Liver Cirrhosis

Liver Cirrhosis

1. Definition
   Liver cirrhosis is the end‑stage of chronic liver disease in which the normal liver tissue is replaced by fibrous scar tissue and regenerative nodules, resulting in loss of normal liver function.

2. Causes / Etiology

• Chronic alcoholism – long‑term intake of alcohol damages hepatocytes.
• Viral hepatitis B and C – persistent infection leads to ongoing inflammation.
• Non‑alcoholic fatty liver disease – fat accumulation and inflammation in the liver.
• Autoimmune hepatitis – body’s immune system attacks liver cells.
• Genetic disorders such as haemochromatosis (iron overload) and Wilson’s disease (copper overload).

3. Types or Classification
   Alcoholic cirrhosis – produced by prolonged excessive alcohol use.
   Post‑hepatitic cirrhosis – follows chronic viral hepatitis.
   Cryptogenic cirrhosis – no identifiable cause, often related to hidden metabolic disease.
   Primary biliary cirrhosis – autoimmune destruction of intra‑hepatic bile ducts.
   Secondary biliary cirrhosis – results from obstruction of extra‑hepatic bile ducts.

4. Pathology (stepwise)
   step 1 → chronic liver injury (alcohol, virus, fat, etc.) →
   step 2 → inflammation and hepatocyte necrosis →
   step 3 → activation of stellate cells → deposition of collagen (fibrosis) →
   step 4 → formation of regenerative nodules around fibrous bands →
   step 5 → distortion of hepatic architecture → impaired blood flow and loss of synthetic function.

5. Clinical Features

General:

• Persistent fatigue and weakness.
• Unexplained weight loss.
• Generalised abdominal discomfort.

Specific:

• Jaundice – yellowing of skin and sclera (due to bilirubin rise).
• Ascites – accumulation of fluid in the abdomen, causing distension.
• Spider angiomas – small dilated vessels on the skin.
• Palmar erythema – reddening of palms.
• Hepatic encephalopathy – confusion, altered sleep pattern, asterixis (hand‑flap).

6. Complications

Acute:

• Hepatic encephalopathy (sudden mental change).
• Variceal bleeding – rupture of enlarged oesophageal veins.
• Spontaneous bacterial peritonitis – infection of ascitic fluid.

Chronic:

• End‑stage liver failure (coagulopathy, hypoalbuminaemia).
• Hepatocellular carcinoma – primary liver cancer.
• Portal hypertension – leads to splenomegaly and hypersplenism.

7. Diagnosis / Investigations

Routine tests:

• Liver function tests (ALT, AST, ALP, bilirubin, albumin) – show hepatocellular injury and synthetic failure.
• Complete blood count – may reveal anaemia, leukopenia, thrombocytopenia.
• Prothrombin time/INR – assesses clotting ability.

Imaging:

• Abdominal ultrasound – shows coarse echotexture, nodularity, splenomegaly, ascites.
• Doppler ultrasound – evaluates portal vein flow.
• CT or MRI – better delineates nodules and detects tumour.

Special tests:

• Liver biopsy – gold standard for confirming fibrosis stage and type.
• Upper GI endoscopy – screens for oesophageal varices.
• Serum alpha‑fetoprotein – marker for hepatocellular carcinoma.

8. Management

General measures:

• Absolute abstinence from alcohol.
• Avoid hepatotoxic drugs (e.g., certain NSAIDs).
• Vaccination against hepatitis A and B.

Modern treatment:

• Diuretics (spironolactone ± furosemide) for ascites.
• Lactulose and rifaximin for hepatic encephalopathy.
• Non‑selective beta‑blockers (propranolol) to reduce portal pressure.
• Antiviral therapy for chronic hepatitis B or C.
• Consider liver transplantation in decompensated cirrhosis.

Dietary advice:

• Low‑sodium diet (≤2 g salt/day) to control ascites.
• Adequate protein (1.0–1.2 g/kg) unless encephalopathy worsens; use vegetable protein.
• Plenty of calories from complex carbs and healthy fats.
• Supplement vitamin D, calcium, and fat‑soluble vitamins if deficient.

9. Homeopathic Therapeutics

Natrum Muriaticum

• Ascites with feeling of heaviness in abdomen.
• Marked weakness and loss of appetite.
• Thirst for small sips of water, especially cold.
• Sensitivity to emotional upset, especially grief.
• Dry, cracked skin on hands.
• Tendency to develop depressive thoughts.

Lycopodium Clavatum

• Enlarged liver with a sense of fullness in the right upper quadrant.
• Bloating and flatulence after meals.
• Early evening fatigue, better after rest.
• Skin eruptions such as acne or eczema.
• Anxiety about performance, fear of failure.
• Desire for warm drinks, intolerance to cold.

Chelidonium Majus

• Jaundice with bitter taste in mouth.
• Sharp, cutting pain in the liver region radiating to the right shoulder.
• Nausea and vomiting of bile.
• Pruritus (itching) especially on palms and soles.
• Restlessness and irritability.
• Sensitivity to light and noise.

Carduus Marianus

• Marked liver enlargement with tenderness.
• Profuse watery diarrhoea alternating with constipation.
• Ascites with a feeling of heaviness and swelling of legs.
• Skin eruptions, especially on the scalp.
• Mental depression, loss of interest in usual activities.
• Preference for cold drinks, aversion to hot foods.

Calcarea Carbonica

• Jaundice with sluggish digestion.
• Bloating and flatulence after dairy foods.
• General fatigue, especially in damp weather.
• Bone and joint aches, especially in the knees.
• Anxiety about health, fear of becoming ill.
• Tendency to develop cold sores and other skin lesions.