Liver cirrhosis is the terminal stage of various hepatic pathologies, which is characterized by progressive scarring of the liver, affecting the synthesis of bile, purification of the blood from toxins and intermediate metabolic products. Non-alcoholic fatty hepatosis, chronic viral hepatitis (with or without jaundice) and alcoholism are the three main causes of this serious liver disease. In our country, such a diagnosis is not uncommon. It is important to know about how the liver works, what are the consequences of its damage and modern methods of treating cirrhosis.

Liver functions: bile synthesis, blood filtration

The liver is a large, dense organ located under the lungs. The liver collects blood from the digestive system and heart. Filtration, or “purification” of blood, is the main function of the liver. It filters and removes waste generated in the body and neutralizes incoming toxins, alcohol and drugs.   

In addition to many other vital tasks, the liver produces bile, a greenish, yellowish, or brown digestive fluid that contains bile acids. Bile helps the breakdown and digestion of fats, carbohydrates, and partially proteins, and is essential for the production of blood clotting factors. In addition, bile stimulates peristalsis – this is the prevention of constipation.

The liver stores energy by storing glucose. It also stores some vitamins and minerals such as copper and iron. They help create new blood cells. The liver also plays a role in the functioning of the immune system and the regulation of blood pressure.

Fibrosis and cirrhosis of the liver

Liver fibrosis is a term used to describe the presence of a large number of scars in the liver. People can develop fibrosis, which is a precursor to liver cirrhosis. In addition, cirrhosis of the liver, starting as fibrotic lesions, may have a latent course for a number of years (from 5 to 10 years). Liver cirrhosis is an advanced stage of scarring that begins to disrupt normal blood flow and organ function. This is the terminal stage of scarring that can form over the years. 

When liver function is impaired, it reduces the body’s overall ability to perform functions closely related to liver function. As a result, this threatens the accumulation of fluid in the abdomen (ascites) and bleeding in the digestive tract.

In cirrhosis, a serious complication is a violation of the synthesis and excretion of bile, and metabolites, partially not rendered harmless by the liver, accumulate in the bloodstream. Medicines, therefore, can have a stronger, toxic effect on people taking them, and the risk of side effects also increases.

Another complication is portal hypertension, in which increased pressure is formed in the veins of the stomach, esophagus and rectum with the risk of bleeding.

Symptoms and diagnosis of cirrhosis: will there be jaundice?

The symptoms of cirrhosis are often nonspecific. These include fatigue, weight loss and a general feeling of malaise, and possibly jaundice. Sometimes, changes in bowel movements can include oily ( steatorrhea ), excessively dark, or discolored feces. People with cirrhosis can be malnourished as they lose their appetite and the ability to digest and absorb fats and certain vitamins. Muscle weakness and degenerative changes in tendons, glands, organs, brain and nervous system can be observed.

Cirrhosis can lead to changes in the skin. Itching of the skin is a symptom of liver pathology, when the outflow of bile is impaired. Damage to the liver can lead to the appearance of dilated blood vessels on the skin’s surface (spider veins). Reddened palms can be signs of cirrhosis, along with enlargement of the terminal phalanges and wrinkling of the skin.

Jaundice – staining the eyes and skin in different shades of yellow, is a classic symptom of progressive liver pathology, since excess bile accumulates in the blood and skin capillaries. Jaundice can be subtle to severe.

How to identify liver pathologies?

Along with a physical examination of the patient, the identification of typical symptoms and jaundice, an assessment of the medical history, such a liver pathology is diagnosed by doctors based on the results of tests and instrumental examinations. Tests for liver damage, blood tests for viral infections such as hepatitis, ultrasound scans, angiography, and liver biopsies are used to confirm the diagnosis of cirrhosis. To date, there is no single blood test that absolutely confirms this liver pathology. No markers have been identified that would be sensitive and very specific for liver cirrhosis.

However, there are several biomarkers that, when combined with other clinical findings, may raise the suspicion that this is a liver pathology. For example, a low platelet count for no apparent objective cause in an adult should raise concern that the patient is suspected of having progressive liver fibrosis.

Alcoholism and cirrhosis

One of the factors in the development of cirrhosis is alcoholism. The longer and the higher the doses people consume alcohol, the higher the risk of developing liver pathologies and cirrhosis. According to research, men who have consumed more than 500-700 ml of alcohol daily for more than 10 years (suffering from alcoholism) very often have cirrhosis of the liver.

According to scientists, women are more vulnerable to liver damage that alcoholism causes. Taking even light alcoholic beverages dramatically increases the risk of developing liver problems. However, alcoholism is far from the only cause of liver problems. Identifying a patient as a person with a high risk of cirrhosis does not mean that the person is an alcoholic. Against the background of existing liver problems (hepatitis), even small doses of alcohol that do not lead to alcoholism can threaten the development of cirrhosis and other lesions. The goal is to identify a subgroup of people who are at risk – they need preventive and therapeutic measures.