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The Liver Advisor

Cirrhosis of the liver

Doctors refer to liver cirrhosis as the end stage of liver disease, which is associated with a pronounced increase in connective tissue and destruction of the liver lobules, and thus an extensive loss of liver function. Here you can find out more about cirrhosis of the liver. Other articles deal with other liver diseases such as toxic liver damage, fatty liver, liver inflammation, hepatitis B and C and liver fibrosis.

Definition of cirrhosis of the liver

Cirrhosis of the liver is the end stage of almost all chronic liver diseases. It can develop over years or decades. Due to the repeated process of tissue destruction and regeneration, the connective tissue (scar tissue) in the liver has occupied more than half of the organ and destroyed a large part of the liver lobules.

The liver function has fallen to a critical value and the blood flow to the liver is severely hindered by the hardening and shrinking of the organ. The blood from the portal vein comes into little contact with liver cells, which, among other things, severely affects the liver's detoxification performance. The blood of the portal vein as well as the hepatic artery backs up in front of the liver. The resulting high pressure in the portal vein causes major symptoms and complications of cirrhosis of the liver. The condition cannot be reversed. Only liver transplantation promises effective help.

Causes of cirrhosis of the liver

The causes of cirrhosis of the liver are largely the same as those of liver fibrosis. The most common causes in Germany are long-term high alcohol consumption, which is responsible for around half of all cases, and chronic viral hepatitis (hepatitis B or hepatitis C). The following overview summarizes the most important causes of liver cirrhosis:

  • long-term high alcohol consumption
  • (Other) permanently acting liver poisons
  • long-term medication use
  • chronic viral hepatitis (hepatitis B or hepatitis C)
  • Fatty liver hepatitis
  • chronic congestive hepatitis (e.g. with severe chronic heart failure)
  • prolonged congestion of the bile in the liver
  • Autoimmune diseases of the liver or biliary tract
  • rare hereditary causes (e.g. hemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency)

Symptoms and complications of cirrhosis of the liver

With cirrhosis of the liver, all non-specific and specific complaints and symptoms of liver diseases can occur. In addition, cirrhosis of the liver can be associated with some complications. The main complications of liver cirrhosis include:

  • dangerous bleeding from varicose veins of the esophagus ("esophageal varices") or the stomach with vomiting of blood or black stools ("tarry stools")
  • increased bleeding from injuries or surgery because of the liver-related disorder of blood clotting
  • Liver-related disturbance of the brain function ("hepatic encephalopathy") as a result of the reduced detoxification function of the liver
  • Liver cancer
  • Emaciation
  • increased susceptibility to infection
  • a disorder of kidney function (renal failure)

The main complications of cirrhosis of the liver are discussed in more detail in the following section.

Varicose veins in the esophagus or stomach and bleeding

Strongly dilated veins (varicose veins) in the esophagus and stomach are caused by the increased pressure in the portal vein. The blood congested in front of the liver uses these varicose veins as a bypass circuit around the liver. Especially the varicose veins in the esophagus ("esophageal varices") are prone to injury. Badly chewed, sharp-edged food residues, but also excessive stretching, for example when vomiting, can tear them and bleed profusely. The blood may be vomited or drained through the gastrointestinal tract.

If it is digested, it appears in the stool as a tough, black mass, which the doctor calls a "tarry stool". Bleeding in cirrhosis of the liver is particularly dangerous because the disease also leads to a disruption of blood clotting. The formation of important coagulation factors and also of the growth factor, which stimulates the formation of blood platelets, is greatly reduced in cirrhosis of the liver.

Liver-related disorder of brain function

Another complication of liver cirrhosis is the liver-related disturbance of the brain function ("hepatic encephalopathy"). It is a consequence of the liver's limited ability to detoxify. The liver normally converts the toxic ammonia in the blood, mainly from the intestines, into harmless urea, which is excreted in the urine. If this detoxification performance reaches a critical low, too much ammonia gets into the brain and disrupts its function.

Not only ammonia, but also other toxins such as mercaptans and gamma-aminobutyric acid can cause liver-related disorders of brain function. Mercaptans are also responsible for the typical breath odor in severe liver diseases. In addition to fatigue, concentration and memory disorders, mood swings and irritability, the ability to react decreases.

Driving a vehicle or operating machines with a high risk potential can become too risky for the affected patients and their fellow human beings. The disturbance of the brain function can develop into a hepatic coma (deep unconsciousness).

Liver cancer

Liver cancer (hepatocellular carcinoma) is more likely to develop on cirrhosis than in a healthy liver. Patients with liver cirrhosis are therefore examined regularly in order to detect the cancer as early as possible.

Diagnosis of cirrhosis of the liver

For the diagnosis of cirrhosis of the liver, all of the methods mentioned in the Diagnostics section can be used. These include:

  • Medical history (questioning the patient about his or her history, risk factors and current symptoms)
  • physical examination
  • Laboratory examination (liver values, routine laboratory, detection of hepatitis viruses)
  • Imaging procedures: e.g. ultrasound (sonography), computer tomography (CT), magnetic resonance tomography (MRT)
  • Tissue removal (liver biopsy)
  • Laparoscopy (direct view of the liver through an endoscope)

The cirrhotic liver looks inconsistent and nodular in the ultrasound image. Their edge is not thin and smooth as is normal, but rather thick and wavy. The number and size of blood vessels and bile ducts in the liver are reduced. The ultrasound also shows fluid in the abdomen (ascites) and possibly an enlarged spleen.

With special ultrasound methods (e.g. color duplex sonography), a reduced blood flow in the portal vein and an increased resistance in the hepatic artery can be detected. Other imaging tests and a liver biopsy help make an accurate diagnosis. A point value (the so-called Child-Pugh score) can be calculated from various examination findings, which enables the severity of liver cirrhosis to be classified.

Treatment of cirrhosis of the liver

The liver-damaging influence must be turned off for treatment. This often means giving up alcohol or stopping drugs that damage the liver. In addition, the lack of certain substances (e.g. vitamins, amino acids) must be compensated for.

In the case of proven zinc or B12 deficiency, these substances can be administered in a targeted manner. Sufficient energy intake with food is also important. The preservation of the liver function that is still present can be promoted by a herbal medicine with milk thistle extract. Special causes of liver cirrhosis are treated with special procedures, for example iron overload of the liver in hemochromatosis with bloodletting or autoimmune hepatitis with cortisone.

The acute treatment of complications, such as hemostasis and blood replacement for bleeding esophageal varices, the treatment of liver-related disorders of the brain function or liver cancer that has developed, is of vital importance. In the case of a liver-related disturbance of the brain function, vegetable protein is usually better tolerated than animal protein. In addition to laxative agents such as lactulose, ornithine aspartate can also be used as a detoxifying substance.

Bacterial infections or bleeding in the gastrointestinal area should be excluded as the cause, since these events can also cause liver-related disorders of brain function. Studies are currently underway on the antibiotic rifaximin, which inhibits the production of certain toxins in the intestine and thus apparently also prevents some episodes of liver-related disorders of brain function. However, further clinical data must be collected for a general recommendation.

If the cirrhosis progresses and the complications can no longer be treated successfully, the only last resort is a liver transplant.