What is Liver Cirrhosis?

Dr Vivek Shetty

Dr Vivek Shetty

Surgical Gastroenterologist, Jaslok Hospital, 10 years of experience

September 11, 2021 Liver Section 692 Views

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What is Liver Cirrhosis?

Liver cirrhosis is the final stage of liver disease wherein scarring of the liver occurs, before liver failure. It occurs due to deterioration of the liver function after long-term harm to the liver due to conditions like fatty liver, hepatitis, and chronic alcoholism.  Thus, here a person’s liver does not function properly due to long-term damage.  When the liver is injured; just like any other organ, compensatory mechanisms spring into action and try to repair it. During this process, scar tissue is formed. As cirrhosis progresses, the amount of scar tissue formed increases. In the early stages of liver disease, if the cause of liver damage is corrected, the liver can repair itself by forming these scar tissues and replacing them with healthy liver tissues. But as cirrhosis progresses, the scar tissue formed interferes with the blood flow to the liver and affects liver function. This increases the risk of developing decompensated cirrhosis wherein the liver function drastically decreases. Hence, liver Cirrhosis can be life-threatening. Once cirrhosis has developed, the Liver damage that has occurred cannot be undone. But early intervention after diagnosis and proper treatment can limit the damage. Let us further explain the causes, treatment, and prevention, symptoms of Liver Cirrhosisof Liver Cirrhosis. 

  • What are the most common causes of Liver Cirrhosis? 
  • Which inherited diseases lead to Liver Cirrhosis?
  • Which conditions related to the digestive system lead to Liver Cirrhosis?
  • What are the rare causes of Liver Cirrhosis?
  • What are the symptoms of Liver Cirrhosis? 
  • What are the stages of Liver Cirrhosis?
  • How is Liver Cirrhosis diagnosed? 
  • How do you prevent Liver Cirrhosis? 
  • What are the complications of Liver Cirrhosis?
  • Dietary goals for people with Liver Cirrhosis 
  • What are the goals of Liver Cirrhosis treatment? 
  • What are the treatments for Liver Cirrhosis?
  • How are the causes of Liver Cirrhosis treated?
  • FAQS on Liver Cirrhosis 

What are the most common causes of Liver Cirrhosis? 

The most common causes of liver cirrhosis are:

  • Alcohol abuse: Alcohol abuse leads to Alcoholic liver disease (ALD). Here, alcohol-related liver disease is caused due to long-term abuse of alcohol. Consumption of more than 14 standard units of alcohol in a week (one unit of alcohol is equivalent to 14ml of pure ethanol) for both men and women for several years is sufficient to cause alcoholic liver disease. Binge drinking is also associated with hepatic steatosis (fat deposition in the liver) and Alcoholic Hepatitis
  • Chronic viral infections of the liver: These may include hepatitis B and hepatitis C. Hepatitis is inflammation of the liver. In this case, it may occur due to hepatitis B virus or hepatitis C virus. If not treated in time hepatitis leads to liver cirrhosis.  ( Know more about- What is Hepatitis B?
  • Fatty liver: This is associated with obesity and diabetes. This condition is known as non-alcoholic steatohepatitis (NASH). ( Know more about- What is Fatty Liver? )

Which inherited diseases lead to Liver Cirrhosis?

Inherited diseases are those that are inbuilt and not due to external influences. Some of them leading to Liver cirrhosis are:

  • Alpha-1 antitrypsin deficiency leads to the build-up of an abnormal protein in the liver
  • Hemochromatosis means excess iron stored in the liver 
  • Wilson’s disease is excess copper stored in the body. ( Know more about- Wilson’s disease )
  • Cystic fibrosis is a condition wherein sticky, thick mucus builds up in the liver
  • Glycogen storage diseases wherein the liver can’t store or break down glycogen which happens to be a form of sugar
  • Alagille syndrome wherein a person is born with fewer than the normal number of bile ducts. This affects bile flow and results in jaundice 

Which conditions related to the digestive system lead to Liver Cirrhosis?

Bile juice is a digestive juice that is secreted by the gallbladder in the liver and is necessary for the digestion of food. Bile is mainly essential for the digestion of fat. Diseases that damage or block bile ducts in the liver can result in liver cirrhosis. Some conditions are:

  • Primary biliary cholangitis in which injury and inflammation of the bile ducts occur
  • Primary sclerosing cholangitis wherein inflammation of the bile ducts causes scarring and narrowing of the ducts. This results in the collection of bile in the liver
  • Blocked bile duct due to stones in the bile duct that cause infections and backup of products in the liver
  • Biliary atresia is a condition in which infants are born with poorly formed or blocked bile ducts

What are the rare causes of Liver Cirrhosis?

Some causes of liver cirrhosis that are seen less commonly include:

  • Autoimmune hepatitis wherein the body’s immune system attacks the healthy liver tissue and damages it
  • Use of certain medicines
  • Chronic heart failure in which there is a backflow of blood into the liver swelling known as edema in other areas of your body
  • Amyloidosis, in which abnormal protein deposition takes place in the liver 

What are the symptoms of Liver Cirrhosis? 

Symptoms of liver cirrhosis are mild in the beginning but may progress to severe symptoms. Based on when the symptoms normally appear it can also be divided into- early and late symptoms. They are as follows:

Early symptoms of liver cirrhosis 

  • fatigue
  • decreased appetite
  • sudden loss of weight 
  • nausea and vomiting
  • aching in the upper right side of the abdomen

Late symptoms of Liver cirrhosis

  • easy bruising and bleeding 
  • confusion
  • memory loss ( Know more about- What is Alzheimer’s disease?
  • personality changes
  • sleep disorders
  • swelling of the legs, ankles, called edema
  • an increased amount of fluid build-up in the abdomen called ascites
  • itchy skin 
  • darkening of the urine
  • the yellowish appearance of the eyes, skin, nail beds called jaundice ( Know more about- Diet for Jaundice patients )
  • Vomiting of blood (Hematemesis) or Passing of blood in the stool (Malena) 

What are the stages of Liver Cirrhosis?

Certain scoring systems have been developed by researchers to grade the severity and stage of the condition. 

  • Compensated cirrhosis: It is a condition in which cirrhosis is present but the patient is still asymptomatic. The laboratory tests and ultrasound scans of the abdomen can detect cirrhosis.  
  • Decompensated cirrhosis: It is a condition in which cirrhosis has worsened and symptoms are noticed. Diagnosis is known after history and physical examination. There will be at least one complication. 

How is Liver Cirrhosis diagnosed? 

  • Physical examination:

The doctor examines the patient looking for the signs and symptoms of cirrhosis including: 

    • blood vessels appear red and spider-like on the abdomen
    • the yellow appearance of the skin and eyes
    • bruises on the skin 
    • palms appear red 
    • bumpy texture to the lower edge of your liver which is the part of your liver below the rib cage that can be felt
  • Blood tests: If liver cirrhosis is present blood will be checked for signs of liver disease. 
    • Complete blood count (CBC) to look for signs of infection or anemia due to internal bleeding 
    • Liver function tests usually show elevated Bilirubin (the pigment causing jaundice), Low albumin levels, and abnormal clotting of blood  
    • Viral hepatitis test to check for hepatitis B or C
  • Imaging tests: These tests show the size and shape of the liver. These tests are used to assess the scarring, the amount of fat in the liver, and fluid in the abdomen. Imaging tests of your liver include:
    • Computerized tomography (CT) scan 
    • Abdominal ultrasound (USG)
    • Magnetic Resonance Imaging (MRI). 
    • Fibroscan – Transient elastography is used to measure the fat content and amount of stiffness in the liver. 
    • Two types of endoscopies might be ordered: 
    • An endoscopic retrograde cholangiopancreatography, to detect bile duct problems, 
    • Upper endoscopy, to detect enlarged veins or bleeding in the esophagus, stomach, or intestines.
  • Liver Biopsy:

A sample of the tissue of the liver is taken out and examined under the microscope. The diagnosis of liver cirrhosis can be confirmed by a liver biopsy.  In addition, it can also determine the extent of liver damage or enlargement. A liver biopsy shows how much scarring is present in the liver. It can be used to diagnose cirrhosis when the results of other tests are not definitive. The cause of cirrhosis can also be identified from the biopsy. Liver Cancer may also be diagnosed through biopsy. 

How do you prevent Liver Cirrhosis? 

The following measures can be taken to prevent liver cirrhosis:

  • Excessive alcohol consumption should be stopped. Alcohol consumption in those with liver disease due to other causes can also cause rapid liver damage.
  • You should eat healthy food in your diet, which includes fresh green vegetables and fruits. Reduce oil and more fatty foods. Consume medicines only when prescribed by a doctor. 
  • A person should protect himself from hepatitis infection to avoid liver disease. Both Hepatitis B and C infections are caused by unprotected sex or by using infected injections or needles. To prevent Hepatitis infection, always use condoms while having sex, and always use sterile injections and needles.

If a person has non-alcoholic fatty liver disease, then he should maintain healthy body weight. Those with pre-existing fatty liver must try to lose weight if they are overweight and control their blood sugars and cholesterol levels with medicines. An active lifestyle can also reverse fatty liver.

What are the complications of Liver Cirrhosis?

There are several complications of liver cirrhosis. They are:

  • Portal hypertension is the most common complication that occurs due to an increase in the pressure in the portal vein. The portal vein is a large blood vessel that takes blood to the liver from the digestive organs
  • Hypersplenism wherein the spleen is overactive. This results in premature destruction of red blood cells (RBCs)
  • Risk of Infections increases such as bacterial peritonitis an infection of the tissue lining the inner wall of your abdomen 
  • Malnutrition results due to the inability of the liver to process nutrients
  • Liver cancer can occur after cirrhosis of the liver.
  • Liver failure occurs when your liver isn’t functioning well enough 

Dietary goals for people with Liver Cirrhosis 

  • Consume a  healthy, well-balanced diet
  • Raw or undercooked shellfish, fish, and meat should be avoided since bacteria or viruses from them may lead to severe infections in patients with cirrhosis
  • Limit the amount of salt and fat in the diet 
  • Stop drinking alcohol 

What are the goals of Liver Cirrhosis treatment? 

Cirrhosis cannot be cured. The damage done is permanent. However, treatment is still undertaken with certain goals in mind. The treatment goals are to:

  • Slow further damage to your liver
  • Prevent and treat symptoms
  • Prevent and treat complications

What are the treatments for Liver Cirrhosis? 

If the disease is still in its early phase, then the speed of scar tissue formation should be reduced to prevent further complications.  Severe cases of liver cirrhosis may require hospitalization. 

  • People who are suffering from cirrhosis must get vaccinated for Hepatitis A and B. Both these infections further increase liver cirrhosis. People affected by liver cirrhosis should also undergo a screening blood test. 
  • To reduce the symptoms of liver cirrhosis, the doctor can prescribe certain medicines to the patient. The patient should have regular check-ups. 
  • If there is complete liver failure, then the last treatment is a liver transplant. A liver transplant is a surgery in which a damaged liver is replaced by a healthy liver. A healthy liver is donated by a donor. 

There are many renowned hospitals and doctors in different parts of India where liver transplant surgery is done. 

How are the causes of Liver Cirrhosis treated?

The causes of liver cirrhosis need to be essentially treated. The causes and treatment for them are as follows:

  • Alcoholic liver disease: The consumption of alcohol should be stopped
  • Non-alcoholic fatty liver disease: Weight loss is essential through healthy eating and physical activity 
  • Chronic hepatitis C: A few medications may be prescribed 
  • Chronic hepatitis B:  Antiviral medicines that slow or stop the virus are prescribed.
  • Autoimmune hepatitis is treated with medicines that suppress, or decrease the activity of your immune system
  • Blocked bile ducts are treated by surgical procedures to open bile ducts 

FAQS on Liver Cirrhosis 

Is liver cirrhosis cancer? 

Ans: No, cirrhosis of the liver isn’t cancer. But most people who have liver cancer also have liver cirrhosis. People with liver cirrhosis are at a higher risk of developing liver cancer. Patients with hepatitis B or hepatitis C, have an increased risk of liver cancer since these diseases often cause liver cirrhosis at a later stage. 

Is liver cirrhosis inherited from parents?

Ans: Cirrhosis itself is not an inherited disease. However, some of the diseases that are inherited can lead to liver cirrhosis. 

Is liver cirrhosis fatal?

Ans: Not always. If cirrhosis continues and more scarring occurs, the liver function would continue to decline to lead to a fatality. However, timely intervention and treatment of the underlying cause can improve the quality of life. 

We hope we were able to answer your questions about Liver Cirrhosis in this article.

If you want more information and treatment for Liver Cirrhosis, you can contact a Hepatologist/ Liver and Hepatobiliary surgeon.

We only aim to give you information through this article. We do not recommend medication or treatment in any way. Only a doctor can give you the best advice.

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