Cirrhosis

Cirrhosis is an advanced stage of liver disease characterized by scarring (fibrosis) of the liver. Scar tissue gradually replaces your healthy liver cells preventing the liver from working properly and can eventually lead to liver failure and life-threatening complications. The condition usually progresses over a long period of time and is commonly due to infection or alcohol addiction.

Disease Overview

The liver is a vital organ that performs some of the important body functions including production of bile juice, storing sugars in the form of glycogen, producing proteins that help in blood clotting, and purifying blood from harmful substances such as drugs or alcohol. When your liver gets injured - whether by excessive alcohol intake, a disease condition, or another cause - it attempts to repair itself. In the process, scar tissue develops. As cirrhosis advances, more and more scar tissue develops making it harder for the liver to function – a condition known as decompensated cirrhosis. The damage to the liver caused by cirrhosis normally cannot be undone. But if liver cirrhosis is detected at an early stage and the cause is cured, further damage can be restricted and sometimes even reversed.

Causes

A wide range of conditions and diseases can cause liver damage and result in cirrhosis. These include:

• Chronic alcohol abuse
• Chronic hepatitis
• Non-alcoholic fatty liver disease
• Primary biliary cholangitis
• Autoimmune hepatitis
• Inherited conditions, such as hemochromatosis and Wilson’s disease
• Certain medications, such as methotrexate or isoniazid
• Infections, such as syphilis and brucellosis

Signs and Symptoms

Cirrhosis generally has no signs or symptoms until substantial liver damage occurs. When signs and symptoms do occur, they may include:

• Nausea
• Loss of appetite
• Weight loss
• Fatigue
• Jaundice (a yellow discoloration of the skin and eyes)
• Ascites (fluid build-up in the belly)
• Edema (swelling of the legs, ankle, and feet)
• Easy bruising or bleeding
• Itchy skin
• Fever
• Portal hypertension

Diagnosis

Your physician will review your medical and medication history and conduct a physical examination to check for signs and symptoms of cirrhosis. If cirrhosis is suspected, a combination of tests are performed. These include:

• Laboratory tests: These involve routine blood tests to check for signs of liver malfunction, such as excess bilirubin, as well as certain enzymes that may indicate liver damage. Creatinine levels are assessed for kidney function and also for hepatitis viruses.
• Biopsy: In this study, a sample of tissue is extracted from your liver and examined under a microscope. A biopsy can help to identify the cause, severity, and extent of liver damage.
• Imaging tests: Your physician may order imaging tests such as magnetic resonance imaging (MRI), computerized tomography (CT) scan, and abdominal ultrasound. These tests help to identify the shape, size, and texture of the liver. Furthermore, they help to determine the amount of fat or scarring in your liver, as well as the amount of fluid in the abdomen.

Treatment

Treatment for cirrhosis depends upon the underlying cause, the symptoms you are experiencing, and to what extent the disease has progressed. Treatments may include medications, lifestyle changes, and surgery.

Medications: Your physician may prescribe certain medications like beta-blockers or nitrates for management of conditions such as portal hypertension. They may also prescribe antibiotics or antiviral medications to treat infections such as hepatitis. Treatment for autoimmune hepatitis will involve medications to supress your immune system. In cases where certain medications have resulted in cirrhosis, your physician may lower the dosage, change to a different drug, or stop the drug completely.

Lifestyle changes: If your cirrhosis is due to chronic alcohol consumption, your physician will strongly advise you to stop drinking alcohol through therapies such as behaviour modification, counselling, detoxification programs, and medication.

Lifestyle changes will involve following a healthy diet, losing weight, and regular exercise if the underlying cause of your cirrhosis is nonalcoholic fatty liver disease.

If you are experiencing ascites or edema, a low-sodium diet may also be recommended. This helps to reduce the amount of fluid in the tissue, as well as to keep high blood pressure and swelling under control.

Surgery:  In advanced cases of cirrhosis, where your liver is severely damaged, liver transplant surgery may be the only treatment option. Liver transplantation is a surgical procedure to replace a damaged or diseased liver with a healthy liver from a deceased donor or with a portion of a liver from a living donor.

Summary

Liver cirrhosis is an advanced stage of liver disease and can occur from untreated hepatitis infection, chronic misuse of alcohol, or untreated non-alcoholic fatty liver disease. When left untreated, the damage to the liver can become so severe that it can no longer function properly. While not every instance of cirrhosis can be averted, there are methods to prevent it. Maintaining regular physical activity, a nutritious diet, moderate to limited alcohol intake, and regular health check-ups with a physician are all methods to keep your liver in good condition.