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Cirrhosis of the liver : Causes, Types, Symptoms, Diagnosis and Treatment

 What is cirrhosis of the liver?

Cirrhosis could be a late-stage result of disease and its complications. you will not have symptoms within the starting stages of the malady. Common causes embody habit, {hepatitis|infectious malady|liver disease} and nonalcoholic liver disease disease. Treatment depends on the reason behind cirrhosis of the liver and the way a lot of harm exists. Liver transplantation could also be an associate degree possibility if your liver is failing.

Cirrhosis could be a late-stage disease within which healthy liver tissue is replaced with connective tissue and therefore the liver is for good broken. connective tissue keeps your liver from operating properly.


Many types of liver diseases and conditions injure healthy liver cells, inflicting necrobiosis and inflammation. This is often followed by cell repair and at last tissue scarring as a result of the repair method.


The connective tissue blocks the flow of blood through the liver and slows the liver’s ability to method nutrients, hormones, medicine and natural toxins (poisons). It conjointly reduces the assembly of proteins and alternative substances created by the liver. cirrhosis of the liver eventually keeps the liver from operating properly. Late-stage cirrhosis of the liver is grave.

Scientists estimate that cirrhosis of the liver of the liver affects regarding one in four hundred adults within the U.S. It affects one in two hundred adults aged forty five to fifty four, the people most typically full of cirrhosis of the liver. Cirrhosis of the liver causes twenty six,000 deaths annually within the U.S. and is the seventh leading reason behind death within the U.S. among adults twenty five to sixty four years old.


What is cirrhosis of the liver


Explanation of medical terms and concepts Cirrhosis

Cirrhosis may be a late stage of scarring (fibrosis) of the liver caused by several types of liver diseases and conditions, like infectious disease and chronic alcoholism.

Each time your liver is lac — whether or not by malady, excessive alcohol consumption or another cause — it tries to repair itself. within the method, connective tissue forms. As cirrhosis of the liver progresses, a lot of and a lot of connective tissue forms, creating it troublesome for the liver to perform (decompensated cirrhosis). Advanced cirrhosis of the liver is dangerous.

The liver harm done by cirrhosis of the liver usually cannot be undone. However, if cirrhosis of the liver is diagnosed early and therefore the cause is treated, any harm is restricted and, rarely, reversed.

Cirrhosis Of Liver? Cirrhosis is a degenerative disease of the liver It can be either caused by infections and other non-alcoholic causes or due to heavy alcohol consumption If left untreated cirrhosis may lead to critical illness like hepatic encephalopathy liver failure and death.

Cirrhosis is a disease of the liver in which healthy tissue is replaced with scar tissue The cells that make up this scar tissue contain fibrous proteins and are unable to perform all their normal functions including breaking down toxins and producing proteins and other substances necessary for helping blood clot when needed Untreated cirrhosis can lead to life-threatening complications including esophageal varices or bleeding from the stomach into the abdominal cavity; inflammation of the pancreas (pancreatitis) fluid accumulation around the heart (ascites) or in the abdomen (pleural effusion); poor nutrition; kidney failure; hep.

Symptoms Cirrhosis

The symptoms of unwellness} rely on the stage of your disease. within the starting stages, you will not have any symptoms. If you do have symptoms, some areas are unit general and will simply be mistaken for symptoms of many different diseases and diseases.

Cirrhosis often has no signs or symptoms until liver damage is extensive. When signs and symptoms do occur, they may include:

  • Fatigue

  • Easily bleeding or bruising

  • Loss of appetite

  • Nausea

  • Swelling in your legs, feet or ankles (edema)

  • Weight loss

  • Itchy skin

  • Yellow discoloration in the skin and eyes (jaundice)

  • Fluid accumulation in your abdomen (ascites)

  • Spider Like blood vessels on your skin

  • Redness in the palms of the hands

  • For women, absent or loss of periods not related to menopause

  • For men, loss of sex drive, breast enlargement (gynecomastia) or testicular atrophy

  • Confusion, drowsiness and slurred speech (hepatic encephalopathy)

When to see a doctor

Make an arrangement along with your doctor if you've got any of the signs or symptoms listed on top of. 

Causes Cirrhosis

A wide variety of diseases and conditions will harm the liver and result in liver disease.

drinking an excessive amount of alcohol over a few years

being infected with infectious disease for a protracted time, notably viral hepatitis or hepatitis C

a severe variety of non-alcoholic liver {disease} disease (NAFLD), referred to as non-alcoholic steatohepatitis, wherever the liver becomes inflamed from a build-up of excess fat

Cirrhosis can even be caused by a haul moving your digestive juice ducts (such as primary biliary cholangitis) or system (such as reaction hepatitis), some transmitted conditions, and therefore the long-run use of sure medicines.

Some of the causes include:

  • Chronic alcohol abuse

  • Chronic viral hepatitis (hepatitis B, C and D)

  • Fat accumulating in the liver (nonalcoholic fatty liver disease)

  • Iron buildup in the body (hemochromatosis)

  • Cystic fibrosis

  • Copper accumulated in the liver (Wilson's disease)

  • Poorly formed bile ducts (biliary atresia)

  • Alpha-1 antitrypsin deficiency

  • Inherited disorders of sugar metabolism (galactosemia or glycogen storage disease)

  • Genetic digestive disorder (Alagille syndrome)

  • Liver disease caused by your body's immune system (autoimmune hepatitis)

  • Destruction of the bile ducts (primary biliary cirrhosis)

  • Hardening and scarring of the bile ducts (primary sclerosing cholangitis

  • Infection, such as syphilis or brucellosis

  • Medications, including methotrexate or isoniazid

Risk factors Cirrhosis

  • Drinking too much alcohol. Excessive alcohol consumption is a risk factor for cirrhosis.

  • Being overweight. Being rotund will increase your risk of conditions that will result in cirrhosis of the liver, like soft liver {disease} disease and soft steatohepatitis. 

  • Having viral hepatitis. Not everyone with chronic hepatitis will develop cirrhosis, but it's one of the world's leading causes of liver disease.

Complications

Complications of cirrhosis can include:

  • High blood pressure in the veins that supply the liver (portal hypertension). Cirrhosis slows the normal flow of blood through the liver, thus increasing pressure in the vein that brings blood to the liver from the intestines and spleen.

  • Swelling in the legs and abdomen. The accumulated pressure within the vein will cause fluid to accumulate within the legs (edema) and within the abdomen (ascites). swelling and pathology conjointly might result from the shortcoming of the liver to create enough of sure blood proteins, like albumen. 

  • Enlargement of the spleen (splenomegaly). Portal hypertension can even cause changes to and swelling of the spleen, and tack of white blood cells and platelets. small white blood cells and platelets in your blood are often the primary sign of liver disease. 

  • Bleeding. Portal hypertension will cause blood to be redirected to smaller veins. Strained by the additional pressure, these smaller veins will burst, inflicting serious trauma. Malignant hypertension could cause enlarged veins (varices) within the gorge (esophageal varices) or the abdomen (gastric varices) and result in severe trauma. If the liver cannot create enough activity factors, this can also contribute to continuing trauma. 

  • Infections. If you have cirrhosis, your body may have difficulty fighting infections. Ascites can lead to bacterial peritonitis, a serious infection.

  • Malnutrition. Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss.

  • Buildup of toxins in the brain (hepatic encephalopathy). A liver broken by cirrhosis of the liver is not able to clear toxins from the blood additionally as a healthy liver will. These toxins will then build up within the brain and cause confusion and issue concentrating. With time, viscus brain disease will attain quality or coma. 

  • Jaundice. Jaundice happens once the pathologic liver does not take away enough hematoidin, a blood stuff, from your blood. Jaundice causes yellowing of the skin and whites of the eyes and darkening of excretion. 

  • Bone disease. Some people with cirrhosis lose bone strength and are at greater risk of fractures.

  • Increased risk of liver cancer. A large proportion of people who develop liver cancer have pre-existing cirrhosis.

  • Acute-on-chronic cirrhosis. Some folks find themselves experiencing multiorgan failure. Researchers currently believe this is often a definite complication in some those who have liver disease, however they do not totally perceive its causes. 

Prevention

Reduce your risk of cirrhosis by taking these steps to care for your liver:

  • Do not drink alcohol if you have cirrhosis. If you have liver disease, you should avoid alcohol.

  • Eat a healthy diet. Choose a plant-based diet that's full of fruits and vegetables. Select whole grains and lean sources of protein. Reduce the amount of fatty and fried foods you eat.

  • Maintain a healthy weight. An excess amount of body fat can damage your liver. Talk to your doctor about a weight-loss plan if you are obese or overweight.

  • Reduce your risk of hepatitis. Sharing needles and having unprotected sex will increase your risk of serum hepatitis and C. raise your doctor concerning liver disease vaccinations.
    If you are involved concerning your risk of liver disease, see your doctor concerning ways that you'll scale back your risk. 

Diagnosis Cirrhosis

People with early-stage cirrhosis of the liver sometimes do not have symptoms. Often, cirrhosis of the liver is initially detected through a routine biopsy or medical exam. To assist in diagnosing, a mixture of laboratory and imaging tests is typically done.

Your health care supplier can initial raise regarding your case history and over-the-counter and medicine use. they'll conjointly raise regarding any supplements or seasoner product you'll take. Your supplier could suspect you have got cirrhosis of the liver if you have an extended history of substance abuse, injectable substance abuse or have had viral hepatitis or C and have the symptoms listed during this article.

Physical exam: Your doctor can examine you, searching for the signs and symptoms of cirrhosis of the liver including: the red, spider-like blood vessels on your skin; yellowing of your skin or whites of your eyes; bruises on your skin; redness on your palms; swelling, tenderness or pain in your abdomen; enlarged firmer-feeling, rough texture to the lower fringe of your liver (the a part of your liver below the skeletal structure that may be felt).

Blood tests: If your doctor suspects cirrhosis of the liver, your blood is going to be checked for signs of disease. Signs of liver injury include:

Lower than traditional levels of albumin and blood coagulation factors (lower levels means that your liver has lost its ability to form these proteins).

Raised levels of liver enzymes (suggests inflammation).

Higher level of iron (may indicate hemochromatosis).

Presence of autoantibodies (may indicate response infectious disease or primary biliary cirrhosis).

Raised animal pigment level (suggests liver isn’t operating properly to get rid of animal pigment from the blood).

High white corpuscle count (indicates associate degree infection).

High creatinine level (a sign of uropathy that means late-stage cirrhosis).

Lower levels of atomic number 11 (is associate degree indicator of cirrhosis).

Raised level of alpha-fetoprotein (indicates presence of liver cancer).

In addition, different blood work can embody a whole blood count to appear for signs of infection and anemia caused by internal hemorrhage and a hepatitis check to see for viral hepatitis or C.

Imaging checks: Imaging tests show the dimensions, form and texture of the liver. These tests may also confirm the number of scarring, the number of fat you have got in your liver and fluid in your abdomen. Imaging tests of your liver that would be ordered embody X-radiation (CT) scan, abdominal ultrasound and resonance imaging (MRI). A special ultrasound, referred to as a transient elastography, measures the fat content and quantity of stiffness in your liver. 2 differing types of endoscopies may be ordered: associate degree examination retrograde cholangiopancreatography to sight common bile duct issues, and/or higher examination to sight enlarged veins (varices) or hemorrhage in your passage, abdomen or intestines.

Biopsy: A sample of liver tissue (biopsy) is far from your liver and examined below the magnifier. A liver diagnostic assay will ensure a diagnosing of cirrhosis of the liver, confirm different causes or extent of liver injury or enlargement or diagnosing carcinoma.

Tests

Your doctor may order one or more tests that may suggest a problem with your liver, including:

  • Laboratory tests. Your doctor might order blood tests to visualize for signs of liver malfunction, like excess animal pigment, moreover as certainly enzymes which will indicate liver injury. To assess excretory organs, your blood is checked for creatinine. you will be screened for infectious disease viruses. Your international normalized magnitude relation (INR) is additionally checked for your blood's ability to clot.
    Based on the biopsy results, your doctor is also able to diagnose the underlying explanation for cirrhosis of the liver. He or she will additionally use blood tests to assist determine however serious your cirrhosis of the liver is. 

  • Imaging tests. Magnetic resonance elastography (MRE) could also be counseled. This noninvasive advanced imaging check detects hardening or stiffening of the liver. different imaging tests, like magnetic resonance imaging, CT and ultrasound, may be done. 

  • Biopsy. A tissue sample (biopsy) isn't essentially required for diagnosing. However, your doctor could use it to spot the severity, extent and reason behind liver injury.
    If you've got liver disease, your doctor is probably going to suggest regular diagnostic tests to watch for signs of malady progression or complications, particularly muscle system varices and liver disease. noninvasive tests are getting additional wide obtainable for observation. 

Treatment Cirrhosis

Treatment for liver disease depends on the cause and extent of your liver harm. The goals of treatment are to slow the progression of connective tissue within the liver and to forestall or treat symptoms and complications of liver disease. you will have to be hospitalized if you've got severe liver harm.

Treatment for the underlying cause of cirrhosis

In early cirrhosis, it may be possible to minimize damage to the liver by treating the underlying cause. The options include:

  • Treatment for alcohol dependency. People with liver disease caused by excessive alcohol use ought to attempt to stop drinking. If stopping alcohol use is tough, your doctor could suggest a treatment program for inebriation. If you've got liver disease, it's vital to prevent drinking since any quantity of alcohol is venomous to the liver. 

  • Weight loss. People with cirrhosis caused by nonalcoholic fatty liver disease may become healthier if they lose weight and control their blood sugar levels.

  • Medications to control hepatitis. Medications may limit further damage to liver cells caused by hepatitis B or C through specific treatment of these viruses.

  • Medications to control other causes and symptoms of cirrhosis. Medications could slow the progression of sure varieties of liver liver disease. For instance, for individuals with primary biliary liver disease that's diagnosed early, medication could considerably delay progression to liver disease.
    Other medications will relieve sure symptoms, like haptic sensation, fatigue and pain. Biological process supplements are also prescribed to counter deficiency disease related to liver disease and to forestall weak bones (osteoporosis). 

Treatment for complications of cirrhosis

Your doctor will work to treat any complications of cirrhosis, including:

  • Excess fluid in your body. A diet and medicine to forestall fluid buildup within the body might facilitate management pathology and swelling. More-severe fluid buildup might need procedures to empty the fluid or surgery to alleviate pressure. 

  • Portal hypertension. Certain vital sign medications could manage magnified pressure within the veins that provide the liver (portal hypertension) and stop severe injury. Your doctor can perform a higher examination at regular intervals to see for enlarged veins within the passageway or abdomen (varices) which will bleed. 

  • If you develop varices, you seemingly can want medication to cut back the chance of hurt. If you have got signs that the varices square measure hurt or square measure seemingly to bleed, you will want a procedure (band ligation) to prevent the hurt or cut back the chance of more hurt. In severe cases, you will want a little tube — a transjugular intrahepatic portosystemic shunt — placed in your vein to cut back vital signs in your liver.

  • Infections. You may receive antibiotics or other treatments for infections. Your doctor also is likely to recommend vaccinations for influenza, pneumonia and hepatitis.

  • Increased liver cancer risk. Your doctor will likely recommend periodic blood tests and ultrasound exams to look for signs of liver cancer.

  • Hepatic encephalopathy. You may be prescribed medications to help reduce the buildup of toxins in your blood due to poor liver function.

Liver transplant surgery

In advanced cases of cirrhosis of the liver, once the liver ceases to perform, a liver transplant is also the sole treatment choice. A liver transplant could be a procedure to exchange your liver with a healthy liver from a deceased donor or with a part of a liver from a living donor. Cirrhosis of the liver is one among the foremost common reasons for a liver transplant. Candidates for liver transplant have intensive testing to work out whether or not they square measure healthy enough to own an honest outcome following surgery.

Historically, those with alcoholic cirrhosis of the liver haven't been liver transplant candidates as a result of the danger that they're going to come to harmful drinking once transplant. Recent studies, however, recommend that fastidiously elite folks with severe alcoholic cirrhosis of the liver have post-transplant survival rates like those of liver transplant recipients with alternative forms of disease.

For transplant to be an option if you have alcoholic cirrhosis, you would need:

  • To find a program that works with people who have alcoholic cirrhosis

  • To meet the requirements of the program, which would include lifelong commitment to alcohol abstinence as well as other requirements of the specific transplant center

Potential future treatments

Scientists are operating to expand current treatments for liver disease, however success has been restricted. As a result of liver disease has varied causes and complications, there are several potential avenues of approach. a mix of augmented screening, fashion changes and new medications could improve outcomes for individuals with liver harm, if started early.

Researchers are acting on therapies that may specifically target liver cells, serving to slow or maybe reverse the pathology that ends up in liver disease. whereas no targeted medical aid is sort of prepared, the framework for developing such treatments is in situ, and progress is fast.

 Are there stages of cirrhosis?

If you've been diagnosed with liver disease, you're already on the far side of the first stages of disease. Having liver disease suggests that your liver has connective tissue in it as a result of it's been broken.


Liver specialists and researchers have developed many various grading systems to predict outcome and to guide treatment for chronic disease. Some specific liver diseases even have their own grading systems. However, not each disease incorporates a classification system and there’s no classification system if you happen to own quite one disease at identical time.


For these reasons, maybe it’s easier to speak regarding liver disease consistent with an arrangement you're additionally able to listen to from your aid supplier. He or she might visit you having either salaried liver disease or decompensated liver disease.


Compensated liver disease suggests that you've got liver disease however you don’t nevertheless have noticeable symptoms (you square measure asymptomatic). Your work work and imaging findings might not be abnormal. A liver diagnostic test could also be the sole thanks to ensure a diagnosing of liver disease. Median survival in patients with salaried liver disease is just about 9 to twelve years. (Median is that the middle purpose in the set of numbers, therefore associate degree with an equal variety of people survived but nine to twelve years because the variety of people WHO survived over this point vary.)


Decompensated liver disease suggests that your liver disease has worsened to the purpose that you just have noticeable symptoms. Your aid supplier acknowledges your condition supports your history, physical and work findings. you've got a minimum of one complication, which incorporates jaundice, ascites, internal organ brain disease, hepatorenal syndrome, variceal hemorrhage or liver disease. you're typically admitted to the hospital for care. Median survival in patients with decompensated liver disease is just about 2 years.

Lifestyle and home remedies

If you have cirrhosis, be careful to limit additional liver damage:

  • Don't drink alcohol. Whether your illness} was caused by chronic alcohol use or another disease, avoid alcohol. Drinking alcohol could cause additional liver harm. 

  • Eat a low-sodium diet. Excess salt will cause your body to retain fluids, worsening swelling in your abdomen and legs. Use herbs for seasoning your food, instead of salt. select ready foods that area unit low in atomic number 11. 

  • Eat a healthy diet. People with cirrhosis can experience malnutrition. Combat this with a healthy plant-based diet that includes a variety of fruits and vegetables. Choose lean protein, such as legumes, poultry or fish. Avoid raw seafood.

  • Avoid infections. Cirrhosis makes it tougher for you to fight infections. shield yourself by avoiding those who are sick and laundry your hands oftentimes. Get insusceptible for infectious hepatitis and B, influenza, and respiratory illness. 

  • Use over-the-counter medications carefully. Cirrhosis makes it harder for your liver to method medicine. For this reason, raise your doctor before taking any medications, as well as nonprescription medicine. Avoid medicine like Bayer and nonsteroidal anti-inflammatory drugs (Advil, Motrin IB, others). If you've got liver harm, your doctor could advise you to avoid Anacin III (Tylenol, others) or take it in low doses for pain relief. 

Alternative medicine

A number of other medicines are wont to treat liver diseases. Milkweed (silymarin) is the most generally used and best studied.

However, there's not enough proof of clinical trials to advocate use of any flavoring product to treat liver disease. Additionally, some different medications might damage the liver. speak together with your doctor if you are curious about attempting practice medicine to assist you deal with liver disease.

Preparing for your appointment

If you've got liver disease, you'll be observed by a doctor United Nations agency makes a speciality of the systema alimentarium (gastroenterologist) or the liver (hepatologist).

Here's some data to assist you prepare for your appointment and what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions, such as diet restrictions on the day before your appointment.

  • Write down your symptoms, including when they started and how they may have changed or worsened over time.

  • Take a list of all your medications, as well as any vitamins or supplements.

  • Write down your key medical information, including other diagnosed conditions.

  • Bring results of medical tests done so far, including digital copies of CT, MRI or ultrasound images and biopsy slides if a liver biopsy has been done.

  • Write down key personal information, including any recent changes or stressors in your life.

  • Take a family member or friend along to help you remember things.

  • Write down questions to ask your doctor.

Questions to ask your doctor

Preparing a list of questions can help you make the most of your time. Some basic questions to ask your doctor include:

  • What is most likely causing my cirrhosis?

  • Is there a way to slow or stop my liver damage?

  • What are my treatment options?

  • Are there medications or supplements that can hurt my liver?

  • What signs and symptoms of complications should I watch for?

  • I have other health conditions. How can I best manage them together?

Don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Be prepared to answer questions your doctor is likely to ask, including:

  • When did you first begin experiencing symptoms?

  • Have your symptoms been continuous or occasional?

  • How severe are your symptoms?

  • What, if anything, seems to improve your symptoms?

  • What, if anything, appears to worsen your symptoms?

  • How often do you drink alcohol?

  • Have you been exposed to or taken toxic drugs?

  • Do you have a family history of liver disease, hemochromatosis or obesity?

  • Have you ever had viral hepatitis?

  • Have you ever had jaundice?

  • Have you ever had a blood transfusion or used injection drugs?

  • Do you have any tattoos?

General summary

Cirrhosis of the liver occurs when the normal functional tissue of the liver is gradually replaced by scar tissue In most cases there are no obvious causes for the condition; however excessive alcohol consumption or chronic infection with Hepatitis B or C can lead to cirrhosis Cirrhosis results in a decreased ability of the body to process nutrients This leads to fatigue and overall weakness as well as an increase in bleeding that can result in blood pressure problems The goal of treatment for cirrhotic patients should be supportive care and prevention of further damage without interfering with normal treatments for cirrhosis.

Can you recover from cirrhosis?

Cirrhosis a progressive illness that occurs when liver cells are damaged cannot be cured But it can be controlled with a healthy lifestyle and medications Cirrhosis has many causes; it is most often associated with alcoholism but can also be caused by chronic hepatitis C or B infections autoimmune hepatitis primary biliary cirrhosis and some rare genetic diseases.

Can you live with cirrhosis of the liver?

Some patients can live with cirrhosis of the liver or the end stage of chronic liver disease But at some point a patient's symptoms may become so severe that they begin to interfere with daily activities Symptoms of advanced cirrhosis include jaundice easy bruising and bleeding development of large varicose veins in the lower extremities ascites (swelling caused by fluid buildup in the abdomen) accumulation of fluid in the abdominal cavity collection of fluid under the skin and muscle tissues (the skin becomes doughy on examination) high blood pressure due to portal hypertension and enlargement of the spleen Repeated.

What are signs that your liver is struggling?

The liver is the body's major cleansing organ Its job includes filtering blood producing bile for digestion manufacturing cellular energy and storing vitamins minerals and other nutrients When you have been consuming alcohol regularly--at least three drinks a day--the liver is put into overdrive to handle all the toxins produced by excessive drinking The result is that the organ becomes inflamed leading to a condition called fatty liver disease In some cases it can even progress to damage or scarring of this vital organ Here are five signs your liver may be struggling.

How do I know if my liver is failing?

Liver disease can be easy to overlook because the signs and symptoms do not always appear quickly Often there is a gradual progression of the condition which may include fatigue or jaundice As liver disease progresses and damage worsens pain in the upper right abdomen may develop as well as nausea and vomiting Excessive swelling of the legs and arms may also occur due to poor blood clotting from liver problems In addition yellowing of eyes and skin might occur due to increased amounts of bilirubin in the bloodstream which is normally processed by healthy livers Liver disease often does not cause many symptoms at first.

What are signs that your liver is not functioning properly?

Signs that your liver is not functioning properly can include a loss of appetite and abnormally dark colored urine The skin may also turn yellow in color which is known as jaundice This indicates the buildup of bile in the body's cells Other symptoms can include a mild fever and slight nausea Additionally you may feel fatigued which means your energy levels are low Often times an individual suffering from this condition will experience extreme fatigue during the late afternoon or early evening hours.

How can I check my liver health at home?

You can check your liver health by checking the color of your nail beds If you are in full possession of all five senses then you can perform this at-home test to determine if you have a liver problem The color of your nails is an indication as it reflects that of the other organs as well So if they are pale or yellow and brittle there are chances that your liver has started showing signs of damage To check if there is protein buildup in the body you can merely look at the nails on your fingers Pale or yellowish nails could reflect poor protein quality due to long-term illness or.

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Cirrhosis of the liver : Causes, Types, Symptoms, Diagnosis and Treatment

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