Management of Liver Cirrhosis in Old Age

Introduction

The liver is the largest organ in the human body, which regulates the level of chemicals in the blood. It secretes bile, a fluid that breaks down fat in the body and will also assist in the removal of waste from the body. Liver cirrhosis is the hardening of the liver, mainly due to excessive alcohol intake, viral infections, and systemic diseases. Liver cirrhosis in the elderly could be extremely severe and fatal.

What Are the Normal Functions of the Liver?

The liver performs several essential functions in the body. Some of them are:

• Produces proteins that help to carry away fat.

• Assists in the removal of waste materials from the body.

• Produces bile which breaks down fat.

• Converts excess sugar and stores it as glycogen (the stored form of glucose), utilized whenever the body needs energy.

• Regulates the level of amino acids in the blood, which are protein-building units.

• Stores iron and processes hemoglobin (oxygen-transporting proteins present in the blood)

• Metabolizes drugs and creates products soluble in water, which is necessary to make the excretion process easy.

• Detects and clears disease-causing organisms entering the body.

What Is Liver Cirrhosis?

Liver cirrhosis is the hardening of the liver due to scarring (more fiber tissues). The liver can repair itself each time it gets injured or diseased. However, the repairing process leads to scar or fibrous tissue formation. Gradually the formation of more fibrous tissue will make the liver hard and leads to cirrhosis, affecting the normal functioning of the liver. It can gradually lead to liver failure.

What Are the Age-Related Changes in the Liver?

With age, the size and blood flow to the liver decreases. As a result, the secretory function of the liver gets affected, leading to a decreased secretion of bile. In addition, the cells of the liver get altered and old, and the rate of cellular death and loss also rises.

The primary energy is derived in the human body by breaking down glucose. The excess glucose will be stored in the liver in the storage form called glycogen. When excess energy is required, these glycogen stores in the liver release glucose. However, with age, this whole process gets ineffective and reduced. In addition, high-density cholesterol increases, and fat accumulation occurs in the liver.

The age-related changes further increase neutral fat and blood cholesterol levels. Metabolism of cholesterol or fat will also get impaired. The natural regenerating ability of the liver gets severely affected and decreases.

Liver Fibrosis and Liver Cirrhosis:

Steps will be undertaken within the liver to heal chronic liver injuries. As a result, more fibers will be produced in the liver, leading to liver fibrosis. The later stage of liver fibrosis leads to more fibrous accumulation, causing liver cirrhosis. In addition, it affects hepatocytes (liver cells), leading to liver failure and further impairing functioning. The susceptibility of fibrosis increases with age.

What Causes Liver Cirrhosis in Older People?

The primary etiology of the occurrence of liver cirrhosis in older adults are:

• Prolonged consumption of alcohol.

• Viral hepatitis (viral infection of the liver), like hepatitis B virus (HBV) and hepatitis C virus (HCV).

• Obesity (increased body weight).

• Diabetes (increased blood sugar).

• Previous history of liver diseases.

Is Liver Cirrhosis and Liver Cancer the Same?

Liver cirrhosis is not cancer. Liver cirrhosis is usually diagnosed in an advanced stage. Since it is a late-stage liver disease, it can further lead to liver cancer. The chances get intensified as the person ages.

What Are the Complication of Liver Cirrhosis?

There are many internal complications associated with liver cirrhosis, like

Portal Hypertension- The portal vein carries blood from the digestive system to the liver. Increased pressure in the portal vein due to the blockage of supply to the liver causes the enlargement and rupturing of the vein causing internal bleeding. Portal hypertension can cause edema or swelling of the lower legs, abdomen, spleen, and kidney. It can also secondarily lead to kidney failure.

Hypersplenism- The spleen is an organ that filters damaged and old red blood cells. Hypersplenism is an overactive spleen that does an early job leading to the destruction of young and premature blood cells.

Infections- Liver cirrhosis can increase the rate of bacterial infections affecting the digestive system's inner lining. It causes inflammation of the inner lining leading to peritonitis.

Malnutrition- The damaged liver processes fewer nutrients, leading to malnutrition, increased body weight, and overall weakness.

Liver Failure- Liver cirrhosis gradually leads to the non-functioning of the liver, called liver failure.

Can a Non-alcoholic Get Liver Cirrhosis?

Non-alcoholic fatty liver disease (NAFLD) is characterized by a group of liver issues affecting those who drink less or no alcohol. In NAFLD, more fat accumulates in the liver causing steatosis or fatty liver. In advanced NAFLD, more fat accumulates, leading to a condition called steatohepatitis, which gets advanced to causing damage to the liver cells, leading to inflammation, fibrosis, and cirrhosis.

In older people, NAFLD mainly occurs in the case of diabetes due to insulin resistance. Insulin resistance may also occur due to obesity and increased visceral fat, further increasing the chances of cirrhosis. Swelling and pain in the upper right abdomen are the main symptoms of NAFLD.

What Is Alcoholic Cirrhosis?

Prolonged use of alcohol leads to the replacement of healthy living liver cells with scar tissue- alcoholic liver cirrhosis. The liver has been given the responsibility to break down alcohol. But when the consumption exceeds a limit, it will become hard for the liver to process the alcohol. As a result, it gradually impairs liver functioning, causes fatty liver, and further leads to liver cirrhosis.

Alcoholic liver disease is preventable by moderating alcohol consumption. It is linked with hepatitis B and hepatitis C viral infections.

How Is Liver Cirrhosis Diagnosed?

• Examination by the Doctor- The doctor will check for signs of swelling and pain in the abdomen, bruises and redness on the skin, enlarged and firm part of the liver felt below the rib cage.

• Blood Tests- If the doctor suspects liver cirrhosis, it will be advised to take blood tests for confirmation. Tests will be done to check the level of liver enzymes and proteins. A complete blood count indicates the presence of anemia (lack of healthy red blood cells in the blood) due to internal bleeding. Tests for viral infections like hepatitis B and C will also be done.

• Imaging Tests- These will indicate the liver's size, shape, and texture. Computerized tomography (CT) scans, abdominal ultrasound scans, and magnetic resonance imaging (MRI) scans are usually done as part of imaging tests.

• Biopsy- A part of liver tissue will be taken and examined under a microscope.

Liver Transplantation

Liver transplantation is the treatment for late-stage or advanced liver cirrhosis. It is a process by which the non-functioning liver will be surgically removed and replaced by a healthy liver. Transplantation may be accompanied by complications which also depend on the age and health condition of the individual. Therefore, it will be done in a transplant center after proper evaluation and availing of a suitable donor. The chance of rejection post-surgery is high because of which anti-rejection medications should be taken.

How to Prevent Liver Cirrhosis?

• Alcohol Moderation- Moderating the levels of alcohol consumed and quitting drinking if the liver starts presenting symptoms should be considered.

• Good Diet- It includes eating healthily and limiting the intake of excess fat-containing foods.

• Track and Control the Body Weight- Controlling the body weight and seeking help from a nutritionist may help reduce the weight healthily.

• Reduce the Chances of Viral Infections- Reducing the chances of viral hepatitis getting into the body by avoiding unprotected sex and needle exchange can prevent the occurrence of viral infections.

• Have a Track- Tests should be conducted regularly to check for systemic conditions like diabetes and hypertension.

• Cholesterol- Cholesterol is the villain and should be tracked intermittently and kept under control.

Conclusion

Prevention is better than cure. Taking the necessary steps to prevent liver cirrhosis is the best option to prevent suffering in the extreme stages. If symptoms arise, taking help from the doctor is recommended. With age, all the diseases worsen, and transplantation may be the only treatment option once advanced in the case of liver cirrhosis. So one has to observe, track and moderate the underlying risk factors.