Liver Cirrhosis

CIRRHOSIS
Cirrhosis is the name given to the hardening and shrinking of the liver on the basis of chronic liver disease, with the formation of nodules (lumps) of various sizes on it. Liver cirrhosis can lead to life-threatening consequences such as bleeding, jaundice, fluid accumulation in the abdomen (ascites), infection, and coma resulting from the accumulation of toxic waste.

Because the liver is irreversibly damaged in cirrhosis,  the mainstay of treatment for cirrhosis patients is the prevention of complications that may develop. In patients with advanced cirrhosis in whom complications have developed, the only life-saving option is to remove the diseased liver and transplant a healthy one in its place. Only with an organ transplant performed in this way can the patient's life be saved.

COMPLICATIONS OF CIRRHOSIS

ASCITES: The accumulation of fluid in the abdominal cavity (ascites) is the most common complication of liver failure. The liver produces albumin, which carries many substances in our body and keeps water inside the blood vessels. In this way it prevents the formation of swelling called edema in our body. When albumin production decreases because of liver failure and its level in the blood falls below a certain point, edema and fluid accumulation in the abdominal cavity may occur. This fluid can even collect in the chest cavity (hepatic hydrothorax) and cause serious breathing difficulty. It is managed with a salt-free diet and diuretic (water-removing) drugs, and when necessary fluid can be drained from the abdomen (paracentesis). In these cases, hospital admission for albumin supplementation is often required. In patients who develop ascites, this fluid may become infected, resulting in a very serious infection of the abdominal lining called peritonitis.
 

JAUNDICE: When the blood cells we call red blood cells complete their normal lifespan and break down, the liver removes from our body the substances that are released and must be eliminated. Bilirubin, the end product of these substances, causes jaundice if it cannot be excreted from the body and accumulates in the blood. The reason jaundice occurs in liver diseases is the elevated bilirubin level in the blood.
 

ENCEPHALOPATHY: For many of the drugs we take to be usable, and to be eliminated from our body after use, they must be processed in the liver. Likewise, removing (detoxification) the many harmful substances that are produced during the normal functioning of our body or that arrive through the digestive tract is among the liver's daily tasks. If it cannot do this work, harmful substances accumulate in the blood. They damage our brain, kidneys, heart and many other organs. Through the effect of a wide variety of toxic substances (especially ammonia) on the brain, a condition called hepatic encephalopathy (brain dysfunction of liver origin) may develop, and the patient may lose consciousness and fall into a coma.
 

PORTAL HYPERTENSION: As a result of the shrinking and hardening of the organ in liver cirrhosis, resistance to blood flow develops in the liver, and the blood coming to the liver flows back, pools behind the liver and begins to find other routes. This condition is called portal hypertension, and as a result enlargement of the spleen (hypersplenism) and esophageal varices (varicose veins of the food pipe) develop. Bleeding from these varices can be life-threatening. As a result of the enlarged spleen, blood cells are destroyed more, and a marked drop in the platelet count (thrombocytopenia) paves the way for bleeding. When this is combined with the liver's deficiency in synthesizing clotting factors, the severity of the bleeding increases.
 

HEPATORENAL SYNDROME: In patients with liver failure, the body's fluid–electrolyte balance is also disturbed, and as a result of constriction of the kidney vessels (vasoconstriction), renal blood flow decreases and kidney failure may also develop. This condition is called hepatorenal syndrome and is one of the most fatal complications of cirrhosis.
 

LIVER CANCER: Liver cancer called hepatocellular carcinoma (HCC) frequently develops in patients with cirrhosis and is an important reason for liver transplantation. In patients with cirrhosis, cancer can develop even when liver function is preserved, and frequent screening with appropriate imaging methods should be carried out to rule out this possibility. The average one-year survival chance of patients who develop end-stage liver failure is around 50%, and with the complications that develop this rate may fall even lower. It has been shown that the worse the condition in which patients are transplanted, the shorter their survival and the harder their postoperative period. For this reason, appropriate timing and appropriate patient selection become even more important in achieving encouraging results.