Cirrhosis is a leading cause of death in Anguilla. The majority of cases of cirrhosis in Anguilla are related to excessive alcohol use. Cirrhosis can place a heavy burden on individuals, their families and the community as a whole in terms of human suffering, hospital costs and loss of time from work.

What is cirrhosis?
Cirrhosis is the permanent injury of liver cells resulting in scarring in the liver. The liver is the largest organ in the body and has many functions. It is essential in keeping the body functioning properly. The scar tissue resulting from cirrhosis blocks the flow of blood through the liver. This slows the processing of nutrients, hormones, drugs and toxins by the liver. You cannot liver without a functioning liver.

What are the causes of cirrhosis?
Cirrhosis can be caused by a number of things, some known and others unknown.
Alcohol - using alcohol in excess is the most common cause of cirrhosis in Anguilla.
Other causes include:
• Viral hepatitis
• Chronic bile duct blockage
• Inherited diseases
• Drugs and toxins
• Autoimmune diseases

Alcohol and the liver
Alcohol is by far the leading cause of liver damage in Anguilla. The amount of alcohol that can injure the liver varies greatly from person to person. In women, as few as two to three drinks per day have been linked with cirrhosis and in men, as few as three to four drinks per day. Alcohol cirrhosis usually develops after more than a decade of heavy drinking. In Anguilla more and younger people are abusing alcohol, so it is expected that we will soon see many more cases of cirrhosis. It is estimated that 10% of heavy drinkers develop advance liver disease. Not eating when drinking and consuming a variety of alcohol beverages are factors that increase the risk of liver damage. There may be genetic factors that increase an individual’s risk of developing alcohol related cirrhosis.

What are the symptoms of cirrhosis?
The vast majority of individuals with cirrhosis have no symptoms in the early stages of the disease. As the disease progresses symptoms include:
• Fatigue, weakness, exhaustion, loss of appetite and weight loss
• Menstrual abnormalities such as amenorrhoea (no periods)
• Impotence and loss of sexual drive
• Painful breast (in men)
• Oedema and ascites (accumulation of fluid in the abdomen)
• Jaundice (yellow skin)
• Intense itching
• Bleeding from the stomach and oesphagus
• Mental function changes

How is cirrhosis diagnosed?
The doctor may diagnose cirrhosis on the basis of symptoms, medical history, physical examination, laboratory tests and other special investigations. A liver biopsy will confirm the diagnosis.

Treatment
Liver damage from cirrhosis cannot be reversed. Treatment is aimed to stop the development of scar tissue and delay further progression and prevent complications. Specific treatment for cirrhosis depends on the underlying cause.
No matter the cause of cirrhosis, every individual with this condition must avoid all substances, habits and drugs that may further damage the liver, precipitate complications or speed the progression to liver failure. Alcohol not only causes cirrhosis, but it may accelerate the progression of liver scarring.
Treatment will also be directed to treating complications such as ascites and oedema.
All individuals with cirrhosis must avoid all alcoholic beverages.

Prevention
Although not all cases of cirrhosis can be prevented, if you avoid alcohol or drink in moderation you can greatly reduce your risk of getting cirrhosis. Knowing and recognising a family history of alcoholism for you or others is an important step is seeking treatment.

Conclusion
Cirrhosis is a serious condition that can result in much suffering and death. In cirrhosis, the normal liver tissue is replaced by scarred tissue which distorts the structure of the liver and results in the liver not functioning well. Excessive alcohol use is the single leading cause of cirrhosis in Anguilla, but there are other causes like viral hepatitis. Excessive alcohol use especially among young people in Anguilla is a major public health issue that needs urgent attention. We cannot continue to pretend that excessive alcohol use is not a problem. If we fail to successfully address this issue, we are likely to see many more cases of alcohol related cirrhosis in Anguilla in the future.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr. Brett Hodge is an obstetrician/gynaecologist and family doctor who has over twenty years in clinical practice. Dr. Hodge has a medical practice in the Johnson Building in The Valley.

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