Cirrhosis

Cirrhosis of the liver is a serious and chronic disease of the liver. In Germany alone, around 400,000 people are affected. Cirrhosis of the liver develops slowly over many years and the treatment of the disease often presents doctors with great challenges. In this text you will find out what constitutes cirrhosis of the liver, how it develops and how to treat the disease.

What is cirrhosis of the liver?

Liver cirrhosis is the common end stage that many chronic liver diseases result in. The development of cirrhosis can take years or even decades.

Chronic liver diseases, such as chronic inflammation of the liver (hepatitis), put a strain on the liver tissue. As a result, the liver is transformed over the years until a large part of the normal liver tissue is finally replaced by scars and connective tissue. The liver's function is severely disturbed. This stage is called cirrhosis.

How common is cirrhosis of the liver?

Around 400,000 people in Germany suffer from cirrhosis of the liver. That is about 0.5 percent of the population. Men are significantly more affected by the disease than women. It is believed that around 20,000 people die in Germany every year as a result of cirrhosis of the liver.

What are the causes of liver cirrhosis?

Cirrhosis of the liver is the result of chronic damage to the liver. The damaging influences, which doctors call “noxia” are varied.

The main causes of cirrhosis are:

• Alcohol
• Viruses (chronic inflammation of the liver)
• Biliary diseases
• Autoimmune diseases
• Metabolic diseases

However, a fifth of all cirrhosis of the liver occurs without a direct cause being identified. In addition, a number of rare diseases cause the illness.

How does alcohol lead to cirrhosis of the liver?

Alcohol, which is broken down in the liver, acts as a poison on the liver in larger quantities. Regular consumption of large amounts therefore leads to changes in the breakdown mechanisms in the liver. This leads to an accumulation of toxic breakdown products which in turn have a damaging effect on the cells. First, the liver becomes fatty, later the liver cells collapse and the liver undergoes connective tissue remodeling.

The final stage of this damage process, which lasts for years, is liver cirrhosis.

How do viruses lead to cirrhosis of the liver?

Inflammation of the liver is also called hepatitis by doctors. Hepatitis viruses are a group of viruses that cause such inflammation of the liver. The main representatives of this group of viruses are hepatitis B and hepatitis C.

One assumes that about 5 - 10 percent of hepatitis B infections and up to 50 percent of hepatitis C infections ultimately lead to chronic liver inflammation.

This chronic inflammation, like chronic alcohol consumption, gradually damages the liver cells. Once a certain amount of damage has occurred, the connective tissue remodeling of the liver begins. Your function is slowly being lost. Liver cirrhosis follows in the final stage.

What are the causes of liver cirrhosis?

Chronic alcohol consumption and hepatitis viruses are the main causes of cirrhosis. But there are other diseases that can lead to cirrhosis of the liver. These include, for example, chronic diseases of the biliary tract (bile duct occlusions and inflammation of the biliary tract), autoimmune diseases (autoimmune hepatitis, primarily biliary cirrhosis, primarily sclerosing cholangitis) and metabolic diseases (hemochromatosis).

Chronic use of some medications can also damage the liver. An overdose of paracetamol can lead to liver failure. Long-term use of the drug can cause permanent liver damage.

What are the symptoms of liver cirrhosis?

The symptoms of cirrhosis of the liver occur - similar to the disease itself - over a long period of time. Early and very general symptoms include

• Fatigue,
• Tiredness,
• Reduced performance and
• Rapid exhaustion.

Unwanted weight loss and persistent nausea can also indicate cirrhosis. However, these symptoms are very unspecific and also occur in many other diseases.

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Are there any special signs / symptoms that indicate liver cirrhosis?

As the disease progresses, more specific symptoms appear. This also includes the so-called "Liver skin signs". These are symptoms that are triggered by cirrhosis of the liver and are externally visible.

These signs include red palms of the hands and feet (palmar and plantar erythema), yellowing of the skin and eyes (jaundice), bright red tongue and lips (lacquer tongue and lips) and small accumulations of blood vessels that are visible through the skin ( Spider naevi, telangiectasia).

Tab.1: Liver-skin sign

The liver also functions as a hormone-producing organ. If this function is disturbed, further symptoms appear:

Erectile dysfunction

Men can experience erectile dysfunction, which can even result in impotence. The testicles can decrease in size and weight (testicular atrophy) and slight breast growth can occur (gynecomastia).

Menstrual problems

Women often complain of menstrual disorders up to the complete cessation of the menstrual period.

Decreased sexual desire

There is often a decrease in libido in both sexes.

Fluid retention

In addition, water can accumulate in the tissue at various points in the body, especially in the legs and abdomen. This is also called “edema". A large accumulation of water in the stomach is called "ascites".

Are there blood tests that indicate cirrhosis of the liver?

There are a number of blood values that are changed in liver diseases.

The two enzymes OLD and AST are located inside the liver cells and develop their effects there. If the liver tissue is damaged, these enzymes emerge from the damaged cells and are increasingly detectable in the blood. In cirrhosis of the liver, ALT and AST are often elevated and are therefore often referred to as "liver function values".

The blood values AP, gamma-GT and bilirubin are also commonly elevated in cirrhosis of the liver. In addition to liver diseases, these blood values are often increased in biliary tract diseases. Bilirubin is also responsible for the yellowing of the skin (jaundice), which is often observed in cirrhosis of the liver.

There are also substances that are not present enough in the blood due to liver cirrhosis because they are produced by the liver. This includes, for example albumin. Albumin is a protein that is found in the blood for the transport of many other substances. Coagulation factors required for hemostasis and some electrolytes may no longer be available in sufficient amounts in cirrhosis of the liver.

What types of liver cirrhosis are there?

Cirrhosis of the liver is usually classified by doctors on the basis of the so-called “Child-Pugh criteria”. This is a series of findings and blood values for which scores are awarded. The more points are awarded, the more severe the illness.

Depending on the total score, the disease is divided into the stages Child A to Child C. In Child A stage, cirrhosis of the liver is only slight, whereas in Child C stage there is a very serious illness.

Is cirrhosis curable?

Cirrhosis of the liver is the final stage of chronic liver disease. You can treat the disease and thus alleviate the symptoms and slow the progress. However, no medical cure for cirrhosis of the liver is known to date. The only way to "cure" the disease is liver transplantation. As part of this, the damaged liver is removed and a new, healthy liver is introduced into the body.

How is cirrhosis treated?

The most important measure in the treatment of cirrhosis of the liver is the absence of substances that are harmful to the liver, especially alcohol. Refraining from alcohol consumption can drastically slow the progress of cirrhosis and significantly alleviate the symptoms. The condition that caused cirrhosis should also be treated.

Since the liver is responsible for processing food components, a balanced and healthy diet is particularly important with cirrhosis of the liver. This can prevent the already damaged liver from being overloaded by the food.

If there are deficiencies, such as vitamins and minerals, these should be taken in the form of nutritional supplements.

If liver cirrhosis is present, regular liver checks should also be carried out. Because cirrhosis of the liver increases the risk of developing liver cancer. To recognize it as early as possible, regular examinations of the liver, for example with an ultrasound device, are necessary.

What is the life expectancy with cirrhosis of the liver?

The life expectancy with cirrhosis depends on the Child stage.

Tab.2: 1-year survival rates for the differentCchild stages

Cirrhosis of the liver is a serious disease that affects many people in Germany. Only a transplant can cure this disease. Nevertheless, a lot of things can be achieved through careful therapy, which also includes changes in diet and lifestyle, and the progression of the disease can be significantly slowed down.