Decompensated Cirrhosis - Causes, Symptoms, and Treatment

Introduction:

The liver is the largest vital organ of the human body, and the liver performs various essential functions in the human body. Its main function involves detoxification, filtration, and metabolization of drugs. A diseased condition of the liver affects liver functions in many ways. These may be due to many causes, leading to inflammation and scarring on the liver. This results in end-stage liver disease cirrhosis. Untreated cirrhosis can lead to liver failure.

What Is Decompensated Cirrhosis?

A complication of advanced liver disease is termed decompensated cirrhosis. Individuals with compensated cirrhosis do not reveal any symptoms because the liver functionality is still good. As the liver functionality affects and reduces, it turns into decompensated cirrhosis. Individuals with decompensated cirrhosis are nearly at the end stage of liver failure and are usually recommended for a liver transplant procedure.

What Causes Decompensated Cirrhosis?

Decompensated cirrhosis is an advanced stage when scarring becomes so severe that the liver fails to function. Anything that damages the liver results in failing liver function and scarring. The common causes are:

• Fat buildup in the liver.

• Long-term heavy consumption of alcohol.

• Chronic hepatitis B and C.

• Poorly formed bile ducts.

• Cystic fibrosis.

• Autoimmune liver disease.

• Excess iron buildup.

• Copper buildup.

• Liver infections.

• Consuming certain medications like Methotrexate.

What Are the Signs and Symptoms of Decompensated Cirrhosis?

Cirrhosis does not reveal any symptoms in the earlier stage, but when it progresses toward decompensated cirrhosis. The signs and symptoms that reveal are:

• Fatigue.

• Nausea and vomiting.

• Weight loss.

• Jaundice.

• Bloated abdomen due to ascites (fluid accumulation).

• Swollen legs.

• Easy bleeding and bruising.

• Slurred speech, confusion.

• Drowsiness.

• Spider veins.

• Redness in the palm of hands.

• Shrinking testicles.

• Gynecomastia (breast formation in men).

• Unexplained itchiness.

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How Is Decompensated Cirrhosis Diagnosed?

Decompensated cirrhosis reveals symptoms that are similar to the condition in cirrhosis, like mental confusion and jaundice. Blood tests and liver function tests usually confirm the condition.

• MELD Score: Amodel for end-stage liver disease is the most commonly used for diagnosing liver disease. This score ranges from 6 to 40.

• Liver Biopsy: This test is done to analyze the liver tissue. A small sample of the liver is taken for examination.

Other imaging tests include:

• CT Scans (Computed Tomography): Diagnostic imaging procedure that uses X-rays and computer technology to image the structures of the body tissues.

• MRI Scans (Magnetic Resonance Imaging): It is a medical imaging technique that uses radio waves and a strong magnetic field to produce images of body structures.

• Ultrasounds: High-frequency sound waves are used. Based on the Doppler effect, the images are recorded on the screen.

• Transient Elastography: Non-invasive technique that is used to assess hepatic fibrosis with chronic liver conditions by measuring the stiffness of the liver.

• Chest X-ray: A method used to produce images by using ionizing radiation.

• Ascitic Tap In Those With Ascites: WBC (white blood cells) and differential culture of the fluid abdomen.

How Is the Assessment of Decompensated Cirrhosis Patients Done?

Assessment of decompensated cirrhosis is done by the ABC method, that is, the airway, breathing, and circulation approach.

• Airway: The airway is compromised in individuals with severe hepatic encephalopathy, which reduces the consciousness level with a large volume of haematemesis (vomiting blood). In this condition, ventilation and early intubation are considered.

• Breathing: Impaired breathing is the main issue with patients with cirrhosis. Individuals with cirrhosis include complications like pneumonia, pulmonary edema, and hepatic hydrothorax gross ascites, which leads to severe breathlessness. Breathlessness can be due to portopulmonary hypertension.

• Circulation: As a result of sepsis, GI (gastrointestinal) bleeding, hypotension, and tachycardia can occur. Tachycardia may be present with significant hypovolemia beta-blockers.

What Is the Treatment for Decompensated Cirrhosis?

The treatment of decompensated cirrhosis depends on the cause of the scarring in the liver. There are limited options when the liver is in decompensated cirrhosis condition. At this stage, liver disease is not reversible. Thus, decompensated cirrhosis-affected individuals are recommended for liver transplants as the best option for treatment. Patients with a MELD score of 15 and at least one symptom of decompensated cirrhosis are strongly recommended for transplantation surgery. A liver transplant is a promising option in many cases. Either partial or whole liver transplantation is done according to the individual affected. Due to the liver’s regeneration property, a portion of healthy liver is enough to regenerate healthy liver within a few months.

Along with recommended liver transplants, some other life quality improvement measures are suggested by the health care provider. They are:

• Avoid using recreational drugs or alcohol.

• Taking a low-sodium diet.

• Taking an antiviral medication for hepatitis B or C.

• Limit fluid intake.

• Taking antidiuretics.

• Taking blood clotting medications.

• Taking medication to improve blood flow.

• Removal of extra fluid from the abdomen.

• Take antibiotics for underlying infections and prevent any new infections.

What Is the Effect of Decompensated Cirrhosis on Life Expectancy?

Decompensated cirrhosis can reduce the life expectancy of the individual. As the model end-stage liver disease score goes higher, the survival chances of the individual reduce. Liver transplantation can be a lifesaver in such cases. But the waiting list for transplantation is always too long. Many people all around the world die waiting for a transplant, as there are very few donors around the world. The survival rate for five years is about 75 %. After a healthy liver transplant, many individuals do return to their usual activities within a span of 6 months.

Conclusion:

An advanced form of the end-stage liver disease leads to decompensated cirrhosis. It is the stage where the liver tissues can not be reversed to their normal form leading to liver failure. Treatment options are also limited due to their irreversible characteristics. A liver transplant is the only treatment option that can improve life expectancy. Do not panic if you are diagnosed with decompensated cirrhosis; you will be recommended for a transplant, and do follow the precautionary methods while waiting on the waiting list. Talking to your healthcare provider, who specializes in liver transplants, would help.