Liver Cirrhosis

Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by hepatitis and chronic alcohol abuse.
A damaged liver tries to heal itself whenever it is injured by disease, excessive alcohol consumption, or another factor. As a result, scar tissue is formed. During the progression of cirrhosis, more and more scar tissue forms, which makes it hard for the liver to function (decompensated cirrhosis).

You may still be able to function normally even when you have cirrhosis. Eventually, cirrhosis can cause liver failure and serious complications, which can be life-threatening.

Hepatitis B and C infections, chronic alcoholism, genetic disorders, and certain infections are some of the factors that cause cirrhosis. Cirrhosis treatment varies according to the cause and stage of the disease.

In its early stages, cirrhosis is usually asymptomatic. Because the liver can still function despite being damaged in the early stages of cirrhosis, there are no symptoms. After your liver has been severely damaged, symptoms begin to appear. When signs and symptoms do occur, they may include:

• Fatigue
• Nausea and vomiting
• Swelling in your legs, feet, or ankles (edema)
• Weight loss
• Redness in the palms of the hands
• Mild pain or discomfort in the upper right side of the abdomen
• Insomnia

If cirrhosis progresses further, some of the symptoms and complications include:

• Severe itching
• Vomit containing blood
• Dark urine or tarry-looking stool
• Yellow discoloration in the skin and eyes (jaundice)
• Confusion, drowsiness, memory loss, hallucinations, or slurred speech (hepatic encephalopathy)
• Spiderlike blood vessels on your skin
• In women, heavy menstrual bleeding, irregular periods, or absence of periods not related to menopause
• In men, loss of sex drive, testicular atrophy, or impotence

A routine blood test or checkup first detects cirrhosis. A combination of laboratory and imaging tests is done to confirm a diagnosis.

• Liver function test (LFT)
• Complete blood count (CBC)
• Kidney function test (KFT)
• Antinuclear antibody (ANA)
• Anti-smooth muscle antibody (SMA)
• Anti-mitochondrial antibody (AMA)
• Abdominal ultrasound
• Abdominal computed tomography (CT)
• Magnetic resonance imaging (MRI)
• Magnetic resonance cholangiopancreatography (MRCP)
• Magnetic resonance elastography (MRE)
• Transient elastography (fibroScan)
• Upper endoscopy
• Liver biopsy

Many diseases and disorders can cause liver cirrhosis. Liver cirrhosis progresses slowly over time without proper treatment, eventually leading to liver failure.

Some of the causes include:

• Drinking too much alcohol: Excessive alcohol consumption is a risk factor for cirrhosis.

• Being overweight: Obesity increases your risk of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis, which can lead to cirrhosis.

• Having viral hepatitis: Chronic hepatitis does not always lead to cirrhosis, but it is one of the most common liver diseases in the world.

• High cholesterol: Due to high cholesterol liver is unable to break the fatty deposit that can lead to damage to the liver.

• Chronic exposure to environmental toxins like arsenic.

The general diagnostic procedure will follow the below steps:

Medical history

The doctor will discuss all of the obvious symptoms, the severity, and how long a person has been experiencing the symptoms, and also note down the complete medical history of the patient. Additionally, a doctor will examine the family history and genetic information.

Physical examination

A doctor will look for pale skin, jaundice, red palms, impaired or excess breast tissue (in men), small or enlarged testicles, and swelling of the liver or spleen during a physical examination. During a physical examination, an enlarged liver may be felt along the lower edge of the right rib cage, and an enlarged spleen may be felt just below the left rib cage.

Blood tests

• Liver function Test (LFT): This test measures liver enzyme levels, which can indicate liver damage. Increasing bilirubin levels, liver enzymes alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), or decreased blood proteins can indicate cirrhosis.

• Kidney Function test (KFT): This test determines whether the kidneys are functioning normally or abnormally by measuring creatinine levels, which is a waste product. Cirrhosis also causes the kidneys to lose function in the latter stages.

• Complete blood count (CBC): It can show signs of infection and anemia that may be caused by internal bleeding.

• Other blood tests: Antibodies can reveal hepatitis infections (mainly B and C), and antinuclear antibodies, smooth muscle antibodies, and mitochondrial antibodies are all tests for autoimmune liver conditions.

Imaging tests

• Abdominal ultrasound
• Abdominal computed tomography (CT)
• Body magnetic resonance imaging (MRI)
• Magnetic resonance cholangiopancreatography (MRCP)
• Magnetic resonance elastography (MRE)
• Transient elastography (fibroScan)
• Upper endoscopy

Liver biopsy

A liver biopsy involves taking small tissue samples from the liver with a needle or during surgery. A biopsy is usually considered when other tests have failed to confirm a diagnosis of cirrhosis and the benefits outweigh the risks. Cirrhosis can be diagnosed with an accuracy of 80 to 100 percent depending on the number and size of samples taken and the sampling method.

The severity and cause of liver damage determine the treatment for cirrhosis. The goals of treatment are to slow the progression of scar tissue in the liver.

Treatment for cirrhosis focuses on preventing further liver damage, easing symptoms, and reducing complications. In early cirrhosis, it may be possible to minimize damage to the liver by treating the underlying cause. The options include:

• Treatment for alcohol dependency: Excessive alcohol use can result in cirrhosis, so people with the disease should avoid drinking alcohol. Alcohol addiction treatment programs may be recommended by your doctor if stopping alcohol use is difficult. Any amount of alcohol is toxic to the liver if you have cirrhosis.

• Weight loss: Losing weight and controlling blood sugar levels may help people with cirrhosis caused by nonalcoholic fatty liver disease.

• Medications to control hepatitis: Medications can limit further damage to liver cells caused by hepatitis B and C by treating these viruses.

• Medications to control other causes and symptoms of cirrhosis: In some cases, medications can slow the progression of liver cirrhosis. When primary biliary cirrhosis is diagnosed early, medication may significantly delay progression.
  Certain symptoms, such as itching, fatigue, and pain, can also be relieved by other medications. Supplements may be prescribed to counter malnutrition caused by cirrhosis and prevent weak bones (osteoporosis).

Liver transplant surgery

A liver transplant is the last option for patients with advanced cirrhosis when the liver ceases to function. Liver transplants involve replacing a diseased liver with a healthy liver from a deceased donor or with a portion of a living donor’s liver. Before undergoing liver transplant surgery, candidates undergo extensive testing to determine their health status.