Liver cirrhosis is a slowly progressive disease in which liver tissue is replaced by scar tissue (fibrosis) which causes a reduction in liver function. 
Diseases that cause cirrhosis cause damage and kill liver cells, the body responds causing inflammation and an attempt to repair causing the formation of scar tissue.

Non-dying liver cells multiply in an attempt to replace dead cells. 
The consequence is a mass of new liver cells (regenerative nodules) within the scar tissue.


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The cases of cirrhosis fall into these groups: compensated and decompensated. 
1. Compensated cirrhosis means that the body still works very well, despite damage to the liver. Many people with compensated cirrhosis have few or no symptoms. 
2. Decompensated cirrhosis means that liver fibrosis has damaged and disrupted the body’s essential functions. Patients with decompensated cirrhosis develop severe symptoms and fatal complications.

The primary biliary cirrhosis (or early) is a disease in which the bile ducts of the liver are destroyed slowly. 
Bile is a liquid produced in the liver that helps digest food and remove damaged blood cells, cholesterol, and toxins. 
In primary biliary cirrhosis the bile ducts are damaged and harmful substances can accumulate in the liver, the consequence is the formation of scar tissue in the liver.

The secondary biliary cirrhosis is a disease in which the bile ducts are not able to transport the bile to a secondary cause which results in a blockage, inflammation, scarring or other damage to the bile ducts.

Another type of this disease is Laennec’s cirrhosis : a type of cirrhosis of the liver characterized by the nodular appearance of the liver’s surface attached to alcoholism.


Why does cirrhosis cause health problems?

Scar tissue impairs the liver’s ability to:

  • Fighting  infections
  • Remove toxins from the blood,
  • Develop nutrients, hormones and medications,
  • Produce proteins that regulate blood clotting
  • Produces bile to help absorb fat and fat-soluble vitamins.

A healthy liver is able to regenerate most cells when they are damaged. With end-stage cirrhosis, the liver may not be able to replace dead cells. 
In the case of hypertrophic cirrhosis the liver increases, whereas if the cirrhosis is atrophic the liver becomes smaller.

Causes of liver cirrhosis

Alcoholic cirrhosis
Excessive and chronic alcohol consumption is the most common cause of cirrhosis of the liver. 
It is important to remember that the amount of alcohol that damages the liver can vary from person to person. If a healthy woman drinks the same amount of alcohol as a healthy man, she has a higher risk of cirrhosis. 
Children are particularly sensitive to alcohol damage. Some people have a genetic predisposition to alcohol-related liver diseases.

People with a disease that affects the liver may have a higher risk of alcohol damage. 
Anyone who already suffers from hepatitis B , C or cirrhosis of the liver (for whatever reason) is likely to get worse by drinking alcohol.

Do people who drink a lot of alcohol usually have cirrhosis of the liver? 
Most people who drink large amounts of alcohol can damage the liver, but not everyone develops cirrhosis. 
Women who drink heavily and those infected with the hepatitis B or C virus are more likely to suffer from alcoholic liver damage. 
Alcoholic cirrhosis is of the micronodular type, that is, we can observe uniform nodules smaller than 3 mm. 
When cirrhosis is caused by alcohol or medications it can also be defined as toxic.

Hepatitis and liver cirrhosis
Hepatitis is a general term that means inflammation of the liver. 
Viral hepatitis refers to an infectious disease caused by a virus such as hepatitis B or C. 
Chronic hepatitis C is a common cause of liver cirrhosis, even hepatitis B can cause cirrhosis, in which case there are larger nodules compared to to alcoholic cirrhosis. 
With one of these diseases, you increase the risk of developing cirrhosis if you drink alcohol. 
Hepatic cirrhosis can not be transmitted through sexual intercourse, but hepatitis B and C are sexually transmitted diseases.

Fatty liver
The liver steatosis non-alcoholic (NASH) is a disease characterized by the accumulation of fat in the liver. 
This disease is becoming more common in overweight children. 
Hepatic steatosis usually does not cause pain or nausea.

Hepatic steatosis is caused by the metabolic syndrome which is characterized by:

1. Obesity – 20% of obese people have hepatic steatosis, 
2. Triglycerides and high blood cholesterol 
3. Type 2 diabetes .

Chronic hepatic steatosis can cause non-alcoholic steatohepatitis which is an inflammation of the liver with the formation of scar tissue. 
Over time, steatohepatitis can lead to liver cirrhosis.

People with fatty liver disease have a higher risk of damage the liver if they have hepatitis C .

Cryptogenic cirrhosis
This type of cirrhosis of the liver has an idiopathic origin, that is, the cause is unknown.

Hepatic cirrhosis due to hereditary diseases
Some hereditary diseases damage the liver and this causes the formation of scar tissue that may contribute to cirrhosis. 
Among these diseases are:

  • Hemochromatosis – The body accumulates iron that can damage various organs, including the liver.
  • The Wilson’s disease – copper accumulates in the body tissues.
  • Galactosemia – The body is unable to digest galactose (sugar) that accumulates in the blood and can cause damage to the liver.
  • Cystic fibrosis – mainly affects the lungs, but can also cause liver fibrosis.
  • Deficiency of alpha-1 antitrypsin – can affect respiration, but can also affect liver function and lead to cirrhosis and liver failure.

 

Other causes of liver cirrhosis

There are other liver diseases that can lead to cirrhosis, including:

Some autoimmune diseases – the immune cells that attack and damage the liver. 
Among autoimmune diseases that can cause liver cirrhosis are autoimmune hepatitis and primary sclerosing cholangitis (inflammation and fibrosis of the bile ducts).

Poisons – Poison can damage the liver because one of the main roles of this organ is to remove toxins 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 a parasitic worm called Schistosoma. The worm is transmitted to humans by snails. Schistosomiasis is also called bilharziasis. Chronic schistosomiasis causes damage to internal organs, including the liver.

Some medicines (like medicines used to control heart arrhythmia ) – in rare cases can cause cirrhosis in sensitive people.


Symptoms of liver cirrhosis

Symptoms may not appear until the onset of complications of cirrhosis. 
Many people do not know they have cirrhosis even when they do not develop the complications. 
The most common symptoms of cirrhosis are:

  • Fever
  • Vomiting
  • Itching  caused by deposition on the skin of bile demolition products.
  • Belly swollen due to fluid retention .
  • Swollen ankles and swollen legs (edema) from fluid retention.
  • Confusion, delirium, personality changes or hallucinations (encephalopathy) from the accumulation of drugs or toxins in the bloodstream that influence the brain.
  • Extreme drowsiness , trouble waking or eating – other symptoms of encephalopathy.
  • Bleeding from the nose or gums – due to altered production of clotting factors.
  • Blood in vomit due to variceal bleeding due to hepatic congestion
  • Hemorrhoids – varicose veins in the rectum due to hepatic congestion
  • Loss of muscle mass (deterioration)
  • In men, breast enlargement (gynecomastia), swollen scrotum or smaller testes due to problems in the production of hormones and metabolism.

Symptoms in advanced or terminal
phase In the successive phases of cirrhosis, the person may vomit blood or have black stools and tar-like stools . This is because blood does not flow properly through the liver, so there is an increase in pressure in the vein that carries blood from the intestine to the liver (portal vein). 
Increased blood pressure pushes blood into the smaller, fragile vessels that surround the stomach and esophagus, forming the varicose veins. 
These vessels may burst from high blood pressure, causing visible internal bleedingin vomit and / or faeces.
Over time, toxins that are normally removed by a healthy liver can cause vital organ failure, followed by death.


Complications of cirrhosis

The complications of cirrhosis are:

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

Swelling of the legs and abdomen . The hypertension portal can cause fluid accumulation in the legs (edema) and abdomen ( ascites ). 
Edema and ascites can also cause liver failure by producing certain proteins in the blood.

Hepatorenal syndrome . This disorder causes a renal block even if the patient has no kidney problems (infections, side effects of medications, etc.). 
The course can be of two types: rapidly progressive if renal failure occurs between 15 days or slow if the renal block is evident after a few weeks.

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

Bleeding . Portal hypertension can cause blood to shift to the smaller veins. 
The stress to the additional load can cause the rupture of these small veins, causing serious hemorrhages. 
High blood pressure may cause vasodilation of some veins and may cause dangerous bleeding of the esophagus ( esophageal varices ) or stomach (gastric varices).

Malnutrition . Cirrhosis can make digestion of nutrient substances more difficult, resulting in weakness and weight loss.

High levels of toxins in the blood (hepatic encephalopathy). A damaged cirrhosis liver can not eliminate toxins from the blood. Toxins can cause mental confusion and difficulty concentrating. Over time, hepatic encephalopathy may progress and cause apathy or coma.

Jaundice . Jaundice occurs when the diseased liver does not remove enough bilirubin (a residual product from the blood) in the bloodstream. Jaundice causes yellowing of the skin, yellow eyes (sclera), and dark urine .

Increased risk of liver cancer .

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