Liver Cirrhosis

Cirrhosis is a late-stage liver disease that replaces your healthy liver tissue with scar tissue, permanently damaging the liver. The scar tissue blocks or restricts blood flow through the liver, slowing its ability to produce proteins and process nutrients. Since cirrhosis restricts the liver from working properly, it is a life-threatening condition. Moreover, having cirrhosis puts you at an increased risk of liver cancer. 

Usually, there are no symptoms of cirrhosis in its early stage. When the liver damage increases, you may experience the following:-

1. Easy bleeding or bruising
2. Itchy skin
3. Jaundice (yellowing of eyes and skin)
4. Enlarged spleen 
5. Ascites (fluid buildup in the abdomen)
6. Oedema (swelling in legs, feet, and ankles)
7. Redness in the palms
8. Telangiectasia (spider-like blood vessels on your skin)
9. Brownish or orange-coloured urine
10. Hepatic encephalopathy (confusion, drowsiness, difficulty thinking, memory loss)
11. In women: Loss of periods unrelated to menopause
12. In men: Loss of sex drive, gynecomastia (breast enlargement) or testicular atrophy (shrunken testicles)
13. Continued symptoms like unexplained weight loss, fatigue, nausea, loss of appetite, and weakness for a period of 3 months may indicate liver damage.

The common causes of liver cirrhosis include:-

1. Long-term alcohol abuse
2. Chronic viral infections (hepatitis B and C)
3. Non-alcoholic fatty liver disease (fat buildup in the liver due to obesity or diabetes)
4. Inherited Diseases
   1. Hemochromatosis (iron buildup in the liver)
   2. Alagille syndrome (genetic abnormality in the bile ducts)
   3. Alpha-1 antitrypsin deficiency (abnormal protein buildup in the liver)
   4. Cystic fibrosis (thick, sticky mucus buildup in the liver)
   5. Wilson disease (accumulation of copper in the liver)
   6. Glycogen storage diseases (Inability of the liver to break down glycogen)
5. Autoimmune hepatitis (liver inflammation caused by your immune system)
6. Damage to the bile ducts in the liver
   1. Primary sclerosing cholangitis (scarring and hardening of the bile ducts)
   2. Primary biliary cholangitis (permanent damage of the bile ducts)
   3. Biliary atresia (blockage of bile ducts in infants)
7. Infections, such as brucellosis or syphilis 
8. Bad reactions to medications, such as methotrexate or isoniazid

You are at a higher risk of getting cirrhosis if you:-

1. Drink too much alcohol
2. Have a history of liver disease
3. Are overweight
4. Have viral hepatitis
5. Have diabetes
6. Have unprotected sex
7. Use shared needles to inject drugs

Myth 1: Cirrhosis affects only those people who consume alcohol. 

Fact: Though alcohol abuse is a major cause of liver cirrhosis, it is not the only reason. Various injuries can cause severe scarring of the liver. These injuries include hepatitis B and C, iron and copper buildup, heredity disorders, and other liver diseases. Therefore, cirrhosis can also affect people who do not consume alcohol. 

Myth 2: No symptoms = No cirrhosis

Fact: It is possible to have liver cirrhosis without experiencing any symptoms. In the early stages of cirrhosis, the liver functions well enough to support your body’s daily operations. In such a situation, fatigue is a notable symptom that can be mistaken for other illnesses. When the liver becomes totally dysfunctional, you may experience other serious symptoms. 

You can reduce your risk of cirrhosis by following these preventive tips:-

1. Do not drink alcohol if you have liver disease
2. Have a well-balanced diet that consists of vegetables, fruits, proteins, and whole grains
3. Avoid using too much salt in your diet
4. Avoid eating raw seafood, as it can contain bacteria that cause serious illness
5. Reduce body weight as excess fat can damage the liver
6. Quit smoking
7. Exercise regularly
8. Get vaccinated against hepatitis B
9. Avoid high-risk behaviours, such as sharing needles and having unprotected sex

Complications of cirrhosis include:-

1. Portal hypertension: It refers to high blood pressure in the veins that supply blood to the liver. Risks of portal hypertension include:-
   1. Splenomegaly: Enlargement in the spleen, trapping white blood cells and platelets.
   2. Swelling in your legs and abdomen: Fluid accumulation in legs (oedema) and fluid accumulation in the abdomen (ascites). 
   3. Bleeding: Portal hypertension can redirect blood to smaller veins. Due to this extra pressure, these small veins can burst, causing excessive bleeding. 
   4. Hepatic Encephalopathy: Confusion, changes in behaviour, difficulty thinking. 
2. Malnutrition: Cirrhosis makes it difficult for your body to process nutrients, causing weakness and excessive weight loss. 
3. Infections: Cirrhosis makes it difficult for your body to fight infections, such as bacterial peritonitis. 
4. Bone disease: Sometimes, people with cirrhosis lose their bone strength and are at a higher risk of bone fractures. 
5. Hypersplenism (overactive spleen): Causes premature and quick destruction of blood cells.
6. Liver cancer: Usually, people who develop liver cancer have pre-existing cirrhosis.
7. Liver failure: Cirrhosis can also lead to liver failure. 

Progression of Liver Cirrhosis

1. Compensated Cirrhosis: In this stage, you won’t experience any symptoms. Your liver can still help your body perform its daily operations as it has enough healthy cells to compensate for the damaged cell. You can stay in this stage for years, and the median survival in patients is about 9 to 12 years. 
2. Decompensated Cirrhosis: During this stage, your cirrhosis worsens, and you experience noticeable symptoms. The median survival in patients is around two years. If you have decompensated cirrhosis, you experience at least one of the following complications:-
   1. Jaundice
   2. Bleeding varices
   3. Ascites
   4. Hepatorenal syndrome
   5. Hepatic encephalopathy
   6. Liver cancer

During the diagnosis of liver cirrhosis, your doctor will ask you about your medical history and the medications you take. He/she may suspect that you have liver cirrhosis if you have a history of alcohol abuse, hepatitis B or C, or any other cirrhosis symptoms. The doctor will conduct these tests to diagnose the condition:-

1. Physical Exam: The doctor will examine you to look for signs such as:-
   1. Yellowing of skin and eyes
   2. Hand tremors
   3. Redness in palms
   4. Swelling, pain or tenderness in your abdomen
   5. Enlarged liver or spleen
   6. Decreased alertness
2. Blood Test: If the doctor suspects cirrhosis, he/she will conduct a blood test to look for signs of liver disease, which include:-
   1. Higher levels of liver enzymes
   2. Higher level of iron
   3. Buildup of bilirubin
   4. Lower blood clotting factors
   5. High count of white blood cell
   6. Low levels of sodium and proteins
   7. Presence of autoantibodies 
3. Imaging Tests: These tests help the doctor examine your liver’s size, shape, and texture. Magnetic resonance elastography (MRE) can determine the stiffening or hardening of the liver. He/she may also conduct other imaging tests, such as MRI, CT scan and ultrasound. 
4. Biopsy: The doctor will extract a sample of liver tissue to examine it under the microscope. A biopsy can confirm the diagnosis of cirrhosis and determine the extent of liver damage. 

Although there is no treatment to reverse the effect of cirrhosis, it can stop its progress and reduce complications. 

Treatment for the underlying causes of liver cirrhosis include:-

1. If the cause of your cirrhosis is alcohol dependency, you should stop drinking. You can ask your provider to suggest treatment programs for alcohol addiction.
2. Medications can limit the liver damage caused by hepatitis B or C.
3. You can manage non-alcoholic fatty liver disease by losing weight, maintaining a healthy diet, and exercising regularly. 
4. Get vaccines for pneumonia, hepatitis B and hepatitis C.
5. Drink enough fluids to avoid dehydration. 
6. Practice good hygiene.
7. You may also need blood pressure medications to lessen bleeding inside the body. 

Liver Transplant Surgery: Liver transplant surgery is the other treatment for liver cirrhosis. In this procedure, the surgeon removes your damaged liver and replaces it with a healthy liver from a donor. In the advanced stages of cirrhosis, liver transplant surgery is the only option when the liver cannot function. 

In the early stages, liver cirrhosis does not cause any symptoms. You may not realise that you have liver cirrhosis unless the doctor diagnoses it during a routine checkup. Consult a healthcare provider right away if you experience the following symptoms:-

1. Yellowing of eyes and skin (jaundice)
2. Fatigue
3. Easy bruising and bleeding