Cirrhosis of the liver is a slowly progressive condition in which the tissue of the liver is replaced by fibrous tissue, which prevents the liver from functioning properly.

Diseases that lead to cirrhosis damage and kill the liver cells, the body responds with inflammation and an attempt at repair, which leads to the formation of scar tissue.

The non-dead liver cells multiply in an attempt to replace the dead cells, resulting in cell groups of new liver cells (regeneration nodes) inside the scar tissue.


Classification of cirrhosis of the liver

Cirrhosis is divided into two phases: compensated and decompensated.
1. Compensated cirrhosis means that the body still functions sufficiently well despite the liver damage. Many people with compensated cirrhosis have few or no symptoms.
2. Decompensated cirrhosis means that liver fibrosis has damaged or destroyed essential bodily functions. Patients with decompensated cirrhosis develop serious symptoms and fatal complications.

Primary biliary cirrhosis (or primary biliary cholangitis, PBC) is a condition in which the bile ducts in the liver are slowly destroyed.
Bile is a fluid produced in the liver that is used to digest food and eliminate broken down blood cells, cholesterol and toxins.
In primary biliary cirrhosis, the bile ducts are damaged and harmful substances can accumulate in the liver. The result is the formation of scar tissue in the liver.

Secondary biliary cirrhosis is a condition in which the bile ducts are unable to effectively deliver bile for secondary reasons, resulting in blockage, inflammation, scarring or other damage to the bile ducts.

Another type of this condition is Laennec’s cirrhosis: a type of cirrhosis of the liver characterized by a nodular appearance of the liver surface and associated with alcoholism.

Why does cirrhosis cause problems?

The scar tissue impairs the ability of the liver to:

  • fight infections,
  • to remove poisons from the blood,
  • process nutrients, hormones and medications,
  • produce proteins that serve blood clotting,
  • To produce bile, which serves the absorption of fat and fat-soluble vitamins.

A healthy liver is able to regenerate most of its own cells if they have been damaged. In cirrhosis in the last stage, the liver can no longer replace the dead cells.
In hypertrophic cirrhosis, the liver is enlarged, while in atrophic cirrhosis, the liver becomes smaller.

Causes of cirrhosis of the liver

Alcohol-related cirrhosis Chronic excessive alcohol consumption is the most common cause of cirrhosis
of the liver.
It must be borne in mind that the amount of alcohol that damages the liver varies from person to person. If a healthy woman drinks the same amount of alcohol as a healthy man, she has a greater risk of developing cirrhosis.
Children are particularly susceptible to alcohol damage. Some people also have a genetic predisposition to liver disease associated with alcohol.
People with liver disease may have a higher risk of alcohol damage.
Those who already suffer from hepatitis B, C or cirrhosis of the liver (of any cause) risk aggravating it when drinking alcohol.

Do people who drink a lot of alcohol surely have cirrhosis of the liver?
Most people who drink large amounts of alcohol damage their liver, but not all develop cirrhosis.
Women who drink a lot and people infected with the hepatitis B or C virus are more likely to suffer from alcohol damage to the liver.

Alcohol-induced cirrhosis is of the micronodular (small-knotted) type. A size of the nodules below 3 mm is observed.
If cirrhosis is caused by alcohol or medication, it is also defined as exotoxic.

Hepatitis and cirrhosis
of the liver 
Hepatitis is a general term that means “inflammation of the liver.”
Viral hepatitis refers to an infectious disease caused by a virus, as with hepatitis B or C.
Chronic hepatitis C is a common cause of cirrhosis of the liver and hepatitis B can also lead to cirrhosis. In this case, there are larger nodules than in alcohol-induced cirrhosis.
If any of these conditions are present, the risk of cirrhosis increases if alcohol is drunk.
Cirrhosis of the liver is not transmitted through sexual intercourse, but hepatitis B and C are sexually transmitted.

Fatty liver (steatosis hepatis)
Non-alcoholic fatty liver disease (NASH) is a condition characterized by fat accumulation in the liver.
This condition is becoming increasingly common in overweight children.
Fatty liver usually does not cause pain or nausea.

Steatosis hepatis is caused by metabolic syndrome, which is characterized by:

  1. Overweight – 20% of overweight people have hepatic steatosis,
  2. increased triglycerides and cholesterol in the blood,
  3. Type 2 diabetes.

Chronic steatosis hepatis can cause non-alcoholic steatohepatitis, an inflammation of the liver with the formation of scar tissue.
Over time, fatty liver can lead to cirrhosis of the liver.
People with fatty liver have an increased risk of liver damage if they have hepatitis C.

Cryptogenic cirrhosis
of the liver 
This type of liver cirrhosis has an idiopathic origin, so the cause is not known.

Hereditary cirrhosis
of the liver 
Some hereditary diseases damage the liver, leading to the formation of scar tissue, which can contribute to cirrhosis.

These diseases include:

  • Hemochromatosis – The body accumulates iron, which can damage many organs, including the liver.
  • Wilson’s disease – copper accumulation in body tissues.
  • Galactosemia – The body is unable to digest galactose (a type of sugar). This accumulates in the blood and causes liver damage.
  • Cystic fibrosis – It mainly affects the lungs, but it can also cause fibrosis of the liver.
  • Lack of alpha-1 antitrypsin – May affect breathing but also affect liver function and cause cirrhosis and hepatic insufficiency.

Other causes of cirrhosis of the liver

There are other liver diseases that can cause cirrhosis, including:

Some autoimmune diseases – immune cells attack the liver and damage it. Autoimmune diseases that can lead to cirrhosis include autoimmune hepatitis and primary sclerosing cholangitis (inflammation and scarring of the bile ducts).

Poisons – poison can damage the liver, because one of the main tasks of this organ is to filter the poisons from the blood. Prolonged exposure to environmental toxins such as arsenic can damage the liver and lead to cirrhosis.

Schistosomiasis – a tropical disease caused by the parasite Schistosoma. This worm is transmitted to humans by snails. Schistosomiasis is also called schistosomiasis. Chronic schistosomiasis causes damage to internal organs, including the liver.

Some medications (such as drugs used to treat cardiac arrhythmias) – can also cause cirrhosis in rare cases in sensitive people.

Symptoms of cirrhosis of the liver

The symptoms may also not appear until complications of cirrhosis become noticeable.
Many people do not know that they have cirrhosis as long as complications do not develop.
The most common symptoms of cirrhosis are:

  • Fatigue;
  • Weakness;
  • Nausea;
  • loss of appetite;
  • loss of libido, as cirrhosis of the liver reduces the level of testosterone in the blood;
  • jaundice – yellowing of the skin and eyes due to the deposition of bilirubin in these tissues; bilirubin is a product of the decomposition of old blood cells, which takes place in the liver;
  • Fever;
  • Vomit;
  • itching due to deposits of breakdown products of bile in the skin;
  • swollen abdomen due to fluid retention;
  • swollen ankles and swollen legs (edema) due to fluid retention;
  • confusion, delirium, personality changes or hallucinations (encephalopathy) due to accumulation of drugs or toxins in the blood that affect the brain;
  • extreme drowsiness and difficulty waking up or coma – other symptoms of encephalopathy;
  • gum or nosebleeds due to impaired production of clotting factors;
  • blood in vomit due to varicose veins in congestive liver;
  • hemorrhoids – rectal varices due to congestive liver;
  • loss of muscle mass (muscle wasting);
  • in men: enlargement of the breast (gynecomastia), swelling of the testicles or small testicles due to problems with the production of hormones and metabolism.

Advanced or terminal
In the late stages of cirrhosis, blood may be vomited or black stools or tarry stools may be discontinued. This occurs because the blood can no longer flow correctly through the liver. There is increased pressure in the vein (portal vein or vena portae), which carries the blood from the intestine to the liver.
The increase in blood pressure pushes the blood into the small and fragile vessels that run along the stomach and esophagus, subsequently forming varicose veins.
These vessels can burst due to the increased blood pressure and thus cause internal bleeding, which is noticeable in vomit and/or stool.
Over time, the toxins normally removed by a healthy liver can lead to insufficiency of vital organs and, as a result, death.

Complications of cirrhosis of the liver

Complications of cirrhosis include:

Portal hypertension. Cirrhosis slows down normal blood flow through the liver, thereby increasing the pressure in the vein that carries blood from the intestine and spleen to the liver.

swelling of the legs and abdomen. Portal hypertension can lead to fluid accumulation in the legs (edema) and abdomen (ascites).
Edema and ascites can also lead to the inability of the liver to make certain proteins of the blood.

Hepatorenal syndrome. This disorder leads to kidney failure, even if the patient does not have kidney disease (infection, side effect of medications, etc.).
The course can occur in two ways: rapidly progressive, if renal insufficiency manifests itself within 15 days, or slow, if renal failure begins only after a few weeks.

Infections. With cirrhosis, the body may have difficulty fighting infection.
Ascites (fluid accumulation in the abdomen) can cause bacterial peritonitis, which is a serious infection.

Bleeding. Portal hypertension can cause the diversion of blood to smaller veins.
The tension caused by the additional strain can lead to a bursting of these small veins and thus to severe bleeding. The high blood pressure can lead to vasodilation (dilation) of some veins and thus to dangerous bleeding in the esophagus (esophageal varices) or stomach (stomach varices).

Malnutrition. Cirrhosis can make it difficult to digest nutrients, resulting in weakness and weight loss.

High levels of toxins in the blood (hepatic encephalopathy). A liver damaged by cirrhosis is no longer able to filter toxins from the blood. The toxins can lead to disorientation and difficulty concentrating. Over time, hepatic encephalopathy can lead to apathy and coma.

Jaundice. Jaundice occurs when the diseased liver does not filter enough bilirubin (a waste product of the blood) from the circulating blood. Jaundice leads to yellowing of the skin, yellow eyes (sclera) and dark urine.

Increase in the risk of liver tumor.

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