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Cirrhosis: what is it? Causes, Symptoms and Treatment

Cirrhosis is a disease characterized by a progressive replacement of healthy liver tissue with nodules and fibrous tissue (fibrosis) that progressively alters liver function . It is a serious and progressive disease.

Cirrhosis most often results from chronic liver damage , for example due to excessive consumption of alcohol or infection with a virus (hepatitis B or C).

This persistent inflammation or damage, which causes little or no symptoms for a long time, eventually leads to irreversible cirrhosis, which destroys the cells of the liver. In fact, cirrhosis is the advanced phase of some chronic liver diseases.

Who is affected?

In France, the prevalence of cirrhosis is estimated at about 2,000 to 3,300 cases per million inhabitants (0.2 to 0.3%), and it is estimated that there are 150 to 200 new cases per million of inhabitants each year. In total, about 700 000 people suffer from cirrhosis in France, and there are 10 000 to 15 000 deaths per year related to this condition.

The global prevalence of the disease is not known, but it oscillates around the same figures in North America and Western countries as in France. There are no specific epidemiological data for Canada, but it is known that cirrhosis kills approximately 2,600 Canadians each year. This condition is more common in Africa and Asia, and hepatitis B and C are spread diseases and often poorly supported.

The diagnosis occurs on average between 50 and 55 years.

Symptoms of cirrhosis

When cirrhosis is advanced enough to cause symptoms, these usually include:

  • great fatigue, loss of appetite and weight loss which are often the first signs
  • nausea and diarrhea
  • an increase in the volume of the abdomen due to fluid accumulation (ascites)
  • fluid buildup in the legs causing swelling
  • digestive hemorrhage, caused by portal hypertension (this is an emergency that requires immediate hospitalization). It results in vomiting of blood or very black stools (containing blood).
  • easy bruising (bruising) or bleeding
  • itching (pruritus)
  • jaundice (jaundice) that may be associated with the previous symptoms.

To confirm the diagnosis of cirrhosis, a liver biopsy must be performed to visualize the characteristic fibrotic lesions.

People at risk of cirrhosis

Since the causes of cirrhosis are diverse, people at risk belong to different groups:

  • men over the age of 50 are generally more concerned with chronic hepatitis C and alcoholic cirrhosis;
  • people with a metabolic syndrome, including overweight or obesity, insulin resistance or type 2 diabetes, high blood pressure and hyperlipidemia, are at risk of developing a “non-alcoholic fatty liver”.

Risk factors for cirrhosis

Several preventable risk factors are associated with cirrhosis, in particular:

  • Chronic and excessive alcohol consumption. It is the main preventable risk factor for cirrhosis. However, other factors come into play in the development of the disease: only 10 to 15% of alcoholics with liver disease.
  • Being infected with a hepatitis virus (B or C) is also a major risk factor for cirrhosis of the liver.

Prevention of cirrhosis

Can we prevent?
To prevent cirrhosis, it is possible to act on certain preventable risk factors, that is to say:

  • Limit alcohol consumption to 2 glasses per day for women (less than 30 g / d) and 3 glasses for men (less than 40 g / d);
  • Prevent viral hepatitis B through routine vaccination and appropriate medical care in case of accidental contamination;
  • Use disposable equipment (including syringes) and protective measures against sexually transmitted infections (condoms) to prevent viral hepatitis B and C.

 

Basic preventive measures
Once cirrhosis is declared, certain lifestyle and dietary measures can limit the occurrence of complications or at least slow the progression of the disease:

  • Stop drinking if she is still active
  • Give great importance to oral and dermal hygiene (to reduce the risk of infections),
  • Adopt a balanced diet low in salt,
  • In case of excess weight, weight loss is recommended, as well as a drop in blood glucose and blood lipids if necessary.
  • The practice of a regular and adapted physical activity is encouraged.

Medical treatments of cirrhosis

Cirrhosis is an irreversible disease, for which there is no really effective treatment (except liver transplantation).

The cause of cirrhosis must be treated first and the aggravating factors must be limited:

  • In case of so-called alcoholiccirrhosis , weaning is essential.
  • In case of cirrhosis associated with a metabolic syndrome, it is necessary to lose weight, to control diabetes with a well-followed treatment and to lower the level of lipids in the blood.
  • In the case of viral hepatitis, antiviral treatments should be administered.

More generally, the Haute Autorité de Santé stresses the importance of:

  • Prevent and treat complications of cirrhosis (gastrointestinal bleeding, bacterial infections, hepatocellular carcinoma …)
  • Update his vaccinations (hepatitis A, hepatitis B, influenza, pneumococcus)
  • Adopting dietary and lifestyle measures (especially oral care)
  • Benefit from global support

Lifestyle changes

In case of cirrhosis, it is urgent to stop the addictive behavior in question or associated with the disease. It is important to:

  • Stop drinking alcohol, regardless of the cause of cirrhosis. In people suffering from alcohol dependence, several accompanying measures exist and must be put in place (support groups, detoxification clinics, pharmacological treatments, etc.).
  • Stop smoking because it aggravates the disease. Nicotine substitutes can be used, as well as a drug raid at weaning.
  • Stop the use of drugs and drugs that can have a toxic effect on the liver. In particular, avoid taking drugs that are metabolized by the liver (the doctor or pharmacist will inform you).

In case of ascites (accumulation of fluid in the abdomen), the doctor may advise taking diuretic drugs to eliminate water and a diet low in salt. Sometimes punctures are necessary to evacuate the liquid.

Management of the hepatitis in question

If cirrhosis is associated with chronic hepatitis, it is necessary to treat hepatitis:

  • by antiviral therapy with interferon α and / or lamivudine for post-hepatitis B cirrhosis
  • interferon α in case of post-hepatitis C cirrhosis (possibly associated with ribavirin). New and more effective treatments against hepatitis C (current drugs do not cure that 50% of people) are developing.

In the case of underlying active autoimmune disease, corticosteroid or immunosuppressive drug (azathioprine) therapy should be initiated promptly.

Liver transplantation

If cirrhosis is advanced and threatens the life of the person affected, the only possible treatment is liver transplantation (or liver transplant).

However, this operation is risky and organ waiting times are long, at least 1 to 2 years in France and North America.

Psychological care

Cirrhosis is a serious and progressive disease, and its diagnosis inevitably has psychological repercussions. If it deems it necessary, the person with cirrhosis should be able to benefit from psychological support.

Complementary approaches

Important. Cirrhosis and chronic hepatitis are serious diseases that require urgent and long-term medical treatment. It should be noted that some natural health products may have adverse effects on an already damaged liver. It is therefore important to be well informed before starting a natural or complementary treatment.

 

Curcumin . Several studies have shown that curcumin (derived from turmeric) has a beneficial effect on the liver because it prevents the accumulation of fatty acids in the liver cells, caused in non-alcoholic fatty liver (“foie gras”). It is traditionally used against liver disease and some studies have shown to have anti-inflammatory, antioxidant, antimicrobial and antitumor.

In particular, it appears that curcumin attenuates liver damage caused by alcohol, iron overload and certain intoxications; it also appears to have a beneficial effect on cirrhosis lesions, but the lack of studies makes it impossible to make recommendations for use.

Silymarin (silibinin). In case of chronic liver diseases related to alcohol, the metabolic syndrome or the toxicity of certain drugs or drugs, the extract of milk thistle or silymarin ( Silybum marianum ) has a recognized protective and antioxidant action. The main active ingredient, called silibinin, has a positive effect on the regeneration and protection of liver cells and several clinical trials have shown that long-term administration of silymarin can increase the survival of patients with cirrhosis induced by alcohol.

Panax notoginseng. Panax notoginseng is a Korean medicinal herb that has been shown to be effective in vitro and in small clinical trials in Asia on the protection of liver function, especially in cirrhosis.

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