Cirrhosis is a disorder of the liver which, in Anguilla, is usually associated with chronic alcohol abuse. This late stage disorder can cause much distress and suffering and can take a heavy toll on the affected individual when complications occur.
What is cirrhosis of the liver?
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions such as hepatitis C and chronic alcohol abuse. Not all individuals who abuse alcohol get cirrhosis of the liver. Women tend to be more at risk than men. The liver weighs about 3 pounds and is the largest solid organ in the body. It performs many important functions. The scarring associated with cirrhosis occurs in response to damage to the liver. Once scarring has occurred it cannot be undone.
Cirrhosis is a slowly progressing disease in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properly. The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins. It also slows the production of proteins and other substances made by the liver.
If liver cirrhosis is diagnosed early, and the cause is treated, further damage can be limited. As cirrhosis progresses more and more scar tissue forms making it difficult for the liver to function. Advanced cirrhosis is life-threatening and can result in death.
What are the symptoms of cirrhosis?
In the early stages of this chronic disorder there are few if any symptoms or signs. The symptoms of cirrhosis of the liver vary with the stage of the illness. It is only when significant portions of the liver are destroyed that symptoms occur. Symptoms and signs include the following:
• Fatigue
• Itchy skin
• Jaundice (Yellow discolouration in the skin and eyes)
• Ascites (fluid accumulation in the abdomen)
• Loss of appetite
• Nausea
• Swelling in ankles and legs
• Weight loss
• Confusion, drowsiness and slurred speech (hepatic encephalopathy)
• Spider-like blood vessels on the skin
• Bleeding easily
Diagnosis
If you or a friend or relative have the above signs and symptoms a doctor’s visit is required. During a physical exam, your doctor can observe changes in how your liver feels or how large it is. Often, cirrhosis is first detected through a routine blood test or checkup. Your doctor may order one or more tests or procedures to diagnose cirrhosis. Various noninvasive imaging tests can help in making the diagnosis. A tissue sample (biopsy) is not necessarily needed for diagnosis, but your doctor may use it to identify the severity, extent and cause of liver damage.
Treatment
Treatment for cirrhosis depends on the cause and extent of your liver damage. The goals of treatment are to slow the progression of scar tissue in the liver and to prevent or treat symptoms and complications of cirrhosis. Most cases of cirrhosis in Anguilla are associated with excessive and chronic abuse of alcohol. Treating individuals who abuse alcohol in Anguilla is extremely challenging. Unfortunately, there are no rehabilitation centers on the island, something that is much needed and would help in the rehabilitation process of those individuals who wish to stop using alcohol.
Complications of cirrhosis
There are many complications of cirrhosis and many individuals living in Anguilla are very familiar with these complications. Complications include the following:
• Swelling in the legs and abdomen
• High blood pressure in the veins that supply the liver (portal hypertension)
• Enlargement of the spleen (splenomegaly)
• Bleeding. Portal hypertension can cause blood to be redirected to smaller veins. Strained by the extra load, these smaller veins can burst, causing serious bleeding. High blood pressure also may cause enlarged veins (varices) and lead to life-threatening bleeding in the oesophagus (oesophageal varices) or the stomach.
• Infections. If you have cirrhosis, your body may have difficulty fighting infections. Ascites can lead to bacterial peritonitis, a serious infection.
• Malnutrition. Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss.
• Buildup of toxins in the brain (hepatic encephalopathy). With time, hepatic encephalopathy can progress to unresponsiveness or coma.
• Jaundice. Jaundice causes yellowing of the skin and whites of the eyes and darkening of urine.
• Bone disease. Some people with cirrhosis lose bone strength and are at greater risk of fractures.
• Gallstones and bile duct stones. Blocked flow of bile can lead to irritation, infection and the creation of stones.
• Increased risk of liver cancer.
Most of these complications can initially be treated with medicines or dietary changes. Once treatment for these complications becomes ineffective, a liver transplant is considered. This is not available in Anguilla at this time and is very costly.
Can you decrease your chances of getting cirrhosis?
Yes! Many individuals can decrease their chances of getting cirrhosis of the liver. Just like your heart, you must take steps to take care of your liver. The following might prove beneficial:
• Drink alcohol in moderation, if at all. If you choose to drink alcohol, and do not have liver disease or cirrhosis, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men over age 65, and up to two drinks a day for men age 65 and younger.
• Eat a healthy diet. Use lots of fruits and vegetables, as much as possible, and choose a plant-based diet. Select whole grains and lean sources of protein. Decrease the amount of fatty and fried foods you eat. Count down on all these junk foods.
• Maintain a healthy weight. An excess amount of body fat can damage your liver. If you are obese or overweight talk with your doctor, dietician or healthcare provider.
• Reduce your risk of hepatitis. Sharing needles and having unprotected sex can increase your risk of hepatitis B and C.
Conclusion
Cirrhosis affects individuals in Anguilla especially those who chronically abuse alcohol. Almost everyone who chronically abuses alcohol will damage his/her liver, but not everyone will develop cirrhosis. For those who develop cirrhosis, and do not seek medical treatment, the complications can be very severe and can even result in death. Although there is no cure for cirrhosis of the liver, there are treatments available that can stop or delay its progress, minimize the damage to liver cells, and reduce complications.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB, BS, DGO, MRCOG, is an Obstetrician/Gynaecologist and Family Doctor who has over thirty two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
