Hepatic cirrhosis

Hepatic cirrhosis is a chronic liver disease characterized by the replacement of liver tissue by fibrosis, scar tissue, and regenerative nodules, leading to loss of liver function. This condition arises from the prolonged injury to the liver, often due to alcohol abuse, chronic hepatitis B or C infection, and non-alcoholic fatty liver disease (NAFLD).

Etiology

The primary causes of hepatic cirrhosis include:

• Chronic alcohol abuse
• Viral hepatitis, particularly Hepatitis B and Hepatitis C
• Non-alcoholic fatty liver disease (NAFLD), including its more severe form, non-alcoholic steatohepatitis (NASH)
• Autoimmune hepatitis
• Genetic diseases such as Wilson's disease and hemochromatosis
• Biliary cirrhosis, resulting from diseases such as primary biliary cholangitis and primary sclerosing cholangitis

Pathophysiology

Hepatic cirrhosis involves the progressive destruction of liver cells, which are replaced by fibrous scar tissue. This process disrupts the normal structure and function of the liver, impairing blood flow and the liver's ability to process nutrients, hormones, drugs, and toxins. The regenerative nodules that form in an attempt to repair liver damage further compromise the liver's architecture and function.

Clinical Features

Symptoms of hepatic cirrhosis may not be apparent in the early stages of the disease. As cirrhosis progresses, symptoms may include:

• Jaundice
• Fatigue
• Weakness
• Loss of appetite
• Weight loss
• Itching
• Easy bruising and bleeding
• Swelling in the legs (edema) and abdomen (ascites)
• Confusion, drowsiness, and slurred speech (hepatic encephalopathy)

Diagnosis

Diagnosis of hepatic cirrhosis involves a combination of history taking, physical examination, blood tests, imaging studies, and sometimes liver biopsy. Blood tests may show elevated liver enzymes, bilirubin, and other markers indicative of liver dysfunction. Imaging studies like ultrasound, CT scan, and MRI can assess liver size, texture, and the presence of nodules and fibrosis.

Treatment

There is no cure for hepatic cirrhosis, but treatments can manage symptoms and slow the progression of the disease. Management strategies include:

• Cessation of alcohol consumption
• Medications to control liver disease causes and symptoms, such as antivirals for hepatitis B and C, and corticosteroids for autoimmune hepatitis
• Treatment for complications, such as diuretics for edema and ascites, antibiotics for infections, and lactulose or rifaximin for hepatic encephalopathy
• Liver transplantation for end-stage liver disease

Prevention

Preventive measures for hepatic cirrhosis focus on minimizing liver damage through lifestyle choices and medical interventions, including:

• Avoiding excessive alcohol consumption
• Vaccination against hepatitis B
• Safe practices to prevent hepatitis C transmission
• Managing risk factors for NAFLD, such as obesity, diabetes, and hyperlipidemia

Prognosis

The prognosis for individuals with hepatic cirrhosis varies depending on the stage of the disease, the underlying cause, and the presence of complications. Early detection and management can improve quality of life and survival rates.