Cirrhosis - causes, symptoms, diagnosis, treatment, pathology

Summary

Cirrhosis is a progressive liver disease caused by chronic liver cell damage, such as from alcohol abuse or viral infections like hepatitis B and C. The liver becomes scarred and fibrotic, impairing its functions, leading to complications like ascites, jaundice, hepatic encephalopathy, and coagulation issues. Early stages may be asymptomatic, but as cirrhosis advances, symptoms worsen. Diagnosis includes liver biopsy and lab tests, and treatment focuses on addressing the underlying cause, with liver transplantation being an option for advanced cases. The process of fibrosis is driven by activated stellate cells that produce collagen and scar tissue.

Takeaways

• 😀 Cirrhosis is a condition where liver tissue becomes scarred and fibrotic due to long-term liver injury or chronic inflammation.
• 😀 Fibrosis in cirrhosis is caused by activated stellate cells in the liver that produce collagen, forming fibrotic tissue around liver cells.
• 😀 Regenerative nodules, or clusters of healthy liver cells, form as a result of liver cell injury, making cirrhotic livers bumpy rather than smooth.
• 😀 Portal hypertension occurs when fibrotic tissue compresses blood vessels in the liver, leading to high pressure in the portal veins.
• 😀 Ascites, or excess fluid in the peritoneal cavity, is a common complication of cirrhosis due to portal hypertension and fluid leakage from blood vessels.
• 😀 Cirrhosis can lead to complications like splenomegaly (enlarged spleen) and hypersplenism due to blood flow back-up into the spleen.
• 😀 As cirrhosis progresses, blood flow is diverted from the liver, leading to portosystemic shunts and further complications, such as renal failure (hepatorenal syndrome).
• 😀 Hepatic encephalopathy, a mental condition caused by the buildup of toxins like ammonia in the blood, can occur when the liver is no longer able to detoxify properly.
• 😀 Patients with cirrhosis may experience symptoms like jaundice, pruritus (itchy skin), gynecomastia, and easy bruising due to decreased liver function.
• 😀 Treatment of cirrhosis includes managing the underlying cause (e.g., stopping alcohol consumption, antiviral treatment) and may require a liver transplant in severe cases.

Q & A

What is cirrhosis and how does it develop?

Cirrhosis is a condition where the liver becomes scarred and fibrotic due to chronic injury or damage. The liver cells, or hepatocytes, die off and are replaced by scar tissue, which leads to a loss of liver function. This can occur due to chronic alcohol consumption, viral infections like hepatitis B or C, or other causes of prolonged liver damage.

What is the role of stellate cells in liver fibrosis?

Stellate cells, located in the perisinusoidal space of the liver, normally store vitamin A and are quiescent. When liver cells are injured, these cells become activated and start producing collagen, a key component of scar tissue, leading to fibrosis. This process is triggered by transforming growth factor beta1 (TGF-beta).

Why does cirrhosis lead to ascites?

Ascites, or fluid buildup in the abdomen, occurs in cirrhosis due to increased pressure in the portal veins (portal hypertension). As the liver becomes scarred and blood flow through the liver becomes restricted, fluid is pushed out of blood vessels and accumulates in the peritoneal cavity.

What are regenerative nodules and why do they form in cirrhosis?

Regenerative nodules are clumps of living liver cells that form as a response to liver cell injury. These nodules are part of the liver's attempt to regenerate itself, but they are a hallmark of cirrhosis. The formation of these nodules results in a bumpy appearance of the liver tissue, with fibrotic tissue between them.

How does cirrhosis affect kidney function?

Cirrhosis can cause hepatorenal failure, a condition where kidney function deteriorates due to reduced blood flow to the kidneys. As portal hypertension leads to diversion of blood flow away from the liver, increased resistance in renal circulation decreases kidney filtration, resulting in kidney failure.

What is hepatic encephalopathy, and how is it related to cirrhosis?

Hepatic encephalopathy is a condition where toxins, particularly ammonia, build up in the brain due to reduced liver function in cirrhosis. The liver is unable to detoxify blood properly, and ammonia, which is normally cleared by the liver, enters the bloodstream and affects the brain, leading to confusion, tremors, and, in severe cases, coma.

What are some of the symptoms associated with decompensated cirrhosis?

In decompensated cirrhosis, where liver function deteriorates significantly, symptoms can include jaundice (yellowing of the skin and eyes), ascites (fluid buildup in the abdomen), pruritus (itchy skin), hepatic encephalopathy (confusion and mental changes), easy bruising, and a weakened ability to stop bleeding due to low coagulation factors.

What role does the liver play in hormone regulation, particularly estrogen?

The liver helps metabolize estrogen into inactive metabolites that can be excreted from the body. In cirrhosis, liver dysfunction can lead to an increase in estrogen levels in the blood, resulting in symptoms like gynecomastia (enlarged breast tissue in men), spider angiomata (spider-like blood vessels), and palmar erythema (redness on the palms).

What are the common diagnostic methods for cirrhosis?

The gold standard for diagnosing cirrhosis is a liver biopsy, where a small sample of liver tissue is examined under a microscope. Other common diagnostic tests include blood tests to check for elevated liver enzymes (like AST, ALT, and ALP), elevated bilirubin levels, and low platelet count (thrombocytopenia).

What are the treatment options for cirrhosis?

Treatment for cirrhosis involves managing the underlying cause of liver damage, such as stopping alcohol consumption or treating viral infections like hepatitis. In advanced cirrhosis, where liver function has declined significantly, a liver transplant may be necessary to restore normal function.