The liver is the largest organ in the human body , being located in the upper right part of the abdomen. The liver performs numerous functions in the regulation of the organism , in the detoxification of blood, in the defense against infections). The liver performs numerous functions in the regulation of the organism, in the detoxification of the blood, in the defense against infections of the organism, in the deposit of products of digestion and energy and in the production of bile that will assist in the digestive process .

It is a disease caused by several causes that lead to an irreversible change in the shape and functions of the liver. Most patients with cirrhosis suffer from prolonged aggression that slowly generates a process of “fibrosis” (excessive scarring) of the liver. This healing damages the structure of the liver, blocking the flow of blood and bile through the organ, transforming the “Liver into stone”.


Causes of Cirrhosis

In Brazil and in the world the most common cause of cirrhosis is hepatitis C virus . In about 10% of cirrhosis patients a specific cause is not found. Other causes and diseases that can cause cirrhosis are:

– Viruses: Hepatitis B, C, D viruses.

– Alcohol abuse.

– Diabetes, obesity, poor diet and increased cholesterol.

– Induction by drugs, drugs or toxins.

– Genetic, immune and metabolic diseases: Familial Amyloid Polyneuropathy, Autoimmune Hepatitis, Wilson’s Disease and Alpha-1-antitrypsin Deficiency.

– Cysts and diseases of the bile ducts: Polycystic liver disease, biliary atresia, Caroli, Alagille, primary, secondary biliary cirrhosis and sclerosing cholangitis.

– Blood vessel disease: Budd-Chiari disease.


Risk factors for Liver Cirrhosis

– Sex and age can be risk factors for multiple diseases that cause cirrhosis. Women are more prone to autoimmune hepatitis when young and middle-aged. Primary biliary cirrhosis occurs more commonly in women over 40 years of age.

– Family history: hemochromatosis, alpha-1 antitrypsin deficiency, Wilson’s disease, familial amyloid polyneuropathy.

– Alcohol abuse: in general> 50g / day for 10 years or more establishes a risk for the development of cirrhosis. A glass of beer, a glass of wine, or a dose of distilled beverage has the equivalent of 10 g of alcohol.

– Personal habits: use of intravenous drugs, health professionals, recipients of multiple blood transfusions and those with sexual promiscuity are at increased risk for viral hepatitis.

– Malnutrition, obesity and hyperlipidemia (high cholesterol) are risk factors for fatty liver.


Symptoms of Liver Cirrhosis

The clinical manifestations of liver diseases (liver diseases) are diverse, ranging from isolated and silent laboratory alterations to dramatic and rapidly progressive liver failure. This broad spectrum partly reflects a large number of pathophysiological processes that can injure the liver , and partly the great capacity that the organ’s reserve has to function properly even when partially affected by disease. This is due to the unique property of normal livers to regenerate. In this way, the liver returns to its initial shape, size and function after being affected by a problem. Cirrhosis can be suspected when there are clinical or laboratory findings can give clues leading to suspicion leading to hepatocytic insufficiency. These signs and symptoms may initially be subtle, such as fatigue or hypoalbuminemia or, from the beginning, present with severe illness such as hemorrhage from esophageal varices. In any case, evidence of hepatocytic insufficiency requires immediate action because of the potential benefits of treatment and the poor prognosis of established cirrhosis. Consequently, the etiological investigation must occur together with proceeding parallel to the treatment, as the diagnosis is not found in more than 30% of cases.


Early diagnosis of liver cirrhosis

It is estimated that approximately 40% of patients with cirrhosis do not have symptoms in the initial phase since the liver is a large organ with enormous capacity for regeneration and adaptation. Early diagnosis of diseases that lead to cirrhosis allows treatment, cure or control. Progression to cirrhosis is slowed or stopped. If there is no early diagnosis and in those with cirrhosis it is confirmed the liver gradually loses its capacity for regeneration, leading, there is a delay in the appearance of symptoms.


Diagnosis of Liver Cirrhosis

They are nonspecific symptoms, which can also be generated by other associated problems:

– Weakness and tiredness

– Weight loss

– Sleep disorders

Manifestations caused by changes in hormones produced or processed in the liver may also occur:

– Loss of sexual interest

– Impotence, sterility, alteration or stopping menstruation

– Men’s breast enlargement and hair loss

In more advanced stages there may be changes related to blood circulation in the liver and altered liver cell work:

– Ascites (water belly) or presence of hydrothorax (water in the pleural space leading to difficulty breathing)

– Swelling in the legs

– Kidney failure

– Ease of bleeding (gums, nose, skin) or digestive bleeding (vomiting or stools with undigested dark blood)

– Abdominal pain not localized

– Itching

– Darkening of the skin

– tremors and, cramps,

– Mental confusion ranging from mild, forgetfulness and disorientation and even coma

– Malnutrition characterized by (weight loss, muscle loss, hair loss and brittle nails

– Jaundice (yellowing): occurs due to the accumulation of bile in the blood, resulting in jaundice (yellowing)

Remember : Cirrhosis is not cancer, but it is the biggest risk factor for the appearance of primary liver cancer, hepatocarcinoma. Viral hepatitis also predisposes to the appearance of hepatocellular carcinoma. Some diseases can cause cirrhosis and cancer of the bile ducts, cholangiocarcinoma. Every person with cirrhosis should undergo frequent tests for early diagnosis of liver cancer.


Cirrhosis Diagnosis

Suspicion of an experienced doctor is of fundamental importance for diagnosis. The reporting of symptoms and examination of patients are associated with some blood and imaging tests.

Blood tests will be used to check the health of the patients as a whole, as well as test the functioning of the liver and kidneys and check for bile obstruction.

Ultrasonography can demonstrate changes in the shape of the liver, presence and signs of complications from cirrhosis. It also serves to locate portions of the liver that are suspected for diagnosis of hepatocarcinoma.

The diagnosis can only be confirmed after examining a small piece (called a fragment) of the diseased liver under a microscope. In practice, the fragment is obtained through the use of a needle through the skin , a procedure called liver biopsy. Biopsy can be performed in clinics or outpatient clinics and does not require hospitalization. Most of the time it is performed with sedation and local anesthetic, the patient is observed for a few hours and then released home.


Treatment of Liver Cirrhosis

Treatment of the disease and the causative factor that causes cirrhosis may be able to keep the liver functioning without signs of disease. Lifestyle changes can also help in the preservation of liver funação (stop all intake of alcoholic beverages). The most common complications of cirrhosis must be investigated, prevented and treated with the use of drugs, appropriate nutrition, and treatment by endoscopy. It is recommended that the patient is accompanied by an expert on the subject.

The only definitive treatment for liver cirrhosis is liver transplantation, where the cirrhotic liver is replaced (with an entire liver or part of it, in the case of interventional transplants). There is a worldwide shortage of livers for transplantation so that there are strict and specific rules and regulations on how to register for a transplant and who acquires priority for receiving in each specific situation. To determine if the patient is a candidate and will benefit from a liver transplant, he must be evaluated by several professionals (doctors, nurses, surgeons, anesthetists, nutritionists and social workers) from a transplant team registered with the Ministry of Health, inform yourself with the Hepatogastro team on how to proceed.


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