Last updated date: 17-Jul-2023
Originally Written in English
Cirrhosis is a condition in which your liver is scarred and permanently damaged. Cirrhosis has many signs and symptoms, such as fatigue and severe itchy skin. Doctors diagnose cirrhosis based on your medical history, a physical exam, and the results of tests. Doctors do not have specific treatments that can cure cirrhosis. However, they can treat many of the diseases that cause cirrhosis. Treating the underlying causes of cirrhosis may keep your cirrhosis from getting worse and may help prevent liver failure.
What is Liver Cirrhosis?
Cirrhosis refers to a late-stage liver condition whereby the liver tissue in good health is replaced by scar tissue. This leads to permanent damage to the liver. Scar tissue obstructs your liver's ability to function normally.
Healthy liver cells are injured by a variety of diseases and disorders, resulting in cell inflammation and even death. This is followed by cell repair and, as a result of the repair process, tissue scarring.
The scar tissue reduces the liver's capacity to metabolize nutrients, hormones, medicines, and natural toxins by blocking blood supply through the liver. It also lowers the liver's production of proteins and other components. Eventually, cirrhosis impairs the liver's ability to function correctly and can be fatal during its late stages.
Causes of Cirrhosis
Cirrhosis can occur due to a variety of diseases and disorders that affect the liver. The following are some of the possible reasons;
- Prolonged abuse of alcohol
The most common cause of liver cirrhosis is excessive and chronic alcohol consumption. Cirrhosis caused by alcohol consumption can develop over time.
It is important to remember that the amount of alcohol required to cause liver damage varies from person to person. If a healthy woman consumes the same amount of alcohol as a healthy man, she is more likely to develop cirrhosis. Children are especially vulnerable to the effects of alcohol. Some people are also genetically predisposed to alcohol-related liver damage.
People with medical conditions, particularly those affecting the liver, may be more vulnerable to the effects of alcohol. If you already have hepatitis B or C, or cirrhosis of the liver (from any cause), drinking alcohol may worsen your condition.
- Hepatitis caused by a chronic virus (hepatitis B, C, and D)
Hepatitis is a broad term that refers to liver inflammation. Viral hepatitis is caused by a virus, such as the hepatitis B or C virus. Cirrhosis of the liver is commonly caused by chronic hepatitis C. Cirrhosis can also be caused by Hepatitis B. If you have either of these conditions, drinking alcohol increases your chances of developing cirrhosis.
- The accumulation of fat in the liver (nonalcoholic fatty liver disease)
- The accumulation of iron in the body (hemochromatosis)
- Cystic fibrosis
- Wilson's illness, a condition in which copper builds up in the liver.
- Bile ducts that aren't properly formed (biliary atresia)
- Alpha-1 antitrypsin deficiency
- Inheritable sugar metabolism diseases (galactosemia or glycogen storage disease)
- A digestive disorder caused by a genetic mutation (Alagille syndrome)
- The immune system of your body causing liver disease (autoimmune hepatitis)
- The bile ducts damage (primary biliary cirrhosis)
- Bile duct scarring and hardening (primary sclerosing cholangitis)
- Infections like syphilis and brucellosis
- Drugs such as methotrexate or isoniazid
Risk Factors of Cirrhosis
Some of the risk factors that can contribute to cirrhosis include the following;
- Overindulging in alcohol: Generally, cirrhosis is linked to excessive intake of alcohol.
- Being overweight: Obesity raises the risk of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis, both of which can result in cirrhosis.
- Viral hepatitis: Cirrhosis does not develop in every person with chronic hepatitis. However, it is one of the most common causes of liver disease worldwide.
What are the different stages of cirrhosis?
Cirrhosis is also known as end-stage liver disease. This simply means that it occurs after the other stages of liver damage, which can include inflammation (hepatitis), fatty deposits (steatosis), increased stiffness, and mild scarring .
Many people with cirrhosis can live for many years without requiring a liver transplant. This is due to the liver's ability to function relatively well even when severely damaged.
Cirrhosis is classified as compensated or decompensated.
- Compensated cirrhosis is where the liver is coping with the damage and maintaining its important functions.
- The liver is unable to perform all of its functions adequately in decompensated cirrhosis. Serious symptoms and complications associated with decompensated liver disease or cirrhosis include portal hypertension, bleeding varices, ascites, and hepatic encephalopathy.
There are also systems for grading the severity of cirrhosis. The Child-Pugh score is one of these, and it uses symptoms such as encephalopathy and ascites, as well as blood test results for bilirubin, albumin, and clotting, to grade cirrhosis from A (relatively mild) to C (severe). Other systems, such as MELD (model of end-stage liver disease), are used to help decide which patients most urgently require liver transplants. It makes use of bilirubin, creatinine, and clotting test results from blood tests (INR).
Signs and Symptoms of Cirrhosis
Cirrhosis symptoms arise when the liver is unable to;
- Filter the blood
- Generate clotting proteins
- Break down toxins
- Aid fat and fat-soluble vitamin absorption
Many cirrhotic people have no symptoms and appear to be healthy for years. One-third of people never develop symptoms. Others experience fatigue and general malaise, lose their appetite, and lose weight:
- Their fingertips may enlarge (called clubbing).
- Jaundice can develop, making the skin and whites of the eyes look yellow and the urine look dark like cola.
- When fats and fat-soluble vitamins are poorly absorbed, stools may be light-colored, soft, bulky, oily-looking, and unusually foul-smelling (called steatorrhea).
Many people are malnourished and underweight as a result of a loss of appetite and poor absorption of fats and vitamins. A reddish purple rash with tiny dots or larger splotches may develop as a result of bleeding from small blood vessels in the skin.
People who have had their liver function impaired for a long time may experience itching all over, as well as small yellow bumps of fat deposited in the skin or eyelids. If cirrhosis is caused by chronic alcohol abuse or a chronic liver disorder, the following symptoms may develop:
- Muscles waste away (atrophy).
- The palms become red (called palmar erythema).
- The tendons of the hand shrink, causing the fingers to curl up (called Dupuytren contracture).
- Small spiderlike blood vessels (spider angiomas) appear in the skin.
- Salivary glands in the cheeks enlarge.
- The nerves outside the brain and spinal cord (peripheral nerves) malfunction (called peripheral neuropathy).
- Because the damaged liver is unable to break down estrogens (female hormones), men may have enlarged breasts (gynecomastia) and shrunken testes (testicular atrophy). Hair in the armpits thins out.
Cirrhosis diagnosis usually starts with a thorough medical history and physical examination. The physician will take a comprehensive medical history. This can include long-term abuse of alcohol, hepatitis C exposure, autoimmune disease family history, and other risk factors.
The physical examination may reveal symptoms of cirrhosis such as;
- Pale complexion
- Jaundice (yellow eyes)
- Reddening of the palms
- Tremors in the hands
- A spleen or liver enlargement
In addition, the doctor can order more diagnostic tests to determine your liver problem. Examples of these tests include;
- Lab tests
The physician or gastroenterologist can ask for blood tests to look for indicators of liver disease and malfunction. This includes high bilirubin levels and some enzymes that signal liver damage. Creatinine levels in the blood are also measured to determine renal function.
If necessary, the doctor will screen for hepatitis viruses as well as testing for the blood's capacity to clot using an international normalized ratio (INR).
Your doctor might be able to detect the primary cause or trigger of cirrhosis depending on the findings of the blood tests. Blood tests can also help determine the severity of liver cirrhosis.
- Imaging tests
The doctor can recommend magnetic resonance elastography (MRE). The liver hardening or stiffening is detected with this noninvasive advanced imaging technique. Some other imaging tests, like a CT scan, an MRI, or ultrasound, might be performed as well.
For liver diagnosis, a biopsy (tissue sample removal) is not always necessary. On the other hand, the doctor may recommend it to determine the seriousness, extent, and source of liver damage.
Endoscopy detects and treats varices in the esophagus or stomach that would otherwise rupture and bleed. A tiny camera and light (endoscope) are passed down your oesophagus and into your stomach. Sedation is usually used for the test.
If cirrhosis is confirmed, ultrasonography is performed every 6 months, with or without a blood test that could indicate a liver tumor (alpha fetoprotein). If ultrasonography reveals abnormalities suggestive of cancer, doctors will perform magnetic resonance imaging (MRI) or CT after injecting a substance visible on MRI or x-rays (contrast agent)
When cirrhosis is confirmed, endoscopy of the upper digestive tract (insertion of a flexible viewing tube) may be required to check for varices, especially if blood and imaging tests show signs of portal hypertension. This endoscopy is performed every 2 to 3 years. If varices are found, it is done more frequently.
Blood tests that assess the liver are done regularly.
Until recently, it was thought that a liver with cirrhosis could not be healed. This is usually the case because most diseases that cause scarring of your liver (fibrosis) are long-term and difficult to ‘cure’. The treatment of Hepatitis B and C, as already mentioned, gives hope for the development of new drugs to combat scarring of the liver. More research, however, needs to be done before any
new treatments become widely available.
Cirrhosis treatment is determined by the cause and severity of the liver damage. The treatment's goals are to decrease the advancement of the scar tissue in the liver, as well as to treat and prevent cirrhosis symptoms or complications. If you have serious liver damage, you may need to be admitted to the hospital.
It might be possible to reduce liver damage in early cirrhosis by addressing the underlying cause. The treatment options are;
- An alcohol addiction treatment program
Cirrhosis due to too much alcohol consumption should quit drinking at all costs. If quitting alcohol is tough, the doctor might suggest an alcohol addiction treatment program. It is vital to stop alcohol consumption if you have cirrhosis since even little drinking is hazardous to the liver.
- Losing weight
Cirrhosis due to nonalcoholic fatty liver disease can positively improve if the patient cuts off weight and keeps their blood sugar under control.
- Hepatitis treatment medications
Through precise treatment of the viruses, medications may reduce other liver cells damage due to hepatitis B or C.
- Medications to treat cirrhosis's other causes and symptoms
Some forms of liver cirrhosis can be slowed down with medication. Medication, for example, can greatly slow the advancement of primary biliary cirrhosis, especially those detected early.
Some blood pressure drugs can help avoid serious bleeding by lowering the pressure in the veins feeding the liver (portal hypertension). At regular intervals, the doctor will do an upper endoscopy to check for swollen veins (varices) in the stomach or esophagus that could bleed.
If you get varices, you'll almost certainly require medicine to prevent bleeding. If the varices are bleeding or most likely to hemorrhage, a procedure (band ligation) may be required to halt the bleeding or limit the risk of additional bleeding. A tiny tube (a transjugular intrahepatic portosystemic shunt) may be inserted in the vein to help lower blood pressure in the liver.
If endoscopy fails to stop the bleeding, a Sengstaken tube is passed down the throat and into the stomach. This device consists of two balloons that, when inflated, apply pressure to the varices and help control the bleeding. For this procedure, people are heavily sedated.
- Too much fluid in the body
Controlling ascites or swelling may be possible with a low-sodium diet and medicines to stop fluid accumulation in the body. The fluid collection that is more severe may necessitate draining techniques or surgery to ease the pressure.
Doctors can recommend antibiotics or other medicines to treat infections. Vaccinations for pneumonia, influenza, and hepatitis are also possible treatment options.
- Hepatic encephalopathy
Many people with cirrhosis have episodes of hepatic encephalopathy, most of the time at a low level. It can manifest itself in overt stages (where it is visible) as sleep disturbance, mild confusion, subtle personality changes, and slightly lower performance in tests such as drawing a star and connecting dots.
It can also cause problems with movement (called ataxia) and speech, slurring of words, tremor, and flapping hands when you extend your arms (called asterixis). In some people, sleepiness can progress to loss of consciousness and even coma, which can be fatal.
Lactulose is the primary treatment for encephalopathy (a sweet syrupy medicine). This not only acts as a laxative but also aids in the removal of toxins that accumulate in the body when the liver fails. Individuals are given enough lactulose to have one or two loose bowel movements per day. Other laxatives and/or an enema may also be administered. The majority of encephalopathy episodes are caused by problems such as an infection, constipation, dehydration, a medication, or a bleed. It is critical that patients seek medical attention so that the source of an episode can be identified and treated.
Cirrhotic patients may develop liver cancer, most commonly hepatocellular carcinoma (HCC). The goal is to find and treat liver cancer as soon as possible.
Treatment may include removing the cancerous portion of the liver. Other treatments aimed at controlling the cancer include chemotherapy injections, radio frequency ablation, and oral medications. Some patients may be candidates for a liver transplant.
- Ascites and peripheral edema
In people with advanced cirrhosis, ascites (fluid building up in your abdominal cavity, causing a bulge across your tummy) and peripheral edema (swelling in your ankles and legs) are very common. Ascites can be painful and make it difficult to breathe and eat normally. Furthermore, there is a risk of infection in the fluid, known as spontaneous bacterial peritonitis (SBP), which can be fatal if not treated with antibiotics.
Sodium restriction is the primary treatment for ascites and edema (low salt diet and diuretics, such as spironolactone and Furosemide). It can be beneficial to consult with a dietitian about how to manage on such a restricted diet. Some patients benefit from having the fluid in their abdomen drained with a needle and tube. This is usually necessary every few weeks. Patients who are thought to be at a higher risk of infection may be given prophylactic (preventative) antibiotics to take every day.
Transplantation of the liver
When the liver fails to function in more advanced stages of cirrhosis, a liver transplant might be the option for treatment. A liver transplant is a process in which your liver is replaced with a healthy one from a deceased donor or a portion of a living donor's liver.
One of the most prevalent reasons for performing a liver transplant is cirrhosis. The candidates for a liver transplant go through a series of tests to see if they are in good shape to have a successful surgery.
Complications of Cirrhosis
Cirrhosis can result in a variety of additional complications, some of which can be fatal. They can include the following;
- Edema or ascites: Edema is an accumulation of fluid in the legs, whereas ascites is an accumulation of fluid in the abdomen. A low-salt diet and water pills can help to treat them. Also, the fluid may need draining severally in extreme situations. Occasionally, surgery is required.
- Varices and portal hypertension: These refer to large, bulging veins in the esophagus and stomach. They can raise blood pressure in the portal vein, which transports blood from the spleen and bowel to the liver. These varices can burst, resulting in a lot of blood loss and clotting.
- Hepatocellular carcinoma: This most frequent form of liver cancer and the world’s third cause of death.
- Hepatopulmonary syndrome (HPS): This is a combination of liver illness, dilated blood vessels of the lungs, and improper gas exchange.
- Hepatorenal syndrome occurs when liver failure progresses to kidney failure. In this syndrome, the body produces and excretes less urine, resulting in a buildup of toxic substances in the blood. People suffering from hepatorenal syndrome eventually have difficulty breathing. This kidney problem can progress to the point where dialysis is required.
- Because the damaged liver can no longer remove toxic substances from the blood, liver failure can also cause brain function to deteriorate (a condition known as hepatic encephalopathy). These noxious substances then circulate through the bloodstream and accumulate in the brain.
Prognosis for Cirrhosis
Cirrhosis is almost always permanent and can progress unless the underlying cause is addressed. It is frequently difficult to predict how quickly it will progress. Cirrhosis patients' prognosis is determined by the cause, severity, presence of other symptoms and disorders, and effectiveness of treatment.
Stopping all alcohol consumption prevents further liver scarring. Cirrhosis worsens if people continue to drink alcohol, even in small amounts, causing serious complications. Once a major complication (such as blood vomiting, fluid accumulation in the abdomen, or deterioration in brain function) occurs, the prognosis is bleak.
Cirrhosis of the liver develops as a late-stage complication of liver disease. Cirrhosis impairs the liver's ability to function correctly. Many of the processes and functions that keep you alive are dependent on the liver.
Even though scarring due to liver disease is permanent, it is still possible to survive for a long time. There’s also a chance to stop or slow down the progression of cirrhosis depending on the underlying trigger. Cirrhosis can be caused by a variety of factors, many of which are curable or controllable.