Liver Cirrhosis - Symptoms, Causes, Diagnosis and Treatment

What Is Liver Cirrhosis?

Liver cirrhosis is the late stage of liver fibrosis, which is the scarring of the liver. It can result from many liver diseases like chronic alcoholism and hepatitis. The liver gets injured by disease or regular large volume alcohol consumption, and scar tissue is formed during these times due to repeated injury to liver tissue, as a mechanism where it tries to repair itself. Repeated injury and scar formation result in the progression of this disease, which can also be fatal. Advanced cirrhosis makes it difficult for the liver to function normally and increases the pressure in the portal venous system, often leading to edema (swelling) of legs, fluid collection in the abdomen, bleeding in the food pipe or stomach (due to dilated veins, otherwise called as varices in the esophagus or stomach).

The liver is present in the upper right side of the abdomen, and it performs essential body functions like:

• It produces bile, which is then stored in the gallbladder. Bile helps in the absorption of fats, vitamins A, D, E, and K, and cholesterol (contradicting popular myth, cholesterol is needed for normal function of the human body)..

• It creates multiple proteins needed for clotting blood.

• It helps in storing sugar, in the form of glycogen, and vitamins.

• It helps in clearing toxic metabolites, especially from drugs, medicines and others, from the blood.

Liver cirrhosis can usually not be reversed. But, early diagnosis helps prevent further damage to the liver. This condition develops over the years. Progressive damage to healthy liver tissue results in scar formation, which blocks the blood flow through the liver. The other causes of liver damage are viral infections and toxins. This condition affects men more than women.

What Are the Symptoms of Liver Cirrhosis?

As the liver is unable to perform its functions, the following symptoms (early stages of cirrhosis are asymptomatic, symptoms appear only in late cirrhosis) of cirrhosis occur:

• Loss of appetite.

• Epistasis (nosebleeds).

• Yellowish discoloration of the skin and sclera (jaundice).

• Spiderlike arteries underneath the skin (spider naevi).

• Weight loss.

• Loss of sex drive.

• Slurred speech.

• Redness in palms.

• Anorexia.

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• Itchiness.

• Tiredness.

• Confusion.

• Ascites (collection of fluid in the abdominal cavity).

• Edema of ankles (swelling).

• Infertility.

• Development of breasts in males (gynecomastia).

What Are the Causes of Liver Cirrhosis?

Diseases that can damage the liver tissues are:

• Chronic alcoholism.

• Hepatitis B, C, and D.

• Nonalcoholic fatty liver disease.

• Hemochromatosis (buildup of iron in the body).

• Cystic fibrosis.

• Alpha-1 antitrypsin deficiency

• Autoimmune hepatitis.

• Wilson’s disease (accumulation of copper in the liver).

• Biliary atresia (disease of the bile duct).

• Disorders of sugar metabolism or glycogen storage disease.

• Alagille syndrome (genetic bile duct problem).

• Primary biliary cholangitis (a condition resulting in the destruction of bile ducts).

• Primary sclerosing cholangitis (inflammation and scarring of bile ducts).

• Syphilis.

• Medications like Methotrexate or Acetaminophen.

What Are the Risk Factors for Liver Cirrhosis?

The factors that increase the risk of liver cirrhosis are:

• Consuming too much alcohol.

• Obesity or being overweight.

• People with viral hepatitis like Hepatitis A, B, C, etc.

What Are the Complications of Liver Cirrhosis?

The complications of liver cirrhosis are:

• Portal hypertension - Cirrhosis increases the blood pressure in the veins that supply the liver by slowing the blood flow, which results in portal hypertension.

• Edema - Portal hypertension results in fluid accumulation in the legs, which is called edema.

• Ascites - Increased pressure in the portal vein can result in fluid accumulation in the abdomen, which is called ascites.

• Varices - Varices are enlarged vein seen in the esophagus or stomach due to portal hypertension. It can lead to severe bleeding, which can be life-threatening.

• Jaundice - The liver is unable to remove enough bilirubin, a blood waste product, from your blood, which results in yellowing of the skin and sclera.

• Bone problems - The risk of fractures increases as bone strength is lost.

• Liver cancer - Cirrhosis increases the risk of liver cancer for some people.

• Splenomegaly and hypersplenism - Enlargement of the spleen results from portal hypertension, which results in the trapping of white blood cells and platelets, and low blood cell counts.

• Bleeding due to coagulopathy - Decreased production of proteins needed for clotting from liver infections.

• Infections - Cirrhosis makes it difficult for your body to fight infections, which can lead to spontaneous peritonitis.

• Malnutrition - Loss of appetite and weight loss makes it difficult for the body to process nutrients, especially loss of muscle mass.

• Hepatic encephalopathy - As the liver is unable to clear toxins from the blood efficiently, these toxins buildup in the brain leading to hepatic encephalopathy. This can progress and cause mental confusion and coma.

How Is Liver Cirrhosis Diagnosed?

If you are experiencing symptoms of liver cirrhosis and have a positive risk factor like alcohol abuse, viral hepatitis, etc., your doctor will take a detailed history and physical exam. Your doctor will suggest you get the following tests done:

• Complete blood count - to check for anemia and low platelets.

• Coagulation tests - to check how fast your blood clots.

• Liver function test.

• Alpha-fetoprotein - to check for liver cancer.

• Endoscopy - to detect esophageal varices.

• Ultrasound of the liver and fibroscan of liver - to assess the grade of fibrosis during pre-cirrhosis stage.

• CT or MRI scan of the abdomen - to assess liver size, modularity, portal vein size, flow or thrombus and liver cancer.

• Liver biopsy - tissue from the liver is tested to look for cirrhosis or fibrosis (not commonly done these days).

How Is Liver Cirrhosis Treated?

Depending on the cause and extent of liver damage, the symptoms are treated, and the disease progression is slowed. If you have developed any complications, then it has to be treated. The cause of cirrhosis has to be identified and treated.

Early Cirrhosis:

Identifying and treating the cause can help minimize liver damage. The treatment options are:

• Alcoholism - If cirrhosis is caused by alcohol abuse, then the person should stop drinking. For alcohol addiction, specialized de-addiction programs can be made use of.

• Weight reduction - If the cause is nonalcoholic fatty liver disease, then weight reduction and an active lifestyle will help a lot.

• Medications for viral hepatitis can prevent further liver damage.

• Medications to relieve symptoms like itching, pain, and tiredness.

Treatment for Complications:

• Ascites and edema - A diet low in sodium will prevent fluid buildup in the legs and abdominal cavity. In cases of severe fluid collection, procedures to drain the fluid or relieve pressure might be needed.

• Portal hypertension - Some antihypertensive drugs can reduce increased blood pressure in the portal vein. This also prevents severe bleeding and enlargement of veins in the stomach (varices).

• Varices - For patients who have already developed varices, the risk of bleeding is reduced by a procedure called band ligation. In severe cases, a transjugular intrahepatic portosystemic shunt is placed in the portal vein to reduce portal blood pressure.

• Infections - Infections are treated with antibiotics. And you might need to take vaccinations against pneumonia, influenza, and hepatitis.

• Hepatic encephalopathy - Medications are given to reduce toxin buildup in the blood.

Late Cirrhosis:

In the late stages of liver cirrhosis, as the liver does not function properly, the only option is liver transplantation.

Liver Transplantation - The diseased liver is replaced with a healthy donor liver. The entire organ can be transplanted from a deceased donor, or a part of a liver from a living donor can be used.

If you have been diagnosed with fatty liver, fibrosis or cirrhosis, frequent checkups, lifestyle changes, and medications can improve your outcome. To know more about ways to prevent liver cirrhosis, consult a gastroenterologist online.