Cirrhosis Of Liver - A Complete Guide!

Cirrhosis of liver is slow and gradual replacement of normal healthy liver tissue with scar tissue which results in poor liver function and blockage of flow of blood through liver which comes from intestines. As more scar tissue replaces normal healthy liver, liver begins to fail.

What causes cirrhosis?

1. Alcohol: Amount of alcohol which can cause liver damage varies from person to person, however those who consume alcohol for long in significant amount are more prone to develop liver damage.
2. Hepatitis B or hepatitis C: Caused by hepatitis B and C viruses, respectively, which are acquired by contact with contaminated blood (like needlestick injury, blood transfusion, injection drug abuser), sexual contact with infected person and from mother to child during childbirth.
3. Non-alcoholic fatty liver disease (NAFLD): Caused by presence of extra fat in liver (after excluding significant alcohol intake) which causes inflammation and scarring leading to cirrhosis. Usually seen in patients who are overweight or obese, having diabetes, high fat in blood, high blood pressure or metabolic syndrome.
4. Drugs causing liver injury.
5. Others: Autoimmune hepatitis (body`s own immunity acting against liver), Wilson disease (build up of copper in body), hemochromatosis (excess of iron in body), certain bile duct disorders, etc.

What are the symptoms of cirrhosis?

1. Early disease can present with nonspecific symptoms like weakness, fatigue (loss of energy), decrease wish to take food, vomiting or nausea, weight loss, etc.
2. Advanced disease can present with fluid accumulation in legs (edema) or abdomen (ascites), facial puffiness, yellowish discoloration of eyes or urine (jaundice), redness of palm (palmer erythema), decrease urine output, small red lesions on skin, easy bleeding following trauma, blood coming out of mouth/anus/other body site, black colored feaces, mental confusion, flapping tremors of hand, etc. In men it can cause impotence, breast enlargement and shrinking of testis.

What are the complication of cirrhosis?

Portal hypertension: It is a common complication of cirrhosis which is due to increased pressure in portal vein. Portal vein is main blood vessel which carries blood to liver from stomach, intestines, spleen, gallbladder and pancreas. Because of scar formation in liver the normal flow of blood from these organs to liver is hampered. As a result of blockage of blood flow to liver there are few complications which can arise like accumulation of fluid in abdomen (ascites) and legs (edema), formation of enlarged veins (varices) in food pipe (esophagus), stomach, etc., enlargement of spleen (splenomegaly), mental confusion/altered behavior/altered sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).

1. Increase risk of infection because of immune system dysfunction.
2. Development of liver cancer (Hepatocellular carcinoma)
3. Easy brusibility or bleeding following light trauma.
4. Gall bladder stone formation
5. Metabolic bone disease

What are the stages of cirrhosis?

1. Compensated cirrhosis: Liver damage is damaged but no abdominal swelling (ascites), blood in vomiting or black/red color feaces (variceal bleed), altered behavior/sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).
2. Decompensated cirrhosis: Presence of abdominal swelling (ascites), blood in vomiting or black/red color feaces (variceal bleed), altered behavior/sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).

How cirrhosis is diagnosed?

1. Your doctor will take good history and do proper physical examination. If there is suspicion of cirrhosis then he will subject you to some blood test, ultrasound abdomen, fibroscan/elastography, upper GI endoscopy and if needed CT scan or MRI of abdomen or liver biopsy.

2. Ultrasound of abdomen in cirrhosis may shows coarse liver echotexture, nodular liver surface, dilated portal vein or collateral, enlarged spleen or abdominal fluid (ascites).

How to prevent cirrhosis?

Best way to avoid development of cirrhosis from predisposing stage of liver illness is to recognize and treat early. Few advices to keep liver healthy are:

1. Dietary modification: Eat healthy balanced diet. Avoid high calorie food or drinks, saturated fat, sugar and refined carbohydrates. Keep yourself hydrated.
2. Lifestyle modification: Maintain healthy body weight. Avoid being overweight or obese. Aerobic exercise (like brisk walk 30-45min/day atleast 5days/week) regularly helps to lower liver fat.
3. Avoid: Avoid use of contaminated needles, sharing of items of personal hygiene (like shaving razors, toothbrush, nail clippers, etc), use of illicit drugs, self medication with over the counter drugs or using drugs beyond doctor`s advice.
   1. Practice safe protected sex
   2. Alcohol
4. Motivate others: to stop drinking and follow hand hygiene and doctor`s advice.
5. Hand hygiene: Wash hand with soap and water regularly before eating, after going to toilet and after touching dirty objects.
6. Vaccination: For hepatitis A or hepatitis B, if you are not vaccinated or not already infected or unsafe antibody titre. Transmission rate of hepatitis B from mother to child at birth can be reduced with vaccination and immunization of newborn starting within 12 hours of birth as well as by using antiviral drugs (if indicated).

Prevent others from getting infected from you if you harbor virus causing liver damage.

How to treat cirrhosis?

Treatment of cirrhosis is based on cause of cirrhosis and complication of cirrhosis. Main aim of treatment in early stage of cirrhosis is to slow the progression of cirrhosis and prevent complications development

1. Stop alcohol, antiviral drugs for hepatitis b or hepatitis C, proper sugar level if diabetes, steroid or other medications for autoimmune hepatitis, medications to reduce copper from body in patients with Wilson's disease, etc.
2. Drugs to lower portal pressure (beta-blocker or nitrates), drugs to remove fluid from body (diuretics), drugs to lower ammonia level for encephalopathy (lactulose and others), drugs to improve kidney function (albumin, terlipressin and others).
3. Opt for liver ransplant, If cirrhosis is life threatening or treatment of cirrhosis complication is ineffective.
4. Low salt high protein diet
5. Stop alcohol intake even if you have other cause of cirrhosis.
6. Stop smoking
7. Avoid over the counter drugs (especially pain killers)
8. Vaccinate if not done already or infected

   If you wish to discuss about any specific problem, you can consult a gastroenterologist.