What is chronic liver disease and liver cirrhosis?
Chronic liver disease and liver cirrhosis are two different terms which are often used interchangeably. Chronic liver disease or CLD is a progressive deterioration of liver functions over a long term, due to a continuous process of inflammation, destruction and regeneration of liver parenchyma, which leads to fibrosis and cirrhosis. Cirrhosis is a final stage of chronic liver disease that results in disruption of liver architecture, leading to progressive decline in liver functions.
Liver has a remarkable capacity to regenerate when injured due to a disease. In fact, this special ability of liver has made living donor liver transplantation possible today. However, when it suffers repeated injuries due to repeated insults, it regenerates in form of scarring. Cirrhosis is the end stage liver disease where the liver tissue is completely replaced by scar tissue. It is an irreversible transformation process, and a cirrhotic liver cannot be reverted back to an architecturally normal liver. It needs to be replaced by a healthy functioning liver by a procedure called liver transplantation.
What causes chronic liver disease and liver cirrhosis in adults?
Heavy long term alcohol intake is one of the commonest causes of liver cirrhosis in India and worldwide. Alcoholic liver disease progresses from steatosis, hepatitis superimposed on steatosis, fibrosis and finally cirrhosis. Every year thousands of people die worldwide from alcoholic liver disease related complications. Viral hepatitis is another common cause of liver cirrhosis. Hepatitis B and Hepatitis C are capable of causing chronic hepatitis, progressing to liver cirrhosis. Fatty liver, also known as non-alcoholic fatty liver disease (NAFLD), has emerged recently as a major cause of chronic liver disease and liver cirrhosis world-wide. NAFLD is mainly caused by long standing diabetes mellitus, obesity and other conditions like hyperlipidemia. Other causes of cirrhosis are auto-immune liver disease, primary sclerosing cholangitis (PSC), primary biliary cirrhosis (PBC), certain medications, hemochromatosis, Wilson’s disease and others.
What causes chronic liver disease and liver cirrhosis in children?
Extra-hepatic biliary atresia is the commonest cause of liver cirrhosis in children. It is generally seen in newborns and infants. If diagnosed early, it can be corrected by a surgery, known as Kasai procedure. However, the success rate of this surgery is less than 50% and most children progress to liver cirrhosis and require liver transplantation. Other causes of liver cirrhosis in children are alpha-1 antitrypsin deficiency, Alagille syndrome, Wilson’s disease, cystic fibrosis, inherited metabolic disorders and others.
What are the clinical features of chronic liver disease and cirrhosis?
Chronic liver disease can present with insidious clinical features like decreased appetite, tiredness, swelling in both feet and can progress to jaundice, tremors, impaired sensorium, blood in vomiting or stools, fluid accumulation in abdomen and deranged kidney function.
What is the treatment of chronic liver disease and liver cirrhosis?
Liver performs many essential functions in the body. The healthy functioning of liver is imperative for normal functioning of many other organs of the body like kidney, lungs, brain, heart, coagulation cascade and circulatory system. In the early stages of liver cirrhosis, the body compensates for the liver dysfunction and one requires supportive medical treatment to slow down the progression of the disease. As the liver cirrhosis progresses, it starts impacting the functioning of these organs, which is medically called ‘decompensated state’. Once the body is not able to compensate for the failing liver, one requires a liver transplantation.
