Cirrhosis
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Cirrhosis is a chronic (ongoing, long-term) disease of the liver. It means
damage to the normal liver tissue that keeps this important organ from
working as it should. If the damage is not stopped, the liver gradually loses
its ability to carry out its normal functions. This is called liver failure,
sometimes referred to as end-stage liver disease.
Symptoms-
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Fig: Cirrhosis of Liver
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The following signs and symptoms may occur in the presence of
cirrhosis or as a result of the complications of cirrhosis. Many are nonspecific
and may occur in other diseases and do not necessarily point to cirrhosis.
Likewise, the absence of any does not rule out the possibility of cirrhosis.
1. Spider angiomata
or spider nevi. Vascular lesions consisting of central arteriole
surrounded by many smaller vessels due to an increase in estradiol.
2. Palmar erythema. Exaggerations of normal speckled
mottling of the palm, due to altered sex hormone metabolism.
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3.
Muehrcke's nails -
paired horizontal bands separated by normal color due to
hypoalbuminemia
4.
Terry's nails - proximal two thirds of the
nail plate appears white with distal one-third red, also due to hypoalbuminemia
5.
Clubbing -
Angle between the nail plate and proximal nail fold > 180 degrees
6. Hypertrophic osteoarthropathy.
Chronic proliferative periostitis of the long bones that can cause considerable
pain.
7. Dupuytren's contracture.
Thickening
and shortening of palmar fascia that leads to flexion deformities of the
fingers. Thought to be due to fibroblastic proliferation and disorderly
collagen deposition. It is relatively common (33% of patients).
8. Gynecomastia.
Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples. This is
due to increased estradiol and can occur up to 66% of patients.
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Liiver size.
Can be enlarged,
normal, or shrunken.
10. Splenomegaly.
Due to congestion of the red pulp as a result of portal hypertension.
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Fig: showing Spider nevi Arising from umbilicus.
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11. Hypogonadism.
Manifested as impotence, infertility, loss of sexual drive, and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or
pituitary function.
12. Splenomegaly.
Due to congestion of the red pulp as a result of portal hypertension.
13. Ascites. Accumulation
of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness).
14.Caput medusa.
In portal hypertension, the umbilical vein may open. Blood from the portal
venous system may be shunted through the periumbilical veins into the
umbilical vein and ultimately to the abdominal wall veins, manifesting as
caput medusa.
15.Cruveilhier-Baumgarten
murmur. Venous hum heard in epigastric region due to collateral
connections between portal system and the remnant of the umbilical vein in
portal hypertension.
Fetor hepaticus
Sweet pungent smell in breath due to increased dimethyl sulfide due to severe
portal-systemic shunting.
16.
Jaundice. Yellow discoloring of the skin, eye, and mucus membranes due
to increased bilirubin (at least 2-3 mg/dL or 30 mmol/L). Urine may also
appear dark.
17.Asterixis. Bilateral asynchronous flapping of outstretched, dorsiflexed
hands seen in patients with hepatic encephalopathy.
18.Other. Weakness, fatigue, anorexia, weight loss.
Complications-
As the disease progresses, complications may develop. In some people, these
may be the first signs of the disease.
1.
Bruising and bleeding due
to decreased production of coagulation
Jaundice due to decreased
processing of bilirubin.
2.
Itching(pruritus) due
to bile products deposited in the skin.
Hepatic encephalopathy- the liver does
not clear ammonia
and related nitrogenous substances from the blood, which are carried to
the brain, affecting cerebral functioning: neglect of personal appearance,
unresponsiveness, forgetfulness, trouble concentrating, or changes in
sleep habits.
Sensitivity to medication
due to decreased metabolism of the active compounds.
3.
Hepatocellular carcinoma is primary liver
cancer, a frequent complication of cirrhosis. It has a high mortality
rate.
4.
Portal hypertension- blood normally carried from the
intestines and spleen through the portal vein
flows more slowly and the pressure increases; this leads to the following
complications:
5. Ascites - fluid leaks through the vasculature
into the abdominal cavity.
Problems in other organs.
1.
Cirrhosis can cause
immune system dysfunction, leading to .
Signs and symptoms of infection may be aspecific are more difficult to
recognize (e.g. worsening encephalopathy but no fever).
2. Fluid in the abdomen
(ascites) may become infected with bacteria normally present in the
intestines (spontaneous bacterial
peritonitis).
3. Hepatorenal syndrome - insufficient blood
supply to the kidneys, causing acute renal failure.This
complication has a very high mortality (over 50%).
4.
Hepatopulmonary syndrome- blood
bypassing the normal lung circulation (shunting), leading to cyanosis
and dyspnea
(shortness of breath), characteristically worse on sitting up.
5. Portopulmonary hypertension - increased
blood pressure over the lungs as a consequence of portal hypertension Remedies-
1. Dolichos pruriens [Dolichos]
Chief indication for chronic cholestatic
hepatitis, activity of third degree, with progressive development and
hepatocellular insufficiency of second degree, with transformation into
cirrhosis of liver. Syndrome of portal hypertension of first degree. Syndrome
of cholestasis with intensive constant itch of skin.
The basic symptoms are:
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The intensive, unbearable, "terrible"
itch of skin which is especially worse in evening at 9 p.m. and nights hours.
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The great general weakness.
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The intensive pains in both hypochondriac
regions, tearing, dull, burning: "As if from the nettle". The dull
pain under the angle of right scapula: "As if there the abscess under the
skin". This pain is more intensive under the scapula rather than in right
hypochondrium. This pain is extending, "shooting" trough the right
hypochondrium to the back and right scapula.
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The constant yellow colour of the eyes.
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The massive deposits of cholesterine around the
eye lids - the so called "ksanthoma", of yellow colour.
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The bitterness in the mouth, during all the
day.
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Stool constipated. Stool of white colour,
resembling white clay.
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The intensive thirst for drinks
2. Carduus Marianus [Carduus mar]
The chief action of this drug is
centered in the liver, and portal system, causing soreness, pain, jaundice. Has
specific relation to the vascular system. Especially indicated in individuals
with abuse of alcoholic beverages, especially beer. Pain in region of liver
especially Left lobe very sensitive. Fullness and soreness, with moist skin.
Constipation; stools hard, difficult, knotty;
alternates with diarrhœa. Hyperæmia of liver, with jaundice. One of
the chief remedies for Cirrhosis of liver.
3. Magnesium
Muriaticum [Mag mur]
Mag mur is chiefly a liver remedy
with pronounced characteristic constipation. It has chronic liver affections
like cirrhosis with tenderness and pain, extending to spine and epigastrium ad
the pain is worse after food. Pressing pain in liver; worse lying on right
side. Liver is enlarged with bloating of abdomen;
yellow tongue.
4. Ptelea
Trifoliata [Ptelea]
Is a remarkable remedy in stomach
and liver affections. The aching and heaviness in the region of the liver is greatly aggravated by lying on the left side.
Liver sore, swollen, sensitive to pressure. Indicated in end stages of
cirrhosis.
5. Nux Vomica [Nux vom]
In liver affections occurring in
those who have indulged to excess in alcoholic liquors, highly seasoned food,
quinine, or in those who have abused themselves with purgatives, Nux is the
first remedy to be thought of. The liver is swollen hard and sensitive to the
touch and pressure of clothing is uncomfortable. The first remedy in cirrhosis of the liver. Colic may be present. In the enlarged liver of drunkards,
Sulphur, Lachesis,
Fluoric acid, Arsenic and Ammonium muriaticum must also be borne in mind,
together with Nux.
6. Lycopodium. [Lyc]
Lycopodium acts powerfully on the liver. The region of the liver is sensitive
to the touch, and there is a feeling of tension in it, a feeling as if a cord
were tied about the waist. Cirrhosis of liver. The pains are dull and aching
instead of sharp and lancinating, as under Chelidonium. Fullness in the stomach
after eating a small quantity. There are no real icteric symptoms, but there is
a peculiar sallow complexion.
7. Chelidonium
Majus [Chel]
The liver symptoms of Chelidonium are very prominent. There is soreness and
stitching pains in the region of the liver, but the keynote for this drug in
hepatic diseases is a pain under the angle of the right shoulder blade, which
may extend to the chest, stomach, or hypochondrium; there is swelling of the
liver, chilliness, fever, jaundice, yellow coated tongue, bitter taste and a
craving for acids and sour things, such as pickles and vinegar. The stools are
profuse, bright yellow and diarrhoea; they may be clayey in color. Taken
altogether, Chelidonium is perhaps our greatest liver remedy; it causes the
liver to secrete thinner and more profuse bile than any remedy; it is a useful
remedy to promote the expulsion of gall stones, and to prevent their formation.
It affects the left lobe of the liver much less than does Carduus marianus.
Other Remedies For
Cirrhosis of Liver are-
Apoc., Ars., Ars. iod.,
Aur. m., Aur. mur., Calc. ars.,Cascara sag., Cinch., Fel tauri,
Fluor. ac., Graph., Hydr., Iod.,
Kali bich., Kali iod., Merc. d., Merc., Nasturt. ag., Nat. chlor.,
Nit. ac., Nit. mur. ac., Phos., Plumb., Pod., Quass.,
Senec.
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