Cirrhosis is the common end point of a host of liver diseases. It is a diffuse process taking place in the liver which converts normal liver structure into abnormal cells which lose their functional ability. The process from liver injury to cirrhosis is a lengthy one, which generally takes a number of years to progress. Once occured, liver cirrhosis is then an irreversible process.
Hepatitis C is now the leading cause of cirrhosis worldwide, followed closely by alcohol induced liver disease. Some other causes of liver cirrhosis include autoimmune diseases, Hepatitis B, cryptogenic causes and primary biliary cirrhosis. In the United States alone, chronic liver disease and cirrhosis lead to >35,000 deaths annually. In Europe, it is the 4th leading cause of death.
SIGNS AND SYMPTOMS OF CIRRHOSIS
Signs and symptoms of patients with cirrhosis will vary, depending on the underlying causative disease. Mostly, patients with end stage liver disease/cirrhosis will present with one or more of the following signs and symptoms:
Profound muscle wasting
fatigue and weight loss
yellowish hue of skin
loss of axillary and pubic hair
Anemia and other bleeding disorders, mainly manifest through easy bruising and excessive bleeding.
Some diseases associated with patients with liver cirrhosis are diabetes, peptic ulcer disease and gallstones.
Inevitably, 20-25% of all liver cirrhosis will lead to hepatocellular carcinoma ( liver cancer).
MANAGEMENT OF CIRRHOSIS
Medical therapy for liver cirrhosis is mainly directed towards treating the underlying etiology. Some important examples are antiviral drugs for the management of Hepatitis B and C, and steroid use for autoimmune hepatitis. While these regimens are useful in managing the above mentioned diseases, once cirrhosis has occurred, it is a fairly irreversible phenomenon. However, steps can be taken to ensure symptomatic relief for patients with progressed disease. One such example is the use of zinc sulphate 220mg twice daily for relieving suppression of appetite, as patients with cirrhosis have been shown to have depleted zinc stores.
DIETARY CAUTION IN CIRRHOSIS
Anorexia ( loss of appetite) is a common feature of patients suffering from cirrhosis. It is in part due to the compression of abdominal fluid (ascites) on the intestinal tract. It is important for patients with cirrhosis to intake adequate amount of calories to prevent malnourishment. Patients with cirrhosis greatly benefit from addition of nutritional/protein supplements in their diets, and from multiple feedings per day.
Recently, liver transplant has emerged as one of the most important strategies in the management of cirrhosis. Quality of life and survival rates after liver transplant are excellent now. However, there are a few contraindications to the transplant, as it is an arduous and meticulous process. Patients with history of drug abuse, severe cardiac or respiratory illnesses/history, and metastases of the disease ( in case of liver cancer) outside of the liver are some instances where a transplant is advised against. Although HIV positive status is also a contraindication, patients who are /have undergone aggressive antiretroviral treatment and have minimal viral load, are eligible for consideration of transplant. Recovery period from a liver transplant is usually 6-10 weeks.
India, Mexico and Jordan are emerging as the major countries for medical tourism with respect to liver transplants in terms of affordability.