CONDITIONS
Liver Cirrhosis
Liver Cirrhosis
Cirrhosis of the liver means a permanent scarring that damages the liver and lessens its functioning.
Liver cirrhosis may even lead to failure of the liver. Liver cirrhosis generally happens over a long period, often due to infection or other causes.
A damaged liver cannot be fixed but if caught early, some treatments might prevent an increase in the damage.
Liver disease accounts for 20 lakh deaths across the world and is responsible for 4% of all deaths (1 out of every 25 deaths worldwide)
How does cirrhosis affect my liver and body?
- – Scarring in the liver blocks the usual process of blood and thereby oxygen through the liver tissues slowing the liver’s ability to process metabolizing nutrients and filtering out toxins.
- – Cirrhosis reduces your liver’s ability to produce bile and essential blood proteins.
- – Scar tissue may also compress blood vessels running through the liver (portal vein system), leading to a condition called portal hypertension.
What are the symptoms of Liver Cirrhosis?
Liver Cirrhosis may become difficult to diagnose early as it often has no symptoms until the damage to the liver is severe.
Early symptoms may be same as other diseases such as:
- Fatigue.
- Easily bleeding or bruising
- Not feeling hungry
- Swelling in the legs, feet, or ankles, called oedema.
- Weight loss
- Itchy skin
- Yellow discoloration in the skin and eyes, called jaundice
- Fluid accumulation in the abdomen
- Nausea
- Pain in right side of the belly
Symptoms of the skin:
- Easy bruising
- Spiderlike blood vessels on the skin.
- Redness in the palms of the hands.
- Pale fingernails, especially the thumb and index finger.
- Clubbing of the fingers, in which the fingertips spread out and become rounder than usual.
- Jaundice (skin and eyes turn yellow)
- Hair loss
Other Symptoms of liver cirrhosis.
- For women, absence of or loss of periods not related to menopause.
- Trouble sleeping
- Nosebleeds or bleeding gums
- Brownish or orange urine
- Light-colored potty or Blood in potty
- Fever
- Easy fracture
- For men, loss of sex drive, testicular shrinkage or breast enlargement, known as gynecomastia.
- Confusion, drowsiness, or slurred speech.
Emergency treatment might be required if:
- The stools are black or look like tar.
- Vomiting blood.
- Severe belly pain.
- A feeling of confusion and sleepiness.
- High fever and if a person cant stop shaking (chills).
- The whites of the eyes suddenly turn yellow.
What are the causes of Liver Cirrhosis?
Lot of diseases may damage the liver lead to cirrhosis. Some of these conditions are:
- Long-term alcohol abuse. According to 2024 study, alcohol is the most common cause of cirrhosis in adults in India.
- Ongoing viral hepatitis (hepatitis B, C and D).
- Nonalcoholic fatty liver disease (NAFLD) – Type 2 Diabetes, obesity increases the risk of this condition. If NAFLD is the cause of cirrhosis, keeping blood sugar levels in check may help.
- Condition causing iron buildup in the body (Hemochromatosis).
- Liver disease caused by the body’s immune system (Autoimmune hepatitis)
- Destruction of the bile ducts caused by primary biliary cholangitis.
- Hardening and scarring of the bile ducts caused by primary sclerosing cholangitis.
- Wilson’s disease (condition in which copper accumulates in the liver)
- Cystic fibrosis.
- Alpha-1 antitrypsin deficiency.
- Poorly formed bile ducts, a condition known as biliary atresia.
- Inherited disorders of sugar metabolism, such as galactosemia or glycogen storage disease.
- Alagille syndrome, a genetic digestive disorder.
- Infections, such as syphilis or brucellosis.
- Medications, including methotrexate or isoniazid.
What are the risk factors of Liver Cirrhosis?
- Drinking too much alcohol.
- Being overweight: Obesity increases the risk of conditions such as nonalcoholic fatty liver disease and nonalcoholic steatohepatitis (NASH).
- Viral hepatitis: Not all chronic hepatitis develops into cirrhosis, but it is known as one of the top reasons for liver disease.
What are the diagnostic tests for Liver Cirrhosis?
Regular health check-up is recommended to catch liver disease early so that it does not lead to liver cirrhosis. Depending on the symptoms or assessment, the doctor advice the following tests:
Laboratory tests:
- Blood tests:
- Check high bilirubin levels or certain enzymes for liver malfunction check.
- Creatinine to check for kidney function.
- Screening for the hepatitis viruses.
- Clotting ability is also checked.
History and blood tests help in diagnosing the underlying cause of cirrhosis. Blood tests also can help identify how serious your cirrhosis is.
- Imaging tests:
- Transient or magnetic resonance elastography (MRE) may be recommended to look for hardening or stiffening of the liver.
- Other imaging tests, such as MRI, CT and ultrasound, also may be done.
- Biopsy: A tissue sample (biopsy) may be done severity of liver damage and the cause of it. This test is not strictly necessary in case of liver cirrhosis.
In the case of liver cirrhosis, regular tests may be recommended to check for progression of disease or to check for signs of complications, especially esophageal varices, and liver cancer.
What are the treatment options in Liver Cirrhosis?
Treatment for cirrhosis depends on the cause and extent of your liver damage. Treating liver cirrhosis means that the progression of scar tissue in the liver is prevented and any complications averted. Hospitalization may be advised in case of severe liver damage.
Treatment for the underlying cause of cirrhosis:
Diagnosing the underlying causes and treating them are the most important goals of managing cirrhosis because treating the underlying cause may result in minimizing damage to the liver. The options include:
Treatment for alcohol dependency:
Alcohol is the most common cause of liver cirrhosis in India and people excessive alcohol intake should stop drinking immediately.
Patients may be enrolled in alcohol addiction programs recommended by the doctor if stopping alcohol is difficult. This is vital because any amount of alcohol is toxic to the liver.
Weight loss: If people lose weight, cirrhosis caused by nonalcoholic fatty liver disease (NAFLD) may be managed in a better way.
Medicines: If caused by hepatitis B or C, damage to liver may be controlled by specific medications and treatments for the viruses.
Medicines to control other causes and symptoms of cirrhosis: Medicines may slow the progression of certain types of liver cirrhosis, such as cirrhosis caused by primary biliary cholangitis if diagnosed and treated early, may significantly delay progression to cirrhosis.
Is Liver transplant surgery an option?
In advanced cases of cirrhosis, a liver transplant may be the only option if the liver stops functioning. A liver transplant is the procedure to replace the liver with a healthy liver or a part of the liver from a deceased donor or part of a liver from a living donor.
If the doctor indicates liver transplant, the candidates undergo rigorous testing to assess if the patient is healthy enough for a good surgery outcome.
People with alcoholic cirrhosis are generally not considered for transplant because they are at a risk of returning to drinking again post-transplant.
The doctor would inform the patient that to be considered for a liver transplant to be an option with alcoholic cirrhosis –
- – a program that works with people who have alcoholic cirrhosis should be there.
- – Meet the requirements of the program such as lifelong commitment to alcohol abstinence
References
- Shekhar Swaroop, Manas Vaishnav, Umang Arora, Sagnik Biswas, Arnav Aggarwal, Soumya Sarkar, et. al. Etiological Spectrum of Cirrhosis in India: A Systematic Review and Meta-analysis. Journal of Clinical and Experimental Hepatology. 2024; 14 (2): 101291.
- Thuluvath PJ, Saraya A, Rela M. An Introduction to Liver Disease in India. Clin Liver Dis (Hoboken). 2021 Aug 20;18(3):105–7.
- Cirrhosis. Mayo Clinic. February 2024. https://www.mayoclinic.org/diseases-conditions/cirrhosis/diagnosis-treatment/drc-20351492
- Cirrhosis of the Liver: Symptoms, Stages & Treatment. WebMD. February 2024. https://www.webmd.com/digestive-disorders/understanding-cirrhosis-basic-information
