Liver Cirrhosis

Introduction to Liver Cirrhosis

Liver Cirrhosis is an advanced stage of chronic liver disease associated with permanent distortion of the liver architecture and replacement of some destroyed hepatocytes with fibrous tissue
It is accompanied by some loss of liver function leading to certain recognized symptoms and signs

Etiology of Liver Cirrhosis

  • Its etiology is similar to some causes of acute liver diseases
  • No known etiology in up to 30% of cases

Clinical features of Liver Cirrhosis

Varies with the extent of liver damage:

  • Fatigue
  • Ascites
  • Pedal oedema
  • Haematemesis
  • Liver may be shrunken or enlarged below the costal margin; it is typically firm

Differential diagnoses

  1. Granulomatous lesion of the liver
  2. Primary or secondary neoplasms of the liver

Complications of Liver Cirrhosis

  • Intractable oedema.
  • Upper gastrointestinal tract bleeding
  • Coagulopathy
  • Hepatic encephalopathy
  • Hepato-renal syndrome

Investigations

  • LFTs and Serum proteins
  • PT, PTTK,
  • Liver biopsy
  • Ultrasound examination of the liver
  • Screening for aetiologic factors in chronic liver disease e.g. viral markers for hepatotrophic viruses (e.g. Hepatitis B & C)

Treatment objectives

  • Prevent further liver damage
  • Prevent deterioration of liver function
  • Symptomatic relief from anaemia, fatigue and oedema

Non-drug treatment

  • Encourage high fibre and low salt diet
  • Enhance opening of bowel
  • Correction of anaemia
  • Reduce oedema and ascites

Drug treatment for Liver Cirrhosis

Ascites and pedal oedema:

  1. Spironolactone tablets 25 – 100 mg orally 12 hourly
  2. Furosemide 20-80 mg orally 12 hourly
  3. Salt-poor albumin for intractable ascites

Prevention of variceal bleeding:

  1. Propranolol 40-80 mg orally daily
  2. Isosorbide mononitrate 10mg orally thrice daily

Replacement of damaged liver:

  1. Liver transplant
  2. Prevention of encephalopathy
  3. Institute measures as outlined in section on hepatic encephalopathy

Prevention

  1. Immunization against hepatitis B, C
  2. Abstinence from alcohol