Cirrhosis and its complications
Causes and risk factors
It develops in people who continuously abuse alcoholic substances or it can represent the evolution of chronic hepatitis B or C virus. In rare cases, cirrhosis may result from chronic inflammation of the biliary tract (biliary cirrhosis, sclerosing cholangitis) or from iron accumulation in liver tissue (hemochromatosis). Cirrhosis associated with C virus infection has a higher risk of evolution to hepatocellular carcinoma.
Which are the symptoms?
Over a long period of time and as long as liver function is preserved, there are no symptoms or signs indicative of the disease. Reduced liver function causes a deficit in the synthesis of proteins (albumin) and substances necessary for blood coagulation; this results in a tendency to peripheral edema and coagulation defects. Moreover, the ability of the liver to carry out its detoxifying action, for example with regard to ammonium in the blood, decreases, resulting in an increase in the circulation of this substance, which can have negative effects on brain function (hepatic encephalopathy). The fibrous consistency of liver tissue makes local circulation difficult with consequent increase of pressure in the portal vein, then increase in volume of the spleen, possible appearance of liquid effusion in the abdomen (ascites) and formation of varices in the esophagus. If the pressure inside the esophagus becomes excessive, the esophagus may rupture, resulting in digestive bleeding (hematemesis).
How is it diagnosed?
Diagnosis is made by blood chemistry tests, ultrasound and liver biopsy. Plasma alpha feto protein dosage and ultrasound, repeated annually, allow early identification of the possible development of hepatocarcinoma.
How is it treated?
The therapy is medical and supportive as it is not able to change the course of the disease nor to regress the lesions that have developed. In more advanced stages and in selected cases, liver transplantation is indicated.