Liver Cirrhosis - Symptoms, Causes, Diagnosis and Treatment

What Do You Mean by Liver Cirrhosis?

Liver cirrhosis is a condition in which your liver is scarred. This may occur due to long-term damage to your liver. In this condition, we can observe the healthy cells in the liver getting replaced by scar tissue.

When there is an inflammation in the liver, it tries to repair itself by scarring. Too much scar tissue in the liver can affect the proper functioning of the liver. Most people think that consuming excessive alcohol is the main reason for cirrhosis, but it is not true. Many other reasons are involved in damaging the liver.

Cirrhosis is also known as end-stage liver disease. The reason for its name is cirrhosis results from being damaged due to other causes like chronic hepatitis or chronic alcoholism. Liver cirrhosis may take many months or years to develop. This is again based on the cause of liver damage.

Are You Aware of the Stages of Liver Cirrhosis?

Cirrhosis progresses as more and more scar tissue is formed in the liver. In the initial stages, your body tries to adjust to compensate for the reduced liver functions. Hence, it has not been noticed. This stage is known as compensated cirrhosis.

As time passes, liver function keeps declining and starts to show symptoms. This stage is called decompensated cirrhosis.

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Do You Know About the Symptoms of Liver Cirrhosis?

Symptoms of liver cirrhosis are based on the severity of the condition. Initially, the symptoms are not present. Only vague symptoms appear, which, too, are similar to other diseases. Symptoms can be observed only when the liver functions start to decline.

Symptoms do not appear (asymptomatic) in the early stage, but symptoms are observed in the late stage of liver cirrhosis. These are also called side effects of cirrhosis of the liver.

Symptoms of liver cirrhosis can be classified into early symptoms and late symptoms.

Early symptoms include:

• Loss of appetite

• Tiredness.

• Weight loss and wasting of muscles.

• Nausea and vomiting.

• Pain in the liver area.

• Spider-like small blood capillaries in the skin above the waistline (spider naevi).

• Redness in palms.

• Disturbed sleep.

Late symptoms include:

• Itchiness in the skin.

• Yellowish discoloration of the skin and sclera (jaundice).

• White nails.

• The ends of fingers become wider or thicker (clubbed fingers).

• Loss of hair.

• Fluid retention that occurs in the legs, ankles, and feet leads to swelling.

• Fluid accumulation in the abdominal cavity (ascites).

• Dark urine can be observed.

• Internal bleeding is represented by dark-colored stools or blood in vomiting.

• Bleeding in the nose and gums.

• Easy bruising occurs, and it is difficult to stop small bleeds.

• Right shoulder pain.

• Development of breasts in males (gynecomastia) and shrunken testes.

• Irregular or lack of menstrual bleeding occurs in women.

• Impotence and loss of sexual desire.

• Dizziness and fatigue (anemia).

• Shortness of breath.

• Rapid heartbeat (tachycardia).

• Confusion, memory loss, difficulty in focussing.

• Personality change.

• Trembling hands may be seen.

• Difficulty in writing.

• Staggering gait when walking, which may cause falls.

• Increased sensitivity to drugs.

• Increased sensitivity to alcohol.

Would You Like to Know the Causes of Liver Cirrhosis?

As we know, liver cirrhosis results from scarring, the main reason for this is chronic inflammation. The diseases of the liver usually lead to inflammation of the liver. This, in turn, leads to chronic hepatitis. Chronic hepatitis eventually, can be responsible for cirrhosis of the liver.

The most common causes include:

• Alcohol-Induced Hepatitis: Heavy alcohol consumption may cause your liver to be damaged. This may lead to alcohol-induced hepatitis.

• Non-alcohol-related Steatohepatitis: This type of liver damage in your liver is due to stored fat. This type of cirrhosis is related to high blood lipids, blood sugar, and blood pressure.

• Chronic Hepatitis C Infection: Hepatitis C infection is caused by a virus and may become a chronic condition. Antivirals can help treat the condition. But many are not aware of this condition.

• Chronic Hepatitis B Infection: Hepatitis B infection is caused by a virus and may become a chronic condition. Once affected by this virus, it remains for a lifetime. Using the right approach, this condition of yours can be controlled effectively. This helps you enjoy a good quality of life.

Less common causes include:

• Autoimmune Biliary Disease: Autoimmune hepatitis (when your body’s immune system attacks your liver cells), primary biliary cholangitis (a liver disease that affects your bile ducts), and primary sclerosing cholangitis (a chronic liver disease in which bile ducts are inflamed and scarred, and eventually they are blocked) are responsible for causing chronic liver inflammation. In the long run, it may lead to cirrhosis of the liver.

• Genetic Disorders: Inherited diseases like glycogen storage disease, cystic fibrosis, and Wilson disease may form toxic substances in your liver. This may further damage the liver.

• Toxic Hepatitis: If you are using certain medications regularly, including painkillers, and if you are exposed to some toxins in certain environments, it may lead to chronic liver damage.

• Cardiovascular Diseases: Certain conditions like congestive heart failure may cause blood to build up in the liver, and conditions like chronic ischemia may prevent the blood from reaching the liver. This may cause cirrhosis of the liver.

Other risk factors for cirrhosis of the liver include:

• Older individuals aged above 50 years.

• Those who consume heavy alcohol.

• Those with chronic viral infections.

• Those having metabolic syndrome.

• Those who are obese or overweight.

• Those who are smokers can be at risk for cirrhosis of the liver.

Do you want to know about complications of cirrhosis in the liver?

If liver cirrhosis is not treated properly, it may lead to certain complications. It may lead to life-threatening conditions, too.

• Portal Hypertension - Cirrhosis may increase your blood pressure in the veins that supply the liver by slowing the blood flow. This causes portal hypertension.

• Edema - Portal hypertension may, in turn, cause fluid accumulation in the legs, which is called edema.

• Ascites - Increased pressure in your portal vein can result in fluid accumulation in the abdomen, which is called ascites.

• Varices - Varices are enlarged veins seen in your esophagus or stomach. These are enlarged due to portal hypertension. It can lead to severe bleeding. It can be a life-threatening condition too.

• Jaundice - The liver is unable to remove enough bilirubin, a blood waste product, from your blood, which results in yellowing of your skin and sclera.

• Bone Problems - The risk of bone fractures increases as bone strength is lost.

• Liver Cancer - Cirrhosis increases the risk of liver cancer for a few people.

• Splenomegaly and Hypersplenism - Enlargement of the spleen results from portal hypertension, which results in the trapping of white blood cells and platelets and low blood cell counts.

• Bleeding Due to Coagulopathy - Liver infections can decrease the production of proteins that are needed for clotting.

• Infections - Cirrhosis makes it difficult for your body to fight infections. This can lead to spontaneous peritonitis.

• Malnutrition - Loss of appetite and weight loss makes it difficult for your body to process nutrients, especially loss of muscle mass.

• Hepatic Encephalopathy - As the liver is unable to clear toxins from the blood efficiently, these toxins build up in the brain, leading to hepatic encephalopathy. This can progress and cause mental confusion and coma.

How to Identify Your Liver Cirrhosis?

If you are experiencing the above-mentioned symptoms of liver cirrhosis and have a positive risk factor like alcohol abuse, viral hepatitis, etc., your doctor will take a detailed history and a physical examination to know your signs and symptoms. Your doctor will suggest you get the following tests done. These include:

• Complete blood count - This test is done to check for anemia and low platelets.

• Coagulation tests - This test is done to know how fast your blood clots.

• Liver function tests - These are a group of blood tests that provide information about the state of the liver.

• Alpha-fetoprotein (AFP) - High levels of AFP indicate liver cancer.

• Endoscopy - This is done to learn about esophageal varices.

• Ultrasound of the liver and fibroscan of the liver - These are done to assess the grade of fibrosis during the pre-cirrhosis stage.

• Computed tomography (CT) or magnetic resonance imaging (MRI) scans of the abdomen - These scans provide information about your liver size, modularity, portal vein size, flow or thrombus, and liver cancer.

• Liver biopsy - The tissue from the liver is tested to look for cirrhosis or fibrosis (not commonly done these days).

How Should You Take Care of Yourself While Living With Cirrhosis of the Liver?

The hard fact about cirrhosis of the liver is that it cannot be cured. The scarring is considered to be permanent. The symptoms can be treated. But further progression of your disease can indeed be stopped.

The treatment is based on the cause and, of course, depends on how well your body responds to the treatment.

Early Cirrhosis:

Identifying early and treating the cause can help minimize liver damage in this condition. The treatment options include:

• The person affected by liver cirrhosis that is caused by consuming alcohol should stop drinking alcohol. Specialized de-addiction programs can be used to overcome alcohol addiction.

• If your liver cirrhosis is due to nonalcoholic fatty liver disease, try to reduce your weight and adopt an active lifestyle. These changes can help you to lead a good life.

• If the cirrhosis of the liver is due to viral hepatitis, medications can be used with the consent of the healthcare provider. This can halt the liver damage further.

• Symptoms like itching, pain, and tiredness can be tackled using certain medications. Medications should be taken with your doctor’s consent only.

Treatment for Complications:

• A diet low in sodium will help prevent fluid buildup in the legs and abdominal cavity. In cases of severe fluid collection, procedures to drain the fluid or relieve pressure might be needed.

• Some antihypertensive drugs can reduce increased blood pressure in the portal vein. This also prevents severe bleeding and enlargement of veins in the stomach (varices).

• For patients who have already developed varices, band ligation can be done. This procedure helps in reducing the risk of bleeding. In severe cases, a transjugular intrahepatic portosystemic shunt is placed in the portal vein to reduce portal blood pressure.

• Infections can be treated with antibiotics. You might also need to get vaccinations against pneumonia (infection of the lungs), influenza (respiratory infection caused by the influenza virus), and hepatitis (inflammation of the liver).

• Medications are given to reduce toxin buildup in the blood, which helps prevent hepatic encephalopathy.

• The diet for cirrhosis of the liver must include proteins, nutrient-dense foods, heart-healthy fats, and herbs and spices.

Late Cirrhosis:

In the late stages of liver cirrhosis, the liver does not function properly. The only option to treat liver cirrhosis would be liver transplantation.

Liver Transplantation - The diseased liver is replaced with a healthy donor liver. The entire organ can be transplanted from an another person, or a part of a liver from a living donor can be used.

Conclusion:

The liver is an important organ of the body. It has to function properly to carry out many functions. Hence, the health of the liver is important. If you have been diagnosed with fatty liver, fibrosis, or cirrhosis, frequent checkups, lifestyle changes, and medications can improve your outcome. It is always important to prevent the diseases from occurring. Hence, knowing about cirrhosis of the liver can help prevent or detect the disease early.