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Wednesday, January 07, 2009
 
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Cirrhosis
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  • Many agents are toxic to the liver and cause it injury, the most common of which is alcohol. Numerous liver diseases also cause injury to the liver. When the liver is repeatedly injured over time, it becomes scarred and damaged. This is called cirrhosis.
  • Many have no symptoms for long periods
  • Weakness
  • Fatigue
  • Abdominal pain
  • Muscle Cramps
  • Weight loss
  • Appetite loss
  • Impotence
  • Nausea/vomiting (later in the disease)
  • Examination:
    1. Enlarged Liver
    2. Enlarged breasts in men
    3. Broken blood vessels in spider pattern
    4. Palms of hands are pink or net-like in appearance
    5. Enlarged spleen
    6. Yellow skin or eyes
    7. Swollen abdomen
    8. Swollen legs
    9. Large bruised areas of skin
    10. Tremor
    11. Asterixis (special test with hands)
    12. Speech difficulties
    13. Confusion
  • Laboratory findings:
    1. Anemia
    2. Modestly elevated SGOT -- a liver blood test
    3. Low albumin (protein) in blood
    4. Gamma globulin level is increased
  • Abstinence from alcohol
  • Vitamin supplementation
  • If Ascites (abdominal fluid) or edema (leg swelling) present:
    1. Dietary salt restriction
    2. Spironolactone (a "water pill")
    3. Lasix (a "water pill")
    4. Large-volume paracentesis (fluid in abdomen drained with a needle)
    5. Surgical shunt procedures (a connection is placed between the abdominal fluid and veins to continuously drain fluid)
  • Mental changes (encephalopathy)
    1. Protein restriction (60grams/day) if mental changes (Encephalopathy)
    2. Lactulose or Neomycin
    3. Oxazepam for severe agitation
  • Vitamin K for bleeding problems
  • Iron supplements for anemia
  • Treatment of above complications as they occur
  • Liver transplant for severe, irreversible disease
  • Alcohol abuse is the most common cause of cirrhosis; therefore, moderate alcohol Consumption is the key for preventing alcohol-induced cirrhosis. For those predisposed to Alcoholism , abstinence is best. For other diseases, Hepatitis B vaccine is available for high-risk individuals (and is now commonly given as a childhood vaccine). In addition, Hepatitis B , Hepatitis C , and the other causes above should be medically treated (see their sections for more details) to prevent progression to cirrhosis.

 


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