had been given only two options
1.Go with surgery of brain which involves huge risk of further bleeding and infection.
2.Medication which could again further damage liver.
Both of the above procedure had a success chance of less than 1.
So any way we could not leave the patient die we had opted for Medication as it was safe as no drilling of scull was required and thus there was no chances of further bleeding .
For past 5 days medication is on and we have to bear a cost of 1 lakhs per day without any significant progress in the patient.
Today the date is 05 wednesday 2020 and the patient is still under ICU without any significant recovery yet.
Had the liver transplant councelling department had explained the facts explicitely or had the consideration for doner husband or could find some alternatives for doner’s husband affudavit the patient life could have been saved.
His wife and two daughters will now have to bear all through her life the burden of one document .
Don’t you think that hospital could have found some way to do the operation fast and could have saved patient life.
Can some merical can
Some of the pictures of hispital and our struggle is being shared here, though the exact feeling and emotions couldn’t be expressed.I will write further to give detailed light on this topic till then we are watching patient and Rela Institute and Medical center ‘s steps and what they can do for recovery of patient.
Please comment and share.
If you’re concerned about your risk of liver cirrhosis, talk to your doctor about ways you can reduce your risk.
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https://ift.tt/2UsMtVI Technology February 05, 2020 at 04:38PM
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