Liver cirrhosis: signs, causes, therapy

Liver cirrhosis occurs when the liver is damaged over a long period of time. Learn more about triggers, symptoms, and treatment

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As the central metabolic organ, the liver has many important functions

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In a nutshell: what is cirrhosis of the liver?

Cirrhosis of the liver is a serious liver disease. It gradually develops through persistent stress such as alcohol abuse or chronic inflammation of the liver (hepatitis). Functional liver tissue perishes and is replaced by connective tissue. The liver scars and shrinks and can no longer do its job properly.

This has numerous consequences, such as metabolic disorders, hormonal balance or blood clotting. Toxins are no longer broken down sufficiently. The risk of liver cancer increases.

Because the structure of the organs changes, the blood cannot flow through the liver as it should; it accumulates in front of the liver. This can cause varicose veins to form, for example in the esophagus (so-called esophageal varices). If left untreated, they can tear and cause dangerous bleeding.

Cirrhosis of the liver is usually irreversible. However, their progress can be slowed down if the causes are eliminated. Complications usually require special therapy. If the triggers cannot be eliminated, liver transplantation is often the only solution.

Symptoms: what are the signs of cirrhosis of the liver?

The first symptoms are often unspecific and do not immediately suggest liver damage:

  • Fatigue, tiredness
  • decreased performance
  • Weight loss
  • sweat
  • psychological upset
  • Possibly a feeling of pressure or pain in the upper abdomen

So-called liver skin signs may appear in the course of the

  • pale gray skin color, thin skin (skin atrophy)
  • Star-shaped neoplasms in the blood vessels, especially on the face and upper body (spider naevi, vascular spiders)
  • itching
  • Reddening of the balls of the hands (palmar erythema), possibly also of the soles of the feet (plantar erythema)
  • Lacquer lips, lacquer tongue (red, smooth and dry lips or tongue)
  • Hardening and thickening of the palm (more under Dupuytren's disease)
  • Whitening of the fingernails

Other possible symptoms of cirrhosis of the liver:

  • in men: bald head (hair loss on the stomach), breast enlargement (gynecomastia), erectile dysfunction
  • in women: menstrual disorders or lack of menstrual bleeding
  • Yellowing of the skin and conjunctiva (jaundice), dark urine
  • Tendency to bleed, bleeding
  • Swelling of the legs or abdomen
  • increased vein markings on the abdomen (caput medusae)
  • Impairment of consciousness

The symptoms described do not have to be present and can also have other causes.

Liver cirrhosis: consequences and complications

The liver fulfills numerous functions in the body. If she falls ill, it can have far-reaching consequences:

Metabolic disorders: patients with cirrhosis of the liver often lose weight. Muscle mass, in particular, declines in the course of the disease. Disorders of the sugar metabolism are possible. Diabetes mellitus can result. If the liver is no longer able to produce important proteins such as coagulants, this impairs blood clotting. Bleeding can then occur.

Disorders in the hormonal balance: Cirrhosis of the liver also affects the hormonal balance, which men especially feel. The testicles shrink and erectile dysfunction occurs. The chest enlarges, the body hair falls out. A so-called bald head develops. In women, irregular menstrual periods are a sign of an impaired hormonal balance.

Blood congestion: Because the blood can no longer flow properly through the scarred liver, it backs up in front of the organ. High blood pressure develops in the affected blood vessels - especially the portal vein. The vessels widen. Varicose veins form mainly on the stomach and esophagus (so-called esophageal varices). In the worst case, they can burst and lead to life-threatening bleeding.

Fluid in the abdomen: The high pressure in the portal vein causes fluid to be forced into the abdomen. This leads to ascites. The stomach swells up and hurts, it is difficult to breathe.

Insufficient detoxification: If the liver can no longer adequately detoxify the blood, toxins enter the brain. This can cause neurological and psychiatric symptoms, a so-called hepatic encephalopathy. The first signs are usually sleep disorders, mood swings or coordination problems. Later the hands start to shake and there are periods of confusion and loss of consciousness. The poisoning can regress if the cause of the cirrhosis of the liver is treated. Otherwise there is a risk of life-threatening liver failure coma.

Liver cell cancer: If the liver is damaged, the risk of liver cell cancer increases. This is especially true if the underlying disease is viral hepatitis.

Causes and risk factors: how does cirrhosis develop?

In contrast to many other organs, the liver can recover relatively well from damage. However, if stress continues for a longer period of time, it affects the liver. First, liver fibrosis occurs - an increase in connective tissue that is still reversible. Ultimately, cirrhosis of the liver develops. The cells of the organ perish. Connective tissue takes its place. The liver, so to speak, forms scars and shrinks. Nodular new formations arise.

Cirrhosis of the liver can have different causes:

Alcohol abuse: In the western industrialized countries, excessive alcohol consumption is responsible for 50 to 60 percent of liver cirrhosis. Alcohol causes the formation of toxic acetaldehyde in the liver cells and promotes fatty liver.

Chronic viral hepatitis: 35 percent of cirrhotic patients have previously had virus-borne chronic type B or type C hepatitis.

Fatty liver: Anyone who drinks a lot of alcohol risks developing what is known as fatty liver. It increases the risk of cirrhosis of the liver. But people who are abstinent can also develop fatty liver. Medically, this form is called non-alcoholic steatohepatitis (NASH). The causes have not been fully clarified. It often occurs together with obesity and diabetes mellitus.

Immune Inflammation: In autoimmune hepatitis, the body's immune system turns against the liver and causes inflammation. An immune-related chronic inflammation of the bile ducts (primary sclerosing cholangitis) can lead to a special form of cirrhosis, primary biliary cirrhosis.

Problematic substances: Many chemicals, such as those found in solvents, the poison of the death cap mushroom, certain active ingredients in medicines or in some natural medicines can put a strain on the liver.

Impaired blood flow: If the heart is weak, blood can back up in the liver and damage the organ. If blood clots or tumors clog the liver veins (Budd-Chiari syndrome), the liver tissue is no longer adequately supplied with nutrients.

Other causes: The risk of liver cirrhosis increases with cystic fibrosis, an alpha-1 antitrypsin deficiency, iron storage disease (hemochromatosis) or copper storage disease (Wilson's disease). In tropical regions, infectious diseases such as schistosomiasis also come into consideration.

How does the doctor make a diagnosis?

The doctor asks about the symptoms and the individual medical history. For example, the physical examination may reveal signs of the liver skin (see section Symptoms). The liver may feel hardened when palpating the abdomen and significantly reduced in size in later stages.

Blood test

When the liver no longer fulfills its detoxification task, waste materials are found in the blood that have no longer been broken down. They also include the bile pigment bilirubin, which is responsible for jaundice. One speaks of elevated liver values ​​when certain enzymes are more abundant in the blood. They can indicate that the liver is inflamed or that cells have already died. Liver values ​​include, for example, GOT / AS (A) T (from the liver cells) or GGT (from the cells of the bile ducts).

Imaging procedures

With the help of an ultrasound examination (sonography), the structure and size of the liver can be made visible. Complications such as ascites, enlargement of the spleen, newly formed blood vessels (varicose veins) or tumors may also be recorded.

Elastography is also an ultrasound examination. An ultrasound wave is sent through the liver and it is observed how quickly it spreads and how much the liver tissue is deformed. If you are very overweight, have water accumulation in the abdomen or have acute liver inflammation, elastography is not reliable.

The most sensitive is the magnetic resonance examination of the liver and the draining biliary tract.

biopsy

Liver cirrhosis can be clearly diagnosed with a tissue removal from the liver (biopsy). The samples taken from the liver provide information on how many cells have already been converted into connective tissue and how inflamed the tissue is, for example in the case of hepatitis.

Stages and prognosis: what do Child and MELD mean?

An assessment according to the so-called Child-Pugh criteria helps to divide the extent of the cirrhosis into different stages. Doctors assign points from 5 to 15 to certain laboratory values ​​and complications such as ascites. When added up, these points produce a value that provides information about the severity and life expectancy of the disease. Each point total is assigned to a specific stage:

Child-Pugh A - easy (5 or 6 points)

Child-Pugh B - medium (7 to 9 points)

Child-Pugh C - difficult (10 to 15 points)

Liver cirrhosis that does not cause any major complications is called compensated liver cirrhosis. At this stage there is no severe limitation in life expectancy. With uncompensated cirrhosis of the liver, complications such as ascites or bleeding from dilated veins occur. Life expectancy is then in some cases significantly reduced. In general, however, the prognosis for liver cirrhosis depends on various factors, such as accompanying diseases.

From a certain degree of disease, the liver tissue is so severely attacked that only a transplant can save the patient's life. The so-called MELD score (Model for End-Stage Liver Disease) is used to quantify the urgency of the necessary liver transplantation. It is calculated according to certain laboratory values ​​and ensures that the most severely ill receive a donor organ more urgently.

Therapy: How is cirrhosis of the liver treated?

To stop the deterioration of liver tissue, the underlying disease must be treated. For example, alcohol addiction must be treated or chronic viral hepatitis fought with appropriate medication. Bloodletting helps with iron storage disease. For many metabolic and autoimmune diseases, however, there are still no special drugs available.

It is important that the liver is not additionally damaged. Alcohol and unnecessary medication are strictly forbidden. Attention: Do not discontinue medication on your own, only after consulting your doctor!

Nutritional advice may be advisable. Depending on the stage of the disease, it may be necessary, for example, to pay attention to the amount you drink or to eat low-salt. The calorie intake must be sufficient to counteract muscle breakdown. If there is a lack of vitamins or minerals, the doctor may recommend specific supplementary preparations.

Regular check-ups help discover complications in good time.

Liver transplantation may be necessary in end-stage liver cirrhosis.

Treatment of individual complications:

Ascites

Urinary drugs (diuretics) help to flush the fluid out of the abdomen. When treating ascites, the fluid balance should be balanced. This means: Patients should not drink more than they are washed out. The doctor and patient agree on the ideal amount to drink. In severe cases, an ascites puncture helps. The doctor sticks a needle into the abdomen under ultrasound control and takes some of the water through a hose.

Varicose vein bleeding

Ruptured varicose veins on the esophagus or stomach are life-threatening. If the patient vomits blood, he must be referred to a clinic immediately. The doctor first stops the bleeding by constricting the varicose vein with a rubber band using endoscopy (rubber band ligation).

If endoscopy is not possible at first, a balloon probe can be used to stop the bleeding. This is inserted into the esophagus and inflated there. This puts enough pressure on the varicose veins in the esophagus wall to stop the bleeding. However, this method is only suitable for severe cases. In the past, varicose veins were sometimes obliterated by injecting a liquid into them that caused the vessel to close. This method has now been largely replaced by the ligature.

To reduce the risk of further bleeding, the patient may be given medication that will lower the pressure in the portal vein.

A surgically established connection between the portal vein and a liver vein (shunt operation) also helps to reduce the high pressure in the vessels. An undesirable side effect is that part of the blood flows past the liver and is no longer freed of harmful substances. This increases the risk of brain dysfunction.

Brain dysfunction

When the liver no longer detoxifies the blood adequately, harmful substances enter the brain. Especially in combination with ammonia, among other things, they can lead to psychological and neural disorders. Hepatic encephalopathy occurs (see section "Consequences and Complications"). With a special diet, the protein intake and thus the ammonia level can be reduced. Medicines with the active ingredient lactulose or a certain antibiotic influence the intestinal bacteria so that fewer harmful substances are produced in the intestine.

Infections

With cirrhosis of the liver, the risk of infections increases. That is why antibiotics may be used more quickly or even as a preventative measure. If the ascites becomes infected with bacteria, it is particularly important to take antibiotics quickly. Patients should also seek advice from their doctor about which vaccinations make sense for them, such as the annual flu vaccination.

Professor Dr. Burkhard Göke

© W & B / Markus Dlouhy

Consulting expert

Professor Dr. Burkhard Göke is an internist, gastroenterologist and endocrinologist. He is medical director and chairman of the board of the University Medical Center Hamburg-Eppendorf. Professor Göke has written 500 publications.

Important NOTE:
This article contains general information only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor. Unfortunately, our experts cannot answer individual questions.

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