Liver cirrhosis (shrinking liver)

Chronic diseases or inflammatory processes in the liver can lead to fatty liver and destroy tissue in the process. Liver cells are then replaced by functionless connective tissue. The result: The liver can no longer or only partially perform their tasks in metabolism and detoxification. Such cirrhosis of the liver is irreversible and life threatening in the terminal stages. Cirrhosis affects more than twice as many men as women.

Causes of cirrhosis

Almost every chronic liver disease can lead to liver cirrhosis. In about half of the cases chronic alcohol abuse is the cause. About one third of those affected are based on chronic viral hepatitis.

Rarer causes are, for example, autoimmune diseases in the area of ​​the liver-located biliary tract, which lead to constant inflammatory reactions, and metabolic diseases such as Wilson's disease or hemochromatosis, in which copper or iron are stored in the liver and lead to cell death.

Cirrhosis: symptoms and consequences

The liver cirrhosis itself usually causes symptoms only relatively late; Depending on the first complaints of the underlying disease are in the foreground. The symptoms of cirrhosis of the liver result from the limited performance of the liver.

The main consequences are an altered protein and hormone balance, the accumulation of toxic substances such as ammonia in the blood, which also reach the brain and damage it (hepatic encephalopathy), as well as an increase in pressure in the portal vein. Since the blood is difficult to flow through the scarred shrinkage of the liver, it creates bypasses, which in turn can lead to life-threatening bleeding in the area of ​​the esophagus. In addition, liver cirrhosis increases the risk of liver cancer.

The leading complications of liver cirrhosis include:

  • General symptoms: decreased performance, fatigue, weight loss
  • Skin abnormalities: vascular spider (Spider naevi), lacerated lips and tongue, reddened palms, white nails, vein extensions under the abdominal skin (signs of a bypass circulation)
  • Bleeding tendency, but also a coagulation tendency is possible
  • Ascites: distended abdomen, possibly with pressure and upper abdominal pain
  • Hormonal disorders: loss of libido, male breast and bald head baldness (loss of male hair on the abdomen), in women menstrual disorders
  • Jaundice (jaundice) with yellow discoloration of the skin and conjunctiva as well as severe itching
  • Signs of brain disorders: Disorientation, memory problems, mental retching or mood swings, inappropriate behavior, later impaired consciousness to unconsciousness (liver failure coma)

During the examination, for example during palpation or ultrasound, the liver appears enlarged at the beginning as a result of the disease processes. If the cirrhosis of the liver progresses, the liver shrinks as a result of the scarring changes, and it becomes small, firm and tubercular.

Diagnosis of cirrhosis

In order to diagnose liver cirrhosis, the typical symptoms and findings in the physical examination often suffice. Laboratory examinations, ultrasound and laparoscopy or liver biopsy are performed to look for causes, to assess the stage of cirrhosis and to plan the therapy.

A gastroscopy is used to check whether or not there are potentially life-threatening circulatory circuits of the blood vessels known as esophageal varices on the esophagus.

Therapy of cirrhosis

Once changed liver tissue can not be reconverted into functional liver cells. Therefore, the primary goal of the therapy is to reduce the progression of cirrhosis. First, therefore, is the treatment of the underlying disease. In addition, it is imperative to avoid substances that can further damage the liver - especially alcohol, but also drugs that are often detoxified via the liver. In addition, a diet adapted to liver cirrhosis makes sense.

In addition, the symptoms and possible complications of cirrhosis of the liver are treated. Thus, ascites is reduced by means of medication or abdominal puncture, or bleeding from esophageal spasm veins is stopped with a reflection. In some cases, a non-dangerous shunt operation is performed in which an artificial bypass of the portal vein system is created. This portosystemic shunt protects against varicose bleeding but increases the risk of liver coma.

In some cases liver function can be restored by liver transplantation. However, due to some exclusion criteria, such as alcohol dependence, many sufferers are out of the question.

Cirrhosis: course and life expectancy

Life expectancy in cirrhosis depends firstly on the cause, on the other hand on how far the cirrhosis of the liver has progressed and how well it can prevent its exacerbation. If nothing is done or if, for example, the liver is further damaged by alcohol, the cirrhosis of the liver ends in death in months to a few years. The most frequent cause of death is bleeding from esophageal varicose veins, followed by hepatic coma and combined liver and kidney failure (hepatorenal syndrome).

To estimate the prognosis, doctors use the Child Pugh score. With its help, liver cirrhosis is divided into stages (Child 1 to Child 3). Relevant are five criteria (three laboratory values ​​as well as the ascites and the severity of the brain disorders), for each of which a score of 1 to 3 is awarded. The higher the score achieved (maximum 15), the lower the life expectancy.

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