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Chronic Liver Disease/Cirrhosis

What is liver disease?
Your liver is your body’s second-largest organ (after the skin). It sits just under your rib-cage on the right side and is about the size of a football. The liver separates nutrients and waste as they move through your digestive system. It also produces bile, a substance that carries toxins out of your body and aids in digestion.

The term “liver disease” refers to any of several conditions that can affect and damage your liver.

What is cirrhosis?
Cirrhosis is when scar tissue replaces healthy liver tissue. This stops the liver from working normally.

Cirrhosis is a long-term (chronic) liver disease. The damage to your liver builds up over time.

The liver is your body’s largest internal organ. It lies up under your ribs on the right side of your belly.

The liver does many important things, including:

  • Removing waste from the body, such as toxins and medicine

  • Making bile to help digest food

  • Storing sugar that the body uses for energy

  • Making new proteins

When you have cirrhosis, scar tissue slows the flow of blood through the liver. Over time, the liver can’t work the way it should.n, an inherited condition, cancer or an overload of toxic substances. Healthcare providers can treat many types of liver disease effectively with medication or lifestyle changes. If you have severe liver disease, a liver transplant may restore your health and extend your life.

In severe cases, the liver gets so badly damaged that it stops working. This is called liver failure.

How common is liver disease in Uganda?
According to the latest WHO data published in 2020 Liver Disease Deaths in Uganda reached 5,122 or 2.47% of total deaths. The age adjusted Death Rate is 33.70 per 100,000 of population ranks Uganda #47 in the world.

The most common causes of cirrhosis are:

  • Hepatitis and other viruses

  • Long-term alcohol abuse

  • Nonalcoholic fatty liver disease (this happens from metabolic syndrome and is caused by conditions such as obesity, high cholesterol and triglycerides, and high blood pressure)

Other less common causes of cirrhosis may include:

  • Autoimmune disorders, where the body’s infection-fighting system (immune system) attacks healthy tissue

  • Blocked or damaged tubes (bile ducts) that carry bile from the liver to the intestine

  • Use of certain medicines

  • Exposure to certain toxic chemicals

  • Repeated episodes of heart failure with blood buildup in the liver

  • Parasite infections

Some diseases passed from parent to child (inherited diseases) may also cause cirrhosis. These may include:

  • Alpha1-antitrypsin deficiency

  • High blood galactose levels

  • Glycogen storage diseases

  •  Cystic fibrosis

  • Porphyria (a disorder in which certain chemicals build up in the blood)

  • Hereditary buildup of too much copper (Wilson disease) or iron (hemochromatosis) in the body

What are the symptoms of cirrhosis?

Your symptoms may vary depending on how severe your cirrhosis is. Mild cirrhosis may not cause any symptoms at all.

Symptoms may include:

  • Fluid buildup in the belly (ascites)

  • Vomiting blood, often from bleeding in the blood vessels in the food pipe (esophagus)

  • Gallstones

  • Itching

  • Yellowing of the skin and eyes (jaundice)

  • Kidney failure

  • Muscle loss

  • Loss of appetite

  • Easy bruising

  • Spider-like veins in the skin

  • Low energy and weakness (fatigue)

  • Weight loss

  • Confusion as toxins build up in the blood

  • The symptoms of cirrhosis may look like other health problems. Always see your healthcare provider to be sure.

How is cirrhosis diagnosed?

Your healthcare provider will look at your past health. They will give you a physical exam. You may also have tests, including:

  • Blood tests. These will include liver function tests to see if the liver is working the way it should. You may also have tests to see if your blood is able to clot.

  • Liver biopsy. Small tissue samples are taken from the liver with a needle or during surgery. The samples are checked under a microscope to find out the type of liver disease.

  • Your healthcare provider may want you to have these tests:

  • CT scan. This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs.

  • MRI. This test makes detailed pictures of organs and structures inside your body. It uses a magnetic field and pulses of radio wave energy. A dye may be shot (injected) into your vein. The dye helps the liver and other organs to be seen more clearly on the scan.

  • Ultrasound. This shows your internal organs as they work. It checks how blood is flowing through different blood vessels. It uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs.

  • Upper endoscopy (EGD). A lighted flexible camera is placed through your mouth into your upper digestive tract to look for enlarged blood vessels that are at risk of bleeding because of your cirrhosis.

  • If you have fluid in the belly (ascites), you may need a low-sodium diet, water pills (diuretics), and removal of the fluid with a needle (paracentesis).

How is cirrhosis treated?

Cirrhosis is a progressive liver disease that happens over time. The damage to your liver can sometimes reverse or improve if the trigger is gone, such as by treating a viral infection or by not drinking alcohol.

The goal of treatment is to slow down the buildup of scar tissue and prevent or treat other health problems.

In many cases, you may be able to delay or stop any more liver damage. If you have viral hepatitis, such as hepatitis B or C, it may be treated to delay worsening of your liver disease.

Your treatment may include:

  • Eating a healthy diet, low in sodium

  • Not using alcohol or illegal drugs

  • Managing any health problems that happen because of cirrhosis

If you have metabolic syndrome, it's important to lose weight and also manage any underlying conditions such as diabetes.

Talk with your healthcare provider before taking prescription medicines, over-the-counter medicines, or vitamins.

If you have severe cirrhosis, treatment can’t control other problems. A liver transplant may be needed. Other treatments may be specific to your cause of cirrhosis, such as controlling excessive iron or copper levels or using immune suppressing medicines.

Be sure to ask your healthcare provider about recommended vaccines. These include vaccines for viruses that can cause liver disease.

What are possible complications of cirrhosis?

Cirrhosis can cause other health problems such as:

  • Portal hypertension. The portal vein carries blood from your intestines and spleen to your liver. Cirrhosis slows the normal flow of blood. That raises the pressure in the portal vein. This is called portal hypertension.

  • Enlarged blood vessels. Portal hypertension may cause abnormal blood vessels in the stomach (called portal gastropathy and vascular ectasia) or enlarged veins in the stomach and the food pipe or esophagus (called varices). These blood vessels are more likely to burst due to thin walls and higher pressure. If they burst, severe bleeding can happen. Seek medical attention right away.

  • Ascites. Fluid collecting in your belly. This can become infected.

  • Kidney disease or failure.

  • Easy bruising and severe bleeding. This happens when the liver stops making proteins that are needed for your blood to clot.

  • Type 2 diabetes. When you have cirrhosis, your body does not use insulin properly (insulin resistance). The pancreas tries to keep up with the need for insulin by making more, but blood sugar (glucose) builds up. This causes type 2 diabetes.

  • Liver cancer. You will be screened with an imaging test (ultrasound, for instance) and sometimes blood tests every 6 months if you have cirrhosis.

Can liver disease be prevented?

You can take steps to prevent some types of liver disease — especially those affected by your diet and lifestyle. If you are at risk for liver disease, your provider may recommend lifestyle changes including:

  • Avoiding or limiting alcohol.

  • Avoiding foods and drinks that contain trans fats or high-fructose corn syrup.

  • Carefully managing your intake of prescription and over-the-counter medications to avoid liver damage, as medications like acetaminophen (Tylenol®) are a common cause of liver injury.

  • Getting regular exercise.

  • Limiting consumption of red meat.

You can minimize the likelihood of contracting viral hepatitis by practicing safe sex and not sharing needles.

Outlook / Prognosis

What is the prognosis (outlook) for people with liver disease?

With early treatment and effective lifestyle changes, many people with liver disease can avoid serious liver damage and prevent liver failure.

Living With

When should I call the doctor?

You should call your healthcare provider if you experience:

  • Changes in the color of your urine or stool.

  • Jaundice or yellowing of your eyes.

  • Pain in the upper right side of your abdomen.

  • Swelling in your arms or legs.

A note from Pan Medical Kampala

Liver disease can result from infection, an inherited condition, cancer or an overload of toxic substances. Healthcare providers can treat many types of liver disease effectively with medication or lifestyle changes. If you have severe liver disease, a liver transplant may restore your health and extend your life.

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