In completing this series of topics related to alcohol, this week I will focus on Liver Cirrhosis. As previously mentioned, liver cirrhosis is one of the more serious complications of long-term alcohol use.
Cirrhosis of the liver occurs when there is persistent inflammation and injury of the liver cells which eventually are replaced by scar tissue resulting in shrinking of the liver. This ultimately results in the liver being unable to perform its many essential functions. Though alcohol is one of the leading causes of cirrhosis there are many other causes of this condition.
Chronic viral infections of the liver with Hepatitis B and Hepatitis C are the second most common cause of cirrhosis after alcohol. These viruses are usually transmitted through sharing of needles amongst drug users, sexually and from mother to child during birth. Other causes of cirrhosis include Non-Alcoholic Fatty Liver Disease (NAFLD) which occurs usually in obese people or diabetics. It results in deposition of fat in the liver and ultimately leading to shrinkage of the liver.
Hemochromatosis and Wilson’s disease are conditions that result in excessive amounts of iron and copper respectively which is then delivered in the liver amongst other organs. The excess iron and copper results inflammation and subsequent formation of scar tissue. There are other genetic conditions which results in build up of abnormal proteins in the liver and those that results in abnormal glycogen metabolism that leads to cirrhosis. Autoimmune diseases of the liver and conditions that affects the bile ducts are also common causes of cirrhosis.
The biggest issue with cirrhosis is that it leads to increased pressure in the vessels supplying blood to the liver, called Portal Hypertension. This has a variety of complications which include fluid accumulation resulting in swollen legs and a distended abdomen. The fluid in the abdomen can get infected and lead to severe systemic infection. The enlarged bloods vessels which can also be found in the oesophagus, stomach and rectum can also rupture and lead to life threatening bleeding. The impaired function of the liver leads to a decreased ability of the liver to clear toxins, this leads to build up of toxins such as ammonia and can lead to confusion and eventually coma.
Individuals with cirrhosis are also prone to infections as their livers are unable to produce adequate antibodies which are protective. These individuals are also prone to bleeding as there is a reduction in clotting factors that are produces by the liver. There is also a reduction of platelets, which are cells that help with blood clotting and this further compound the problem. Patients with cirrhosis have been shown to be at an increased risk of developing primary liver cancer.
This condition can be very difficult to manage and often requires multiple disciplines. Pivotal to the management is to identify the cause and treat the cause if its treatable. It’s also important to avoid things that could potentially harm the liver further such as alcohol, herbal medications and certain prescription medications. Medications that assist with reducing the portal pressures and fluid in the stomach are also used. Some patients will need endoscopy to assess and treat the dilated vessels in the oesophagus. Some individuals with this condition may eventually require liver transplantation.
