In our last column, we looked at the causes and symptoms of chronic hepatitis B and its effects on the liver. Today, we examine cirrhosis, a condition found in patients in the end stages of chronic liver disease.
Cirrhosis is caused by the tissues of the liver being increasingly damaged and replaced by fibrosis, changing the structure and the shape of the liver. The surface of the liver becomes rugged and the fibrosis increasingly accumulates in the liver, which becomes even stiffer. In addition, the increasing loss of liver tissue gravely affects the functions of the liver.
The most common causes of cirrhosis in Thailand are alcohol abuse, chronic inflammatory liver disease which can be divided into hepatitis B and C, fatty liver which commonly found in patients with diabetes and chronic inflammatory liver disease which is caused by, for example, autoimmune disease, and chronic biliary atresia. Certain types of medicines can also produce fibrosis over a prolonged period. However, the exact cause is unknown in 10–15% of cirrhosis patients.
In the past, the condition of a patient inflicted with cirrhosis would gradually deteriorate with death the most likely outcome. Today, thanks to the latest medical advances, doctors can find the causes of cirrhosis and successfully remove them. This can partially improve the condition with regard to the function and pathological conditions of the liver. According to some studies, if patients with chronic cirrhosis from chronic hepatitis B and C receive treatment on time, the production of fibrosis in their liver noticeably decreases. Furthermore, the liver in cirrhosis patients who were heavy drinkers but who now abstain from alcohol consumption will improve and be able to function well.
Patients who are in the early stages of cirrhosis do not display any symptoms. In certain cases, they will only experience tiredness and loss of appetite. The commonly known symptoms such as jaundice and swellings in the legs and abdomen occur at a later stage when the liver is no longer able to function effectively. It is thus vital to monitor the development of cirrhosis closely in those who are at risk.
The diagnosis of cirrhosis involves a set of examinations. A blood test can evaluate the function of the liver. Additionally, radiology tests, including ultrasound, computer X-ray, and magnetic resonance imagining, are able to evaluate the general condition of the liver. In some patients liver biopsy will be necessary. A new technological development called a fibroscan can be employed to evaluate the stiffness of the liver by using ultrasound waves. A recent breakthrough, fibroscan is proving effective in diagnosing fibrosis in the liver and cirrhosis and its use has markedly reduced the number of patients requiring a biopsy.
Once a patient has been diagnosed with cirrhosis, additional testing must be carried out to find its cause so that effective treatment can be planned and proper care administered in order to prevent complications.
Patients with cirrhosis can be divided into two groups based on liver function. The first group, patients at the early stage of cirrhosis (compensated cirrhosis) , usually show no symptoms. The second group, patients in the later stages of cirrhosis (decompensated cirrhosis), suffer such symptoms as high pressure in the hepatic portal venous system, leading to fluid build-up in the abdomen, swelling in the legs, swelling in the blood vessels of the oesophagus and the stomach, and upper gastrointestinal bleeding.
A patient with compensated cirrhosis can expect to see his/her condition deteriorating by 8 to 12 per cent a year. Cirrhosis patients are also more likely to suffer from liver cancer, although the likelihood of each patient developing liver cancer varies, depending on the cause of the cirrhosis, with patients who develop cirrhosis from hepatitis B most at risk.
DR TEERHA PIRATVISUTH and Dr Pitulak Aswakul are specialists in gastroenterology and hepatology at Samitivej Sukhumvit Hospital. |Call (02) 711 8822-4.