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What is Cirrhosis (Cirrhosis of the Liver)?

Cirrhosis, also called chronic liver disease, is the name given to severe damage to the liver. Different levels of damage to the liver can occur due to various diseases, sometimes for unknown reasons.

As a result, various deteriorations occur in the structural functions of the liver and it begins to fail to perform its normal functions. This is the beginning of the cirrhosis process. As the process progresses, the liver begins to harden and shrink as a result of the decrease in liver cells that continue to function.

The flow of blood to the hardened tissues becomes difficult and new vascular pathways are formed due to the inability of the blood to reach the tissue. All these events aggravate the cirrhosis table by affecting the liver more negatively. As a result, the liver begins to fail to function and liver failure occurs.

What are The Common Causes of Cirrhosis (Cirrhosis of the Liver)?

Cirrhosis is not a disease with a single cause and pathophysiology. It is considered the last stage of any disease that damages liver cells.

The most common causes of cirrhosis are:

  • Alcohol Use:

Long-term excessive use of alcohol has been reported to be associated with cirrhosis.

  • Chronic Viral Infections of the Liver (Hepatitis):

Hepatitis B and hepatitis C infections are hepatitis that cause chronic viral hepatitis.

  • Fatty Liver Disease:

This condition, which is seen in obesity and diabetes, is one of the most important causes of cirrhosis. It is also called non-alcoholic steatohepatitis.

Less common causes of cirrhosis are:

Hereditary Diseases:

  1. Alpha-1-Antitrypsin Deficiency:

It causes the accumulation of abnormal proteins in the liver.

  1. Hemochromatosis:

It is a disease that means excessive accumulation of iron in the liver.

  1. Wilson’s Disease:

It is a disease manifested by excessive copper accumulation in the liver.

  1. Cystic Fibrosis:

It is the accumulation of sticky and viscous mucus in the liver.

  1. Glycogen Storage Diseases:

These are diseases in which the liver cannot wash or store glycogen, the storage form of carbohydrates.

  1. Alagille Syndrome:

It is the presence of a smaller amount of bile ducts than normal. There is a problem with the flow of bile. It causes jaundice.

  • Autoimmune Hepatitis:

It occurs as a result of the person’s own immune system attacking and damaging healthy liver tissue.

  • Diseases Affecting Bile Flow in the Liver:

Diseases such as primary biliary cholangitis, primary sclerosing cholangitis, and biliary atresia prevent bile flow and damage the liver.

  • Chronic Heart Failure:

It causes the liver to be overloaded with fluid and not to provide adequate blood circulation.

  • Amyloidosis:

It is a rare disease. It is a disease characterized by the accumulation of amyloid, an abnormal protein that reduces normal liver function.

The progression from liver diseases to cirrhosis occurs gradually. If liver damage continues, cells begin to die. Very rarely, in some severe cases, very rapid progression to cirrhosis may occur.

What are The Symptoms of Cirrhosis (Cirrhosis of the Liver)?

Cirrhosis is a long-term and progressive disease. In the early stages, the symptoms can be very mild. As the damage to the liver increases, the symptoms also worsen.

Early Level Cirrhosis Symptoms:

  • Tiredness
  • Nausea
  • Loss of appetite
  • Red spots on your palm and skin (Spider Angiomas)
  • Losing weight and muscle mass

Advanced Stage Cirrhosis Symptoms:

  • Extreme fatigue
  • Yellowing of the skin, skin and whites of the eyes (Jaundice)
  • Vomiting blood
  • Skin itching
  • Dark urine and solidification of stool
  • Easy bruising and bruising
  • Swelling in the leg area (Edema) or fluid accumulation in the abdomen (Ascites)
  • Loss of sex drive (Libido)
  • Absence or loss of menstruation not related to menopause in women
  • Drowsiness and slurred speech (Hepatic Encephalopathy)

What are The Stages of Cirrhosis (Cirrhosis of the Liver)?

According to the presence of cirrhosis symptoms, it is examined in two stages as compensated and decompensated cirrhosis. If diagnosed early enough, decompensated cirrhosis can turn into compensated cirrhosis.

These two phases are as follows:

  1. Compensated Cirrhosis Stage:

It is the stage when the symptoms of cirrhosis are not seen and the patient has no complaints. There is scar tissue in the liver but not advanced enough to cause symptoms.

  1. Decompensated Cirrhosis Stage:

Symptoms such as jaundice and fluid accumulation in the abdomen (ascites) appear at this stage.

It’s a very serious one. It is possible to reversible in early diagnosis and diagnosis, but if it is late, the only option is liver transplantation. It seriously threatens life.

How is Cirrhosis (Cirrhosis of the Liver) Diagnosed?

  • Physics Examination:

Your doctor will look for specific signs to clearly discover the signs of cirrhosis. Depending on the symptoms such as redness on your skin, spider-like blood vessels, and yellowing of your skin, your process, which stage you are in and which tests you will have are then decided.

  • Blood Tests:

If necessary after the physical examination, your doctor will examine your liver damage due to the suspicion of cirrhosis.

  • Imaging Tests:

Imaging tests show the size, shape, and texture of your liver. It also shows the amount of scarring, the index of fat and fluid in your liver. This imaging process can be used computed tomography (CT) scan, abdominal ultrasound, and magnetic resonance imaging (MRI).

Apart from that, two types of endoscopy may be ordered: endoscopic retrograde cholangiopancreatography to detect bile duct problems, and upper endoscopy to detect enlarged veins (varices) or bleeding in your esophagus, stomach, or intestines.

  • Liver Biopsy:

It is the process of taking a cell sample from your liver. The sample taken from a thin needle is brought to the convenience of being examined under the microscope. A biopsy can confirm the diagnosis of cirrhosis and identify the causes and extent of liver damage or enlargement. If the results of the tests confirm your cirrhosis, you can contact a specialist doctor (hepatologist).

How is Cirrhosis (Cirrhosis of the Liver) Treated?

  • Alcohol Addiction Treatment:

If cirrhosis is caused by long-term heavy alcohol consumption, the patient should stop drinking. If you have alcohol addiction, your doctor will recommend a suitable treatment program.

  • Medicines:

Prescription drugs are usually used in liver cell damage caused by hepatitis B and C.

  • Checking the Pressure in the Portal Vein:

Portal veins are the veins that carry blood to the liver. This can cause veins and high blood pressure. Medication is also often used to control the increased pressure in other blood vessels, and precautions are taken even if there is heavy bleeding. Signs of bleeding can be investigated using the Endoscopy method.

In cases where there is bloody stool or vomit, varicose veins are considered to be in the esophagus. Urgent medical attention is required.

The following procedures may help:

  • Banding:

A small tape is placed around the base of the varicose vein to control the bleeding.

  • Injection Sclerotherapy:

After the endoscopy is taken, a substance that triggers the formation of blood clots and scar tissue is injected into the varicose areas. This helps stop the bleeding.

  • A Sengstaken-Blakemore Tube with Bubble:

This method is used when endoscopy is not sufficient. To stop the bleeding, the tube goes down the patient’s throat to the stomach and the balloon is inflated. Balloons placed at the end of the tube stop the bleeding by putting pressure on the varicose veins.

  • Transjugular Intrahepatic Portosystemic Stent Shunt (TIPSS):

If the treatments mentioned above do not stop the bleeding, a metal tube is passed through the liver to connect the portal and hepatic veins and a pathway is created to allow the blood to flow. The created path prevents the pressure that causes varicose veins.

Other complications are handled in different ways:

  • Infections:

It is the process of preventing infection with antibiotic therapy.

  • Liver Cancer Screening:

Cirrhosis can increase the risk of developing liver cancer. Therefore, it is important to have regular blood tests and imaging scans in patients with cirrhosis.

  • Hepatic Encephalopathy or High Blood Toxin Levels:

Medications can be used to help treat levels of toxins in the blood.

In advanced cases, damage caused by cirrhosis covers the entire liver and is not reversible. In such cases, the person will need a new liver. A suitable donor must be found and this process is recommended as a last resort.

How Should Patients with Cirrhosis (Cirrhosis of the Liver) be Fed?

The energy requirement of patients with cirrhosis is 50% higher than that of healthy people. A healthy adult needs 1500-2000 calories per day, while adults with cirrhosis need 2300-3000 calories. Half of the daily energy of the liver patient should come from simple and compound sugars called carbohydrates, one third from fats and the rest from proteins.

Water and salt restriction should be applied in cases of accumulation of water in the abdomen, widespread swelling and decrease in the amount of salt in the blood. These patients should use regular diuretics and have outpatient controls. Salt consumption should not exceed 1-2 grams. The following list of nutrients is important in liver cirrhosis, as in all liver diseases.

  • Artichoke:

It is rich in vitamins A and B. Artichoke, which has diuretic and antioxidant properties, can slow the progression of liver disease.

  • Multivitamin Support:

Antioxidant and multivitamin preparations can be given to patients with chronic liver disease.

  • Bulgur and Legumes:

Simple sugary foods such as tea sugar, chocolate, honey, jam, acidic beverages should be consumed less.
Simple sugars cause blood sugar to rise and fall rapidly.
Instead, foods containing compound sugars that moderately raise blood sugar and keep blood sugar at the desired level for a long time are recommended.
Foods containing compound sugar such as pasta, bulgur, vegetables, legumes, milk desserts, bulgur pilaf are recommended for liver patients.

  • Prepared Foods:

Consumption of fast food, ready-made market products, sausage, sausage, salami are among the foods that chronic liver patients should stay away from.

  • Meat and Eggs:

One egg-sized piece of meat is equivalent to one egg and 4 tablespoons of legumes. Changes in nutrition should be made by taking these ratios into consideration.

  • Dairy Products:

A glass of milk is equivalent to a bowl of yogurt, a matchbox of cheese and 2/3 of a matchbox of cheddar cheese. The corresponding day of consumption of yogurt should be reduced to milk or cheese.

  • Cereals:

Two slices of bread are equivalent to 4 tablespoons of pasta, rice pilaf and bulgur pilaf. The daily balance should be adjusted according to these ratios.

What Should Cirrhosis (Cirrhosis of the Liver)  Patients Pay Attention To?

  • Regular Doctor Checkup:

Detailed evaluation with a liver specialist is required to grade the disease and determine appropriate treatment.
Regular liver function tests and follow-up should be performed every 1-3 months in early cirrhosis and 1 in 4 weeks in advanced cirrhosis.
The frequency of check-ups is determined by the attending physician, depending on the symptoms and severity of the disease.

  • Healthy Eating:

In chronic liver disease, a healthy diet is crucial for optimal liver function. Contrary to popular belief, except for the presence of severe jaundice, the digestive system of patients can function normally until very advanced stages of liver disease.

Therefore, the need to completely avoid fatty foods and proteins in all types of liver disease is not entirely true. This misinformation among the public can cause many liver patients to be deprived of food, lose weight and deteriorate their health faster.

Alcohol consumption should be avoided in alcoholic cirrhosis. And alcohol should be limited in all other types of cirrhosis, especially hepatitis C.

  • Exercise:

Excessive physical activity should be avoided, especially in viral cirrhosis. But this does not mean constant and mandatory bed rest.
Maintaining a reasonable level of movement and activity is recommended. Contact sports should be avoided in advanced stages of cirrhosis due to insufficient blood coagulation and bleeding tendency.

  • Medication Use:

Since the liver is insufficient, drugs used randomly can damage the liver and the whole body. For this reason, the use of any medication, vitamin, supplement product should be avoided without consulting a doctor.

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