Diseases of Liver
Cirrhosis of the liver
What is cirrhosis of the liver?
Cirrhosis is a diffuse, chronic and irreversible disease of the liver whose definition is anatomical, with the association of three types of lesions :
An achievement of liver cells (liver cells);
A fibrosis ;
Of regenerative nodules in which liver cells try to run but get there wrong because the architectural layout of the new cells do not comply with their duties.
Depending on the size of the nodules, a distinction is made between micronodular and macronodular cirrhosis .
Causes and risk factors
The causes of cirrhosis are numerous: alcohol and viral hepatitis are nevertheless responsible for 90% of cirrhosis.
Alcoholism is responsible for around 50% of cirrhosis . The amount of alcohol and the duration of intoxication necessary to cause cirrhosis seem to vary quite a bit from one individual to another. The alcoholic cirrhosis is usually preceded by a latency period which is reflected by an increased liver volume , due to fat overload ( fatty liver). This overload can regress completely if the intoxication is stopped. It is usually a micronodular cirrhosis;
The viral hepatitis, especially B and C chronic , may be complicated by cirrhosis.
Other causes of cirrhosis
The drug-induced hepatitis or toxic;
A biliary obstruction extended;
The hemochromatosis primitive is a genetic disorder associated with a defective regulation of the intestinal absorption of iron which is excessively:
Iron accumulates in tissues and especially in the liver where, over time, it causes fibrosis and then cirrhosis. This liver damage is well tolerated for a fairly long time and the contrast between the large liver and the few biological signs is suggestive.
he disease is 10 times more common in men than in women (due to the loss of iron during menstruation) and is recognized around 40-60 years.
The other clinical signs of the disease are the witnesses of iron deposits in the different organs: the skin (skin pigmentation), the pancreas ( diabetes ), the heart ( heart failure ), the gonads (gonadal deficit).
A blood test confirms the diagnosis (increased serum iron level or hypersideremia, transferrin saturation). The treatment consists mainly of repeated bleeding which results in the reduction of iron deposits in the tissues. There is also the possibility of administering a so-called iron chelating agent which contains a substance which binds to iron and thus causes its excretion via the faecal / urinary route. There are secondary hemochromatoses linked to repeated transfusions (high iron intake), chronic hemolytic anemia , alcoholic cirrhosis, portocava anastomosis;
Wilson's disease is a genetic disease linked to the accumulation of copper in different organs : liver, cornea , central nervous system. The enzymatic mechanism involved is poorly understood (ceruloplasmin synthesis defect):
The disease is generally recognized in children or adolescents. Liver damage is characterized by fibrosis followed by cirrhosis . Involvement of the cornea is manifested by a brown-green ring located at the periphery of the cornea (Kayser-Fleischer ring). Central nervous system involvement manifests as extrapyramidal syndrome .
Treatment consists of the administration of a copper chelating drug (penicillamine).
Primary biliary cirrhosis is a condition affecting mainly women between the ages of 40 and 50 . It seems to be linked to an obstruction of the intrahepatic bile ducts, the precise cause of which is unknown, but probably autoimmune.
The disease begins with pruritus which precedes the onset of jaundice by several months . The liver and spleen are enlarged and signs of cholestasis appear.
The diagnosis is based on the demonstration of anti-mitochondrial antibodies in the serum. The prognosis is variable.
Other causes of cirrhosis are sometimes found: cardiac cirrhosis, schistosomiasis , galactosemia , etc.
In addition, liver specialists are now alarmed by the damage caused by overweight on the liver at the origin of non-alcoholic fatty liver disease (NASH for its acronym in English). Non-alcoholic steatohepatitis is an accumulation of fatty acids in the form of triglycerides in the liver .
This anomaly is especially found in people with diabetes, overweight, obese or metabolic syndrome. For these nonalcoholic people without viral hepatitis, the risk of developing cirrhosis or liver cancer is high.
Symptoms of cirrhosis
There are no symptoms for a long time . However, sometimes there is fatigue, loss of appetite, weight loss ...
On palpation , the liver is often enlarged , but above all it has a firm or hard consistency with a "sharp" lower edge. It is usually painless.
Other symptoms may already be noted:
Signs reflecting liver failure : slight jaundice of the conjunctiva , stellate angiomas, palmar erythrosis ( redness in the palm of the hand), flapping tremor ( trembling of the hands), etc. ;
Signs indicating hypertension of the portal vein : splenomegaly (increase in the volume of the spleen), abdominal collateral circulation .
Additional examinations and analyzes
In the event of cirrhosis of the liver, laboratory tests are not very explicit . We can see signs of hepatocellular insufficiency (hypoalbuminemia, reduced ability to clot), inflammatory signs, discreet signs of destruction of liver cells (increased transaminases ). The alkaline phosphatase are usually normal:
Anemia, decrease in the number of white blood cells and platelets are common;
The gastroscopy and ultrasound seek complications ( esophageal varices and peptic ulcer disease);
The puncture-biopsy of the liver has an important diagnostic interest and makes it possible to specify the histology of the cirrhosis.
In some cases of liver disease, a measurement of the elasticity and fibrosis of the liver , using an ultrasound device such as Fibroscan, may be performed. Non-invasive and painless, this examination cannot however replace the biopsy, which remains the reference examination.
A non-invasive test dedicated to the diagnosis of cirrhosis, the CirrhoMeter ® , could change practices tomorrow.
Evolution of cirrhosis
The possible complications are numerous:
The ascites is the most common complication. It can set in quickly or gradually. It is a fluid effusion in the peritoneal cavity which results when it is important in the dull distension of the abdomen. The liquid is clear, pale yellow in color;
Ascites is accompanied by a decrease in urine output and edema of the lower limbs. At an advanced stage, hydroelectrolyte abnormalities appear: drops in sodium, potassium and nitrogen in the blood.
Jaundice is also a common complication. There is an increase in free and conjugated bilirubin in the blood. It is a mixed jaundice ;
The infections are very frequent and can be explained by the decrease in the anti-bacterial defense systems;
There is often a moderate fever in cirrhosis, the origin of which is not well known;
The gastrointestinal bleeding (haematemesis, melena) are frequent and serious complications. There are three main causes: ruptured oesophageal varix, peptic ulcer , hemorrhagic gastritis. The diagnosis of the bleeding lesion must be made urgently using endoscopy. The coagulation disorders promote these hemorrhages;
The primary liver cancer (hepatoma) is a serious complication of cirrhosis. Different symptoms make it possible to suspect the appearance of cancer: fever, pain in the right hypochondrium (right flank), very dark jaundice, gastrointestinal bleeding, increase in alkaline phosphatase, increase in alpha-2-globulins and alpha-fetoprotein . The diagnosis is confirmed by ultrasound, computed tomography and selective arteriography;
The encephalopathy liver can be spontaneous or caused by a specific cause (infection, gastrointestinal bleeding, sedatives, diuretics, etc.). The degree of encephalopathy is variable, as is its course. It associates a "flapping tremor" (sudden and brief muscular twitches), a particular smell of the breath (fetor hepaticus), pyramidal signs ( bilateral Babinski ) and extra-pyramidal signs ( hypertonia and cogwheel).
Not to be confused with ...
Cirrhosis of the liver should not be confused with other causes of large liver:
Heart liver secondary to heart failure ;
Liver tumors ;
Large liver from cholestasis;
Amyloidosis;
Steatosis ;
Parasitosis ;
Collagenosis, hemopathies, sarcoidosis ...
Treatment of cirrhosis
There is no cure for cirrhosis. Processing is limited to:
Absolute withdrawal from alcoholic beverages ;
Diuretics (spironolactone);
Symptomatic treatment of complications.
As of 2015, patients with cirrhosis (even decompensated) due to hepatitis C can be treated with direct-acting antiviral drugs, with response rates above 83%.
A healthy lifestyle is also essential. It is advisable not to smoke , to practice regular physical activity , to adopt a balanced diet (making sure to have a sufficient intake of calcium, cirrhosis can be a risk factor for osteoporosis) but also by fighting against possible overweight.
Hepatitis
An organ with multiple functions, the liver has many enemies, including many viruses. More than one in a hundred people would thus be affected by viral hepatitis. These diseases affect the entire liver tissue and are accompanied by an inflammatory reaction, which can progress to cirrhosis or cancer of the liver. Among the hepatitis caused by a virus, we distinguish hepatitis A, B, C, but we have also identified the virus D or delta and the virus E.