Liver cirrhosis

Overview

Cirrhosis is the final stage of many chronic liver diseases. After years of damage, normal liver tissue is replaced by fibrous tissue and regenerative nodules. This changes the structure of the organ, obstructs blood flow through it and reduces the liver's ability to perform its functions.

• Compensated cirrhosis — the liver still functions well enough; the patient often has no symptoms.
• Decompensated cirrhosis — complications appear, such as ascites, bleeding from varices, jaundice or hepatic encephalopathy.

Symptoms

At first there may be no signs at all. Later the following may appear:

• fatigue and loss of appetite
• jaundice (icterus) and itching of the skin
• edema of the legs (swelling) and a buildup of fluid in the abdomen (ascites)
• easy bruising of the skin, bleeding from the nose or gums
• confusion, drowsiness or a change in behavior (hepatic encephalopathy)

Causes

• chronic hepatitis B or C (hepatitis D can make hepatitis B worse)
• excessive alcohol consumption
• steatotic liver disease linked to metabolic disorders (obesity, diabetes)
• autoimmune, biliary or inherited diseases

Not every person with hepatic steatosis develops cirrhosis — the risk depends on the degree of fibrosis and accompanying factors.

Complications

• Portal hypertension and esophageal varices, which can bleed
• ascites and its infection
• hepatic encephalopathy
• kidney damage
• hepatocellular carcinoma (liver cancer)

Diagnosis

• Blood tests: AST and ALT show cell damage; albumin, bilirubin, INR and platelets give information about liver function and portal hypertension.
• Abdominal ultrasound assesses the appearance of the liver, the spleen and the presence of ascites.
• Elastography measures the stiffness of the liver and helps assess fibrosis — it is a different exam from the ordinary ultrasound.
• Biopsy is used only in selected cases.

Treatment

1. Treating the cause — antivirals for hepatitis, complete abstinence from alcohol, control of weight and diabetes. This can slow the disease and, in some cases, improve the fibrosis.
2. Preventing and treating complications — e.g. diuretics for ascites, non-selective beta-blockers for varices, endoscopic procedures.
3. Liver transplantation is considered in advanced disease.

Do not start or stop medicines on your own; many medicines, even over-the-counter ones, affect a damaged liver.

Living with cirrhosis

• Alcohol: none.
• Do not take herbal or “detox” supplements without medical advice. For pain, low-dose acetaminophen (paracetamol) is usually safer than anti-inflammatory drugs, but ask your doctor.
• Diet must contain enough protein — restricting protein is not recommended as a routine. Salt is restricted when there is ascites.
• Ultrasound every 6 months (often with alpha-fetoprotein) for early detection of liver cancer.
• Vaccination against hepatitis A and B, influenza and pneumococcus, as advised by your doctor.