Cirrhosis of Liver

Hello, I am Dr. Somasekhar Rao, gastroenterologist and hepatologist at the Apollo Hospitals, Jubilee Hill, Hyderabad. I would like to talk about cirrhosis of liver and its complications and how to manage those things. Basically cirrhosis of liver is nothing but the liver get shrunken and it becomes nodular and hard so the functions of the liver comes down. The functions which are there are 600 vital functions that a liver does normally in a human being and all these functions are compromised in a patient with cirrhosis.

Most important cause for cirrhosis is always alcohol and next comes viruses called hepatitis B and hepatitis C. The evolving most increasing cause no is nonalcoholic fatty liver disease. Fatty liver disease which we see on ultrasound can cause cirrhosis. Any patient in early cirrhosis may not present with any symptoms. The initial symptoms of decompensations would be:-

• There will be swelling in the fluid
• Swollen feet
• There will be distinction of abdomen because of accumulation of fluid in the abdominal cavity
• Patients may have jaundice.
• Sometimes they may present with a history of passing black color motion that means this patient is having bleeding in the gastrointestinal tract. It can be most common because of the swollen blood vessels called viruses in the esophagus.

So other presentations would be disorientation. Patient can have hepatic encephalopathy,  the functions of the liver because the liver acts as a filter to many toxins. All these toxins enter into your brain and cause disorientation this is called hepatic encephalopathy.

So now we will talk about the treatment of cirrhosis. Whenever we see a patient with cirrhosis, most important thing is we will try and evaluate the cause of cirrhosis. See if the patient is a chronic alcoholic. We are taking a history of all college. The first thing is to cut down and stop intake of alcohol when the patient is in early cirrhosis. It can reverse the cirrhosis to normal liver. Most important and nutritional aspects along with some supportive medication but when a patient presents with complications already, then we will be treating only the complications. Once the cirrhosis sets in and he is in CTP. By the time. you see that the patient eventually progresses most of the time. We are trying to treat the complications of cirrhosis. Then a patient presents to us with bleeding then we will find out whether it is very variceal bleeding and there is a procedure called endoscopic variceal ligation to decrease the pressure of the varices blood pressure in the esophageal varices.

We have some medications which decrease the pressure. We treat these patients and we control the bleeding and a patient presents with fluid in the stomach abdominal cavity or fluid in the legs. These patients are treated with so called restricted diet. Also we give some tablets called diuretics which increase the urine output and decrease the fluid in the legs and in the abdominal cavity and a patient presents with hepatic encephalopathy. We treat hepatic encephalopathy by medications and we try to decrease the ammonia level which is released by cleansing the gut and all those things. So all these things are managing complications of cirrhosis. Very  rarely we see a patient in early cirrhosis then we treat the host.

The cirrhosis can be reversible. It is very rare but eventually when we see a patient in complications, he would always be in a stage called CTPB where he will progress to CTBC. CTBC is the end stage of cirrhosis and at that point of time the patient is left only with option of liver transplant.

Liver transplantation is again transplantation. It can be a live donor transplantation or deceased donor transplantation. So Eventually when you see a patient in CTBC we have to plan for liver transplantation. In these patient he can wait maybe for 2 or 3 months meanwhile we will be managing for complications.