Liver Cirrhosis

Overview

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Liver cirrhosis is a chronic and progressive condition characterized by the replacement of healthy liver tissue with scar tissue, which hampers the liver’s ability to function properly. It marks the final stage of long-term liver damage caused by various liver diseases and conditions, including chronic alcoholism and hepatitis. The scar tissue formed in cirrhosis disrupts the normal flow of blood through the liver, reducing its capacity to process nutrients, hormones, drugs, and toxins.

Cirrhosis develops slowly and can be asymptomatic in its early stages. However, as the disease progresses, symptoms become more evident, and complications may arise. Early diagnosis and appropriate management can significantly slow the progression and improve the quality of life of affected individuals.

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Symptoms

In its early stages, liver cirrhosis may not cause noticeable symptoms. As the liver becomes more damaged, the following symptoms may develop:

  • Fatigue and weakness
  • Loss of appetite and weight loss
  • Nausea and vomiting
  • Abdominal discomfort or pain, particularly in the upper right side
  • Jaundice (yellowing of the skin and eyes)
  • Itchy skin
  • Swelling in the legs, feet, or ankles (edema)
  • Ascites (accumulation of fluid in the abdomen)
  • Easy bruising and bleeding
  • Confusion, memory problems, and difficulty concentrating (hepatic encephalopathy)
  • Spider-like blood vessels on the skin
  • Redness in the palms (palmar erythema)
Complications

As liver cirrhosis progresses, it can lead to several serious and potentially lifethreatening complications:

  • Portal Hypertension: Increased pressure in the portal vein can cause blood to back up into nearby veins, leading to varices and gastrointestinal bleeding.
  • Esophageal and Gastric Varices: Enlarged veins in the esophagus or stomach may rupture and bleed profusely.
  • Ascites: Accumulation of fluid in the abdomen, which increases the risk of spontaneous bacterial peritonitis (SBP).
  • Hepatic Encephalopathy: Build-up of toxins in the brain leading to confusion, altered mental status, and even coma.
  • Infections: People with cirrhosis are more susceptible to infections such as peritonitis, pneumonia, and urinary tract infections.
  • Liver Cancer: Cirrhosis increases the risk of developing hepatocellular carcinoma.
  • Kidney Failure: Known as hepatorenal syndrome, this condition is often fatal without a liver transplant.
  • Coagulation Disorders: Impaired liver function affects blood clotting mechanisms, increasing bleeding risk.
Causes

Liver cirrhosis can result from any condition that leads to chronic liver inflammation and damage. Common causes include:

  • Chronic Alcoholism: One of the most common causes in the developed world.
  • Chronic Viral Hepatitis: Particularly hepatitis B and C infections.
  • Non-alcoholic Fatty Liver Disease (NAFLD): Fat build-up in the liver not related to alcohol use.
  • Non-alcoholic Steatohepatitis (NASH): An aggressive form of NAFLD involving liver inflammation and damage.
  • Autoimmune Hepatitis: The body’s immune system attacks liver cells.
  • Biliary Diseases: Such as primary biliary cholangitis and primary sclerosing cholangitis.
  • Genetic Disorders: Including hemochromatosis (iron overload), Wilson’s disease (copper accumulation), and alpha-1 antitrypsin deficiency.
  • Medications and Toxins: Long-term exposure to certain drugs or toxins.
Prevention

While some causes of cirrhosis are unpreventable, many preventive strategies can reduce the risk:

  • Avoid excessive alcohol consumption
  • Practice safe sex and avoid sharing needles to prevent hepatitis B and C
  • Get vaccinated for hepatitis A and B
  • Maintain a healthy weight and diet to prevent NAFLD/NASH
  • Regular screening if you have a family history of liver disease
  • Avoid unnecessary use of hepatotoxic medications
  • Treat underlying liver conditions early and appropriately
Risk Factors

Certain individuals are at higher risk for developing cirrhosis:

  • Chronic alcohol abuse
  • Infection with hepatitis B or C
  • Obesity and diabetes
  • Metabolic syndrome
  • Family history of liver disease
  • Long-term use of certain medications
  • Exposure to environmental toxins
  • Understanding these risk factors can help in early identification and intervention, which is crucial for halting disease progression.
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How is it Diagnosed?

Liver cirrhosis is diagnosed through a combination of clinical evaluation, laboratory tests, imaging, and sometimes liver biopsy. Initial suspicion arises from symptoms such as fatigue, jaundice, abdominal swelling (ascites), and signs of liver failure or portal hypertension (e.g., varices, splenomegaly). Blood tests include liver function tests (LFTs), complete blood count (CBC), coagulation profile, and serum albumin.

A low platelet count, elevated bilirubin, ALT, AST, and prolonged prothrombin time are indicative. Ultrasound abdomen with Doppler is the first imaging modality, often showing a shrunken, nodular liver and signs of portal hypertension.

Transient elastography (FibroScan) or MR elastography measures liver stiffness, aiding in noninvasive fibrosis assessment. CT or MRI may help evaluate liver structure and screen for hepatocellular carcinoma. In ambiguous cases or for confirmation, a liver biopsy may be done to grade fibrosis. Screening for underlying causes like hepatitis B/C, alcohol use, or autoimmune disease is part of the workup.

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FAQs

Cirrhosis is generally not curable, but early diagnosis and appropriate treatment can significantly slow its progression and improve outcomes.

While scarring is irreversible, treatment of the underlying cause (e.g., hepatitis or alcohol abuse) can halt further damage and, in early stages, lead to some improvement.

A low-sodium, high-protein diet rich in fruits, vegetables, and whole grains is recommended. Alcohol must be strictly avoided.

Diagnosis is based on medical history, blood tests, imaging (like ultrasound), and sometimes liver biopsy.

It varies depending on the cause, severity, presence of complications, and response to treatment. With early intervention, patients can live for many years.

Patients with end-stage liver disease, frequent variceal bleeding, severe ascites, or liver cancer may be candidates for transplantation.

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