The liver is the largest and one of the vital organ which detoxifies various metabolites, synthesizes proteins, and produces biochemicals necessary for digestion. It is responsible for hundreds of chemical actions that the body needs to survive.
what happens when our survival get affected due to liver dysfunctioning.
Here I am going to share some knowledge on the most injurious disorder of liver i.e LIVER CIRRHOSIS.
Cirrhosis is a condition that is deﬁned histo pathologically and has a variety of clinical manifestations and complications,some of which can be life-threatening.
It develops when scar tissue replaces normal, healthy tissue in liver.
The scar tissue makes the liver lumpy and hard, and after a while, the organ will start to fail. The scar tissue makes it tough for blood to get through a large vein (the portal vein) that goes into the liver.
Liver cirrhosis is a major public health problem and a significant source of morbidity and mortality that is preventable and underestimated. It represents the main indication for liver transplantation.
According to the WHO data published in may 2014 Liver Disease Deaths in India reached 216,865 or 2.44% of total deaths. The age adjusted Death Rate is 21.96 per 100,000 of population ranks India ranks 61 in the world.
ETIOLOGY OF CIRRHOSIS
Chronic viral hepatitis -Hepatitis B, Hepatitis C
Biliary cirrhosis- Primary biliary cirrhosis, Primary sclerosing cholangitis
Inherited metabolic liver disease
Wilson’s disease -Antitrypsin deﬁciency
Regardless of the cause of cirrhosis, the pathological features consist of the development of ﬁbrosis to the point that there is architectural distortion with the formation of regenerative nodules.
This results in a decrease in hepatocellular mass, and thus function and an alteration of blood ﬂow.
Excessive chronic alcohol use can cause several different types of chronic liver disease, including alcoholic fatty liver,alcoholic hepatitis,and alcoholic cirrhosis.
Furthermore, use of excessive alcohol can contribute to liver damage in patients with other liver diseases, such as hepatitis C, hemochromatosis.
Chronic alcohol use can produce ﬁbrosis in the absence of accompanying inﬂammation or necrosis.
In alcoholic cirrhosis, the nodules are usually <3 mm in diameter. This form of cirrhosis is referred to as micronodular. With cessation of alcohol use, larger nodules may form, resulting in a mixed micronodular and macronodular cirrhosis.
CIRRHOSIS DUE TO CHRONIC VIRAL HEPATITIS B OR C
Patients exposed to the hepatitis C virus (HCV), approximately 80% develop chronic hepatitis C, and of those, about 20–30% will develop cirrhosis over 20–30 years.
HCV is a noncytopathic virus and liver damage is probably immune-mediated.
Progression of liver disease due to chronic hepatitis C is characterized by portal-based ﬁbrosis with bridging ﬁbrosis and nodularity developing, ultimately culminating in the development of cirrhosis. In cirrhosis due to chronic hepatitis C, the liver is small and shrunken with characteristic features of a mixed microand macronodular cirrhosis seen on liver biopsy.
In addition to the increased ﬁbrosis that is seen in cirrhosis due to hepatitis C, an inﬂammatory inﬁltrate is found in portal areas with interface hepatitis and occasionally some lobular hepatocellular injury and inﬂammation.
CIRRHOSIS FROM NON ALCOHOLIC FATTY LIVER DISEASE AND AUTOIMMUNE HEPATITIS
Many patients with autoimmune hepatitis (AIH) present with cirrhosis that is already established. Typically, these patients will not beneﬁt from immunosuppressive therapy. In this situation, liver biopsy does not show a signiﬁcant inﬂammatory inﬁltrate. Diagnosis in this setting requires positive autoimmune markers such as antinuclear antibody (ANA) or anti-smooth-muscle antibody (ASMA).
When patients with AIH present with cirrhosis and active inﬂammation accompanied by elevated liver enzymes.
Patients with nonalcoholic steatohepatitis are increasingly being found to have progressed to cirrhosis.
As the cirrhosis progresses, it become catabolic and then lose the telltale signs of steatosis seen on biopsy.
It has pathological features that are different from either alcoholic cirrhosis or posthepatitic cirrhosis.
Cholestatic liver disease may result from necro inﬂammatory lesions,congenital or metabolic processes,or external bile duct compression.
The major causes of chronic cholestatic syndromes are primary biliary cirrhosis (PBC),autoimmune cholangitis, primary sclerosing cholangitis (PSC), and idiopathic adulthood ductopenia.
However, they all share the histopathologic features of chronic cholestasis,such as cholate stasis,copper deposition, xanthomatous transformation of hepatocytes and irregular so-called biliary ﬁbrosis.
Antimitochondrial antibodies (AMA) are present in about 90% of patients with biliary cirrhosis.
The earliest lesion is termed chronic nonsuppurative destructive cholangitis and is a necrotizing inﬂammatory process of the portal tracts.
Increased ﬁbrosis ensues with the expansion of periportal ﬁbrosis to bridging ﬁbrosis.
Physical examination can show jaundice and other complications of chronic liver disease including hepatomegaly, splenomegaly, ascites, and oedema.
Hyperpigmentation is evident on the trunk and the arms and is seen in areas of exfoliation and licheniﬁcation associated with progressive scratching related to the pruritus.
Patients with long-standing right-sided congestive heart failure may develop chronic liver injury and cardiac cirrhosis.
In the case of long-term right-sided heart failure,there is an elevated venous pressure transmitted via the inferior vena cava and hepatic veins to the sinusoids of the liver, which become dilated and engorged with blood.
The liver becomes enlarged and swollen, and with long-term passive congestion and relative ischemia due to poor circulation, centrilobular hepatocytes can become necrotic, leading to pericentral ﬁbrosis.
OTHER TYPES OF CIRRHOSIS
There are several other less common causes of chronic liver disease that can progress to cirrhosis.These include inherited metabolic liver diseases such as hemochromatosis, Wilson’s disease, alpha 1 antitrypsin deﬁciency and cystic ﬁbrosis. For all of these disorders, the manifestations of cirrhosis are similar.
Hemochromatosis is an inherited disorder of iron metabolism that results in a progressive increase in hepatic iron deposition which, over time can lead to a portal-based ﬁbrosis progressing to cirrhosis, liver failure, and hepatocellular cancer.
Wilson’s disease is an inherited disorder of copper homeostasis with failure to excrete excess amounts of copper,leading to an accumulation in the liver.This disorder is relatively uncommon, affecting 1 in 30,000 individuals.Wilson’s disease typically affects adolescents and young adults.
Alpha 1 AT deﬁciency results from an inherited disorder that causes abnormal folding of the alpha 1 AT protein, resulting in failure of secretion of that protein from the liver. It is unknown how the retained protein leads to liver disease. Patients with anti trypsin deﬁciency at greatest risk for developing chronic liver disease have the ZZ genotype, but only about 10–20% of such individuals will develop chronic liver disease.
CLINICAL FEATURES OF LIVER CIRRHOSIS
Yellow discoloration in the skin and eyes (jaundice)
Fluid accumulation in your abdomen (ascites)
Loss of appetite
Swelling in your legs
Confusion, drowsiness and slurred speech (hepatic encephalopathy)
Spiderlike blood vessels on your skin
Redness in the palms of the hands
Testicular atrophy in men
Breast enlargement in men
LIVER FUNCTION TEST : blood is checked for excess bilirubin, which is a product of red blood cells breaking down as well as for certain enzymes that may indicate liver damage.
KIDNEY FUNCTION TEST: Your blood is checked for creatinine as kidney function may decline in later stages of cirrhosis (decompensated cirrhosis).
Tests for hepatitis B and C.
CLOTTING TEST: Your international normalized ratio (INR) is checked for your blood’s ability to clot.
MAGNETIC RESONANCE ELASTOGRAPHY: These noninvasive imaging tests detect hardening or stiffening of the liver and may eliminate the need for a liver biopsy.
Other imaging tests.
MRI, CT and ultrasound create images of the liver.
BIOPSY: A tissue sample (biopsy) is not necessarily needed to diagnose cirrhosis. However, your doctor may use it to identify the severity, extent and cause of liver damage.
The clinical course of patients with advanced cirrhosis is often complicated by a number of important sequelae. These include
Gastroesophageal variceal hemorrhage
Spontaneous bacterial peritonitis (SBP)
TREAT THE CAUSE
In early cirrhosis, it may be possible to minimize damage to the liver by treating the underlying cause. The options include:
TREATMENT OF ALCOHOL DEPENDENCY
People with cirrhosis caused by alcohol abuse should stop drinking since any amount of alcohol is toxic to the liver. If stopping alcohol use is difficult, then recommend a treatment program for alcohol addiction.
People with cirrhosis caused by nonalcoholic fatty liver disease may become healthier if they lose weight and control their blood sugar levels. It is important to maintain the diet in terms of protein especially.
MEDICATION TO CONTROL HEPATITIS
Medications may limit further damage to liver cells caused by hepatitis B or C through specific treatment of these viruses.
Medications to control other causes and symptoms of cirrhosis. It may slow the progression of certain types of liver cirrhosis such as people with primary biliary cirrhosis (now known as primary biliary cholangitis).
HOMEOPATHIC TREATMENT OF LIVER CIRRHOSIS
It is among the top natural Homeopathic medicines for treating Cirrhosis of Liver. It covers a wide range of symptoms that are relieved with its use. The first condition for its use is jaundice. The second is dropsical accumulation of water in abdomen.This Homeopathic medicine is also beneficial for patients who feel fatigued or tired and have bouts of nausea and vomiting due to Liver Cirrhosis.
It is a natural Homeopathic medicine for treating Cirrhosis of Liver when the liver has atrophied due to longstanding Cirrhosis. The liver region is sensitive and painful. Hepatitis may be predominantly present. Dropsical conditions consequent to Liver Cirrhosis respond very well to this medicine.
it is of great help for patients of Liver Cirrhosis who experience fatigue as the main symptom. The patient feels totally exhausted from doing a little labour. He or she goes on losing weight due to debilitating effects of Cirrhosis of Liver.
It is a natural Homeopathic medicine of great help for patients of Liver Cirrhosis who have a history of long-term alcoholic abuse. Such patients also suffers from chronic acidity and constipation.
The acidity symptoms including heaviness in abdomen and burning in abdomen a few hours after meals. The constipation is marked by scanty, insufficient stool or poop but with a constant urge to pass stool.
It is a beneficial natural Homeopathic medicine for treating jaundice in patients with Cirrhosis of Liver. The symptoms during jaundice are yellow appearance of skin, and passage of stool of a very offensive nature. Utmost weakness follows the passage of stool. The second sphere where it is a Homeopathic remedy of great help is vomiting of blood.
Ascites or the accumulation of fluid is a common complication of Liver Cirrhosis. To deal with Ascites, natural Homeopathic medicines Apocynum Cannabinum, Quassia and Cardus Marianus are effective remedies.
It removes enlargement, inflammation and very helpful in the condition of cirrhosis of liver. it is also indicated in the condition of jaundice due to hepatic troubles.
It treats enlargement of liver with severe pain, jaundice and fever. Pain extends to hips and shoulders.
It is indicated in liver and dropsy which is generally caused by alcohol abuse or chronic hepatitis.
HOW TO BEAT CIRRHOSIS WITH THE HOME REMEDIES
Take papaya seeds and crush them properly to extract the juice. Now mix it with two tablespoons of lemon juice, Have the mixed juice twice a day for your liver.
BUTTERMILK AND YOGURT
Take two cups of water and add to it two full spoons of yogurt and 2 tablespoons of cumin seeds powder. Add salt to taste. Basically the idea is to make buttermilk and have it twice a day.
Katuki is an herb found in the Himalayas and is highly effective for cirrhosis patients. The roots of the herb can be consumed to keep the liver healthy and aid the digestion process.
Milk thistle contains silymarin, which is active an antioxidant and is known to reduce the damage to the liver and liver cells that sets in as a result of cirrhosis.
This herb is used in traditional Chinese medicine to cleanse the liver, protect liver cells from further damage and help regenerate liver tissues. Studies have found that it can help protect against drug-related liver damage.