Tuesday, 3 December 2013

Cirrhosis - The Symptoms

Cirrhosis is defined as a condition of irreversible scarring liver as a result of liver tissue by fibrosis due to final phase of chronic liver diseases of that can lead to poor function of the liver and liver failure. According to the statistics, Number of discharges with chronic liver disease or cirrhosis as the first-listed diagnosis: 101,000 in 2009 and Deaths per 100,000 population: 10.3 in 2010(a). Hepatitis B infection cause of the disease is very prevalent in South-East Asia.
1. Psychosocial issues and health-related quality of life (HRQOL)
According to the study by the Tehran University of Medical Sciences and Tehran University of Medical Sciences, showed that Increasing severity of CHBV leads to a decline in HRQOL. Cirrhosis worsens HRQOL, whereas treatment and psycho-education improves it. Frequency of mood disorders seems to be increased in patients with CHBV, although not all studies have shown this trend. Some factors such as alcohol consumption and low social support negatively impact patients' mental health. Those with CHBV generally have better HRQOL and mental health than their hepatitis C (HCV) counterparts. Patients with psychiatric disorders, particularly those with prolonged institutionalization, have a generally higher risk of acquiring CHBV infection compared to the general population(18) .Other study indicated that
severity of cirrhosis measured by the Child-Pugh score was not correlated with depression or anxiety, and only had a weak correlation with poor sleep. The psychological distress in cirrhosis such as depression, anxiety, and insomnia were correlated specifically to increased levels of aspartate aminotransferase (AST), increased ratios of low frequency to high frequency power, or reduced nonlinear properties of HRV (alpha1 exponent of detrended fluctuation analysis)(19).

2. Fatigue, Pruritus and Jaundice
In the study to summarize the clinical characters of refractory primary biliary cirrhosis (PBC) versus typical ones and explore the risk factors of prognosis, found that Some clinical severe manifestation (fatigue, pruritus and jaundice) and higher biochemical markers levels (ALT, AST, ALP, GGT, TBIL, DBIL and IgM) seem to predict a worse response to UDCA and a rapid progression of disease in PBC patients(20). 

4. Lower serum aminotransferase, bilirubin, and immunoglobulin G (IgG) for patient with autoimmune hepatitis (AIH)(21).

5. Migraine symptoms
In the study to assess the effects of H. pylori eradication on migraine symptoms in patients with hepatitis-B-virus-related cirrhosis, the results clearly showed that the intensity, duration, and frequency of attacks of migraine were significantly reduced in all the patients in whom H. pylori has been eradicated(22).

6. Cognitive symptoms
According to the study by the Newcastle University, PBC associates with substantial functional impairment. PBC symptom distribution evolves over time, with cognitive symptoms making ever-greater contribution to overall symptom burden. The major potentially modifiable determinant responsible for the functional impairment appears to be orthostatic symptoms(23).
Other indicated that a significant proportion of fatigue in PBC associates with one or both of autonomic dysfunction (OGS > or =4) and sleep disturbance (ESS > or =10)(24).

7. Other symptoms include
Loss of appetite( Progression of the disease),  Itching (liver malfunction), Easy bruising and bleeding (platelet destruction), Weight loss (Malnutrition), Leg swelling (as a result of fluid retention), discrepancies between serum albumin levels(progression of the disease) etc(25).
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(a) http://www.cdc.gov/nchs/fastats/liverdis.htm
(19) http://www.ncbi.nlm.nih.gov/pubmed/23339829
(20) http://www.ncbi.nlm.nih.gov/pubmed/23328240
(21) http://www.ncbi.nlm.nih.gov/pubmed/15954109
(22) http://www.ncbi.nlm.nih.gov/pubmed/17669102
(23) http://www.ncbi.nlm.nih.gov/pubmed/21593676
(24) http://www.ncbi.nlm.nih.gov/pubmed/18237872
(25) http://www.ncbi.nlm.nih.gov/pubmed/22969847

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