Saturday 23 July 2011

Treating Liver Cirrhosis

Published in "Panorama"


When the Liver fails


In the USA alone, about 25,000 people die of liver cirrhosis every year. It is believed to be the 8th leading cause of death by disease. Consequently, we pay a heavy price in terms of human suffering, huge hospital costs and loss of productivity. What is more striking is that most people believe liver cirrhosis to be synonymous with chronic alcoholism; but this is only partly the truth!

The most common cause of liver cirrhosis is Hepatitis B and C, followed by chronic alcoholism, says Dr.Abdul Hussain Omran Mousa, Consultant, Internal Medicine, Zulekha Hospital, Sharjah. Primary Biliary Cirrhosis, a condition where the bile ducts become inflamed, blocked and scarred, is another cause of liver cirrhosis, more common in females. Other causes of liver cirrhosis include Bilharziasis, especially seen among Egyptians and Somalians, certain congenital abnormalities when babies are born with injured or absent bile ducts; in very rare instances, liver cirrhosis occurs due to inherited diseases like Wilson’s Disease, galactosemia and glycogen storage diseases. These are cases of Paediatric liver cirrhosis, not seen in adults, reveals Dr.Mousa.

What happens to a person with liver cirrhosis? How is the liver affected and what implications does it have for the individual affected by it? Explaining the vital functions of the liver in the first instance, Dr.Mousa says, “The liver is the largest organ in the body and it is vital to the proper functioning of our body. It removes toxins, bacteria and other germs from the blood, produces immune agents to control infection and makes proteins that regulate blood clotting. The liver also produces bile to enable absorption of fats and fat soluble vitamins. Hence anything that injures or damages the liver, interferes with these essential functions and exposes the life to risk.”

In Liver Cirrhosis, healthy tissue is replaced by scar5 tissue, blocking the flow of blood through the liver, thus preventing it from functioning normally. As damage to the liver cells continue, progressive liver failure develops. Dr.Mousa emphasizes, “Liver cirrhosis is always a chronic disease and once it starts, it progresses; there is nothing to bring it to normal. Whatever treatment is given, it may only slow down the progression of the disease and check the complications arising from it.”

While paediatric cases of liver cirrhosis are rare, most patients with the disease are seen between the ages of 20-40 years, reveals Dr.Mousa. Primary Biliary Cirrhosis appears to be more common in women; liver cirrhosis from Hepatitis B and C seems to be more common in men; liver cirrhosis from alcoholism develops after prolonged abuse of alcohol and the amount of alcohol that can harm the liver varies from person to person; women, however, are more easily susceptible to livert injury with lesser alcohol intake than men.

What are the symptoms of cirrhosis and how early do they begin to appear? “Clinically there is no specific sign; the only thing we can say is that a certain patient has a chronic liver disease which could progress to cirrhosis, says Dr.Mousa. “Usually there are a lot of silent symptoms. In general, the most common symptom attracting attention is the jaundice and the patient looks weak and debilitated. The other symptoms are distended abdomen with fluid collection in it, lower gastrointestinal tract bleeding, blood in vomit and stools and sometimes bleeding under the skin.”

Many people with cirrhosis have no symptoms in the early stages of the disease. But as scar tissue replaces healthy cells, liver functions deteriorate, at which stage the patient may experience fatigue, exhaustion, appetite loss, nausea and weight loss. Dr.Mousa reassures, “This does not mean that if a patient has jaundice, he has cirrhosis or that if he has abdominal bleeding, he has cirrhosis. These are only presentations of liver disease.”

To confirm liver cirrhosis, explains Dr.Mousa, “we need to undertake investigations other than clinical examination and history taking of the patient. A Liver Function Test needs to be done to check various parameters. But this test is not a definitive investigative tool to diagnose cirrhosis. Only a liver biopsy will confirm diagnosis.”

Once diagnosis of cirrhosis is confirmed, what is the treatment given? Dr.Mousa repeats, “Liver dmage from cirrhosis is irreversible. Any treatment can only halt or delay further progression and reduce complications. Treatment is symptomatic, depending on the cause of the cirrhosis. For instance, a patient might present with fluid in the abdomen and have abdominal distension. Here we seed to drain out the fluid from the abdomen. The patient may have bleeding and require drugs to arrest the bleeding or even blood transfusion. Patients who go into coma may require to be maintained with IV fluids and given enema to remove toxins from the bowel. Antiviral drugs would be given to treat cirrhosis resulting from Hepatitis B and C. Alcoholics would be taken off alcohol.”

Continuing on the treatment modality Dr.Mousa explains, “But in advanced liver cirrhosis, Liver Transplantation is the only treatment option. Only a very small minority of patients with Hepatitis B or C who pass into liver cirrhosis, respond to treatment with antivirals. So mortality is very high if patients have advanced cirrhosis.”

What are the complications arising from cirrhosis? “Loss of liver functions bring their own set of problems,” explains Dr.Mousa. When the liver fails to make the protein albumin, there will be water accumulation in the legs and abdomen. Bile may not reach the gall bladder on account of the cirrhosis, leading to the formation of gall stones. The liver may lose its ability to produce the proteins needed for the clotting of blood. This will then make the person bruise or bleed easily. When the liver is damaged, it fails to remove poisons from the blood, causing them to accumulate in the blood and eventually also in the brain. These can have serious consequences like coma and even death..

Cirrhosis slows the normal blood flow through the portal vein to the liver. This increases the pressure inside the vein, causing portal hypertension. Slow blood flow through the portal vein causes blood from the intestines and spleen to back up into the blood vessels in the stomach and foodpipe. As a result, these blood vessels may enlarge since they are not meant to carry such a quantum of blood. The pressure thus builds up in these enlarged vessels which have a thin wall; hence they could burst, causing bleeding in the upper stomach or foodpipe. This is an emergency situation requiring immediate medical attention.

Finally liver cirrhosis results in a compromised immune system, making the patient easy prey to all kinds of infection.


E N D

No comments:

Post a Comment