In this episode we talk about the fearful liver cirrhosis, a serious liver disease that arises as a complication of other hepatic diseases, neglected or not adequately treated.
Cirrhosis of the liver is a serious disease of the liver caused by repeated damage to its cells. More precisely, in case of continued damage, the liver always tries to repair itself, but also forming scars. Normal liver tissue is thus progressively replaced by fibrous, non-functioning tissue. If this degeneration process is not interrupted, the accumulation of thickenings and scars obviously limits the proper functioning of the liver. For this reason, if not treated in time, cirrhosis can lead to liver failure or can even have fatal consequences.
In most cases, liver cirrhosis is caused by excessive alcohol consumption or chronic viral hepatitis. Among the less frequent causes, we can find metabolic diseases and pathologies of the biliary tract. In some cases, multiple concomitant causes can lead to cirrhosis. Let's now look in more detail at some of these predisposing conditions. The continuous abuse of alcoholic substances is certainly to be mentioned among the main causes. The liver, in fact, degrades alcohol into toxic products, some of which trigger the inflammation at the base of cirrhosis. Among the possible diseases that can damage the liver there is also the increasingly common non-alcoholic fatty liver disease, also called fatty liver. If neglected, in fact, the excessive accumulation of fat in the liver can trigger an inflammatory process, the so-called steatohepatitis; in turn, this inflammation can slowly degenerate into cirrhosis. Among the most common causes of hepatic steatosis are the binomial overweight / sedentary lifestyle. , diabetes and insulin resistance. In other cases, cirrhosis can represent a complication of viral hepatitis, in particular of chronic hepatitis from virus B, Delta or C. Among viral hepatitis, the cirrhosis associated with chronic hepatitis C, which is certainly the cause of more concern. correlated to a high risk of evolution towards hepatocarcinoma. From the possible causes of cirrhosis the intense and prolonged use of some drugs and exposure to toxic agents are not excluded. Liver cirrhosis can also derive from primary biliary cirrhosis, as well as from other inflammations of the biliary tract Some metabolic disorders, such as hemochromatosis and Wilson's disease, are also among the causes of liver cirrhosis, which consist respectively of an excessive accumulation of iron and copper in the liver.
In the early stages of liver cirrhosis, symptoms may also be absent. Often, in fact, the disorders associated with the disease only become evident when the damage to the organ is now extensive, and the liver no longer functions properly. In this regard, it should be noted that liver cirrhosis is in any case a chronic disease with a very slow evolution. Indicatively, 15-20 years pass from the onset of the pathological process to the onset of symptoms. Over time, as the formation of scar tissue in the liver increases, weakness, loss of appetite and nausea, itching, edema of the lower limbs (therefore swelling of the legs), bleeding and frequent bruising may occur. Edema and coagulation defects result from impaired liver function, which is no longer able to synthesize adequate amounts of proteins, including albumin and other plasma proteins. Furthermore, in the event that the liver is no longer able to eliminate bilirubin from the blood, another indicative sign of cirrhosis is jaundice, which consists of yellowing of the skin and the sclerae of the eyes.
The possible complications of liver cirrhosis can be life-threatening. Among the most serious consequences are liver failure and portal hypertension; the term hepatic insufficiency indicates the inability of the liver to perform its functions, while portal hypertension consists of an increase in blood pressure in the vessels going to the liver. Let's focus, for the moment, on the latter. The formation of hepatic scarring impairs normal blood circulation within the liver. Due to the occlusion of these vessels, an increase in pressure in the portal vein can occur. The portal vein is a large vessel that carries blood from the intestine and spleen to the liver. As blood struggles to pass from these organs to the liver, portal hypertension is associated with an enlarged spleen, called splenomegaly, and the accumulation of fluids in the abdomen, known as ascites. Another possible consequence of hypertension portal is the formation of varices in the lower portion of the esophagus. If the pressure inside them becomes excessive, the blood vessels involved in this pathological dilation can also undergo rupture. As regards hepatic insufficiency, in the long run, nodular fibrosis of the liver tissue can seriously compromise the functions of the liver. In addition to the already mentioned decrease in protein synthesis, the ability of the liver to carry out its detoxifying action obviously also decreases, so they can increase the toxic substances in the blood. The accumulation of these substances can have negative effects on the functions of the brain and lead to hepatic encephalopathy, that is a form of brain suffering that manifests itself with confusion, drowsiness and can even lead to coma. , in case of cirrhosis the organism can undergo malnutrition, due to the inability to adequately process the nutrients.We have already anticipated, moreover, how liver cirrhosis increases the risk of liver cancer.
The diagnosis of liver cirrhosis begins, as usual, with the physical examination; during the visit, the doctor will evaluate the general condition of the patient, looking for some typical skin signs, in addition to the enlargement and hardening of the liver. for example, yellow skin, spider-shaped small dilated blood vessels, edema or ascites. To confirm the diagnosis, your doctor may do further investigations, including blood tests, ultrasound, and liver biopsy The blood tests allow to highlight the alterations of various substances, such as bilirubin and liver enzymes (which tend to increase), but also albumin, platelets and coagulation factors which tend to decrease. Ultrasound, on the other hand, evaluates particular characteristics of the liver suggestive of cirrhosis, such as irregular nodular areas and the "enlargement of the organ, as well as of the spleen; the "addition of the Doppler examination to the" ultrasound also allows to highlight the alterations in the flow of the portal vein. Finally, the liver biopsy allows to evaluate under the microscope the extent and extent of damage to the liver cells.
Even if liver cirrhosis is an irreversible condition, it is still possible to limit the onset of life-threatening consequences. The treatment, which must clearly be as early as possible, has the objective of blocking or slowing the progression of the disease, reducing symptoms and preventing further damage to the liver at the same time. As anticipated, it should be emphasized that unfortunately the current therapies are not able to regress already developed lesions. Treatment of liver cirrhosis can be pharmacological and supportive. Basically, it varies according to the cause that produced the cirrhosis and the severity of the case. The most common therapies include the prescription of diuretics, for the control of water retention in the legs or abdomen, the integration of vitamins and mineral salts, and the use of beta-blocking drugs, in order to reduce the pressure in the portal vein. . As a general rule, it is important to avoid the consumption of alcohol and follow a healthy and balanced diet, suitable for maintaining normal weight and counteracting the accumulation of fluids. In the most advanced stages and in selected cases, transplantation may be necessary. liver.
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