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Introduction
Cirrhosis is caused by liver injury that results in fibrogenesis and inflammation. These problems result in collapse of liver structures and significant distortion of hepatic vascular structure. This distortion leads to elevated resistance to portal blood flow as well as portal hypertension. Moreover, hepatic synthetic dysfunction is also caused as a result of these problems. Clinically, liver cirrhosis is considered as an end-stage disease that could result in death until liver transplantation is performed (Tsochatzis, Bosch, & Burroughs, 2014).
Liver cirrhosis is an important cause of morbidity and mortality in most of the developed countries. In adults, it is the 14th most commonly found cause of death and results in about 1.03 million deaths per annum globally. In more developed countries, alcohol misuse, hepatitis C virus, and infection with hepatitis B virus are among the main causes of liver cirrhosis (Tsochatzis et al., 2014).
Normal anatomy of the major body system effected
Usually, liver is brown in color having smooth outer surface. The liver receives blood from portal vein and hepatic artery. Splenic and Superior mesenteric veins combine to form portal vein. In most of the cases, the hepatic artery comes from the celiac artery along with the left gastric and splenic arteries. Sometimes, hepatic artery has replaced vessels that are used to supply the liver. Several anatomic variations have been reported in the anatomy of hepatic artery. Externally, the liver has a smaller left lobe and larger right lobe that are divided by the falciform ligament, which is helpful in attaching the liver to the anterior abdominal wall (Sibulesky, 2013).
Normal physiology of the major body system effected
Liver is the largest organ of the body. It is located between the general and portal circulation, and between the heart and the organs of the gastrointestinal tract. Most important function of the liver is to get nutrients for the body, store them, and to provide those nutrients to other parts of the body. It is also a recycling system, and both parenchymal as well as non-parenchymal cells take part in the clearance activities (Ramadori, Moriconi, Malik, & Dudas, 2008).
Mechanism of Pathophysiology
Cirrhosis is caused by parenchymal degeneration, scarring, and regeneration. Usually, cirrhotic liver differs in respect of size, color, and appearance. Biliary obstruction could result in large and green liver, and advanced alcoholic cirrhosis could result in yellow and small liver (Sibulesky, 2013).
Several mechanisms are involved in the transition of chronic liver disease into cirrhosis. These mechanisms include inflammation, vascular occlusion leading to parenchymal extinction lesions, angiogenesis, and fibrogenesis (Tsochatzis et al., 2014). Formation of regenerative nodules along with surrounding fibrosis in the parenchyma of the liver results in firm and micronodular or macronodular appearance of liver (Sibulesky, 2013). These problems result in significant hepatic endothelial dysfunction and formation of intrahepatic shunts due to loss of parenchymal cells as well as angiogenesis. Endothelial dysfunction results in improper release of vasodilators such as nitric oxide and elevated production of vasoconstrictors such as thromboxane A2. Advanced liver disease leads to structural disturbances and endothelial dysfunction and other such problems lead to functional abnormalities; thereby, causing increased portal pressure. Liver stiffness and elevated hepatic resistance to portal blood flow are also the most important factors leading to increased portal pressure in liver cirrhosis (Sibulesky, 2013; Tsochatzis et al., 2014).
Prevention
In order to prevent the problem of cirrhosis on large scale, it is important to start population screening for the identification of patients with chronic liver disease. Non-invasive fibrosis markers are considered as primary tools for screening purposes. Lifestyle changes are also considered important for the prevention and management of cirrhosis. Overweight patients with liver cirrhosis have to be advised to decrease their weight. In case of alcoholic cirrhosis, abstinence from alcohol could help in improving survival (Tsochatzis et al., 2014).
Treatment
Patients of cirrhosis have to be treated according to the underlying disease of liver. For example, immunosuppression is usually recommended in case of autoimmune hepatitis; zinc or copper chelators are recommended for Wilson’s disease, and venesection is recommended for haemochromatosis. In case of viral hepatitis in patients of cirrhosis, antiviral treatment has to be started. Treatment with tenofovir for about 5 years could result in regression of cirrhosis that is related to hepatitis B virus in patients. In patients of hepatitis-C related cirrhosis, sustained virological response is required to reduce liver-related morbidity as well as mortality. Telaprevir and boceprevir have been found effective in sustaining virological response. Supplementary strategies in sustaining virological response include reduction of weight in obese patients, statins in patients of diabetes, vitamin D supplementation, and drinking coffee. In liver cirrhosis, portal pressure or hypertension, which is an important cause of most of the complications, could be decreased by about 30%, if the functional abnormalities are properly managed and treated. Liver transplantation is considered as the ultimate treatment for cirrhosis (Tsochatzis et al., 2014).
Clinical Relevance
Clinically, cirrhosis is asymptomatic, indolent, and unsuspected until the complications of the liver develop. Usually, liver diagnosis is done when incidental screening tests such as radiologic findings show liver disease and patient go through liver biopsy. It has been reported that nearly 20% of hepatitis C patients and nearly 10% of patients with nonalcoholic steatohepatitis could develop cirrhosis; so, it is important for them to go through biopsy. Some of the important clinical features of cirrhosis include nodular liver, jaundice, white nails, hypogonadism, splenomegaly, and ascites (Schuppan & Afdhal, 2008).
Conclusion
Cirrhosis is one of the diseases of the liver that is characterized by the presence of a number of problems in the liver such as fibrogenesis, inflammation, angiogenesis, and portal hypertension. In cirrhosis, not only functions of the liver are disturbed but its normal appearance and size are also affected. It is also a serious kind of problem as it is asymptomatic and most of the patients remain unaware of the problem until it becomes severe. Prevention can be done by regular screening and lifestyle changes. In order to treat the problem, it is important to treat the underlying causes such as portal hypertension. Future work on the problem may concentrate on the methods for easy and early diagnosis of the disease as well as better therapeutic strategies that can help in reducing the chances of liver transplantation.
References
Ramadori, G., Moriconi, F., Malik, I., & Dudas, J. (2008). Physiology and pathophysiology of liver inflammation, damage and repair. J Physiol pharmacol, 59(Suppl 1), 107-117.
Schuppan, D., & Afdhal, N. H. (2008). Liver cirrhosis. The Lancet, 371(9615), 838-851. doi: 10.1016/s0140-6736(08)60383-9
Sibulesky, L. (2013). Normal liver anatomy. Clinical Liver Disease, 2(S1).
Tsochatzis, E. A., Bosch, J., & Burroughs, A. K. (2014). Liver cirrhosis. The Lancet, 383(9930), 1749-1761. doi: 10.1016/s0140-6736(14)60121-5
