Liver is a vital organ of the body. It is mainly responsible for making protein, helping fight infections, cleaning the blood, helping digest food and storing energy.  One needs to have a healthy liver in order to be able to live a normal life.

Cirrhosis is a chronic liver disease that is characterized by replacement of normal liver tissue by fibrous tissue possibly due to a long-term disease, excessive alcohol consumption or injury. Scar tissue cannot do what a normal liver tissue can do. It impairs the liver’s normal functioning abilities further leading to more complications. This condition is irreversible leaving the liver to be permanently scarred. It can lead to a number of conditions such as easy bruising or bleeding, or nosebleeds, enlarged veins in the esophagus and stomach, extra sensitivity to medicines, swelling of the abdomen, high blood pressure in the vein entering the liver, and kidney failure.

The following are the underlying conditions that could cause liver cirrhosis.

• Alcohol abuse (alcoholic liver disease)
• Chronic viral hepatitis (hepatitis B, C, or D)
• Autoimmune hepatitis, which is destruction of liver cells by the body’s immune system
• Nonalcoholic fatty liver disease or Nonalcoholic steatohepatitis (NASH), which is fat deposits and inflammation in the liver
• some drugs, toxins, and infections
• Blocked bile ducts, the tubes that carry bile from the liver
• Alpha-1 antitrypsin deficiency
• some inherited diseases such as
• Hemochromatosis, a disease that occurs when the body absorbs too much iron and stores the excess iron in the liver, pancreas, and other organs
• Wilson disease, which is caused by the buildup of too much copper in the liver
• protoporphyria, a disorder that affects the skin, bone marrow, and liver

• Galactosemia
• Glycogen storage diseases
• Biliary atresia – usually in babies
• Primary biliary cirrhosis
• Bile duct injury
• Gallbladder surgery
• Environmental toxins
• Schistosomiasis
• Congestive heart failure

Most people with liver cirrhosis do not experience any symptoms early in the stage of the disease because small scarring on the liver does not significantly affect the normal functioning of the organ. However, if the cause of the cirrhosis of the liver is not properly addressed, the disease can advance creating more scars in the organ leading to more damage enough to create symptoms.

Among the symptoms are:

1. poor appetite
2. fatigue
3. weight loss
4. weakness
5. edema
6. ascites
7. portal hypertension
8. esophageal varices
9. hemorrhage
10. jaundice
11. encephalopathy
12. personality changes

poor cognitive functioning

The signs and symptoms presented by the patient together with the medical history and laboratory tests can reveal illnesses likely to lead to cirrhosis. If the doctor suspects liver cirrhosis, he may require blood tests to be done to find out if liver disease is present. He can also ask for CT scan, MRI and ultrasound to better evaluate his diagnosis. The liver can also be inspected through a laparoscope, a viewing device inserted through a small incision in the abdomen. The only definite method in diagnosing cirrhosis is liver biopsy where a tissue sample is taken from the liver and is examined under a microscope to learn more about the organ.

• Edema and ascites
• Spontaneous bacterial peritonitis (SBP)
• Bleeding from esophageal varices
• Hepatic encephalopathy
• Hepatorenal syndrome
• Hepatopulmonary syndrome
• Hypersplenism
• Liver cancer (hepatocellular carcinoma)

There is no known cure for liver cirrhosis because the damage it caused in the organ is irreversible. However, there are treatments for cirrhosis to slow the progression of the disease and reduce complications. Proper nutrition and abstinence from substances that can cause further damage are keys to maintain health. Treatment would include preventing further damage to the liver, treating the complications of cirrhosis, preventing liver cancer or detecting it early, and liver transplantation.

1. Preventing further damage to the liver

• Avoid drugs including alcohol.
• Eat a balanced diet and one multivitamins daily.
• Avoid Nonsteroidal anti-inflammatory drugs (NSAIDs) because it is proven to worsen liver damage.
• Remove blood from patients with hemochromatosis to reduce the levels of iron and copper with patients having Wilson’s disease.
• To prevent inflammation of the liver, drugs such as prednisone and azathioprine should be suppressed.
• Immunize patients with cirrhosis against infection with hepatitis A and B. Currently, there is no vaccine available for Hepatitis C.

2. Treating the complications of cirrhosis

• Variceal bleeding
• Medications include propranolol (inderal) and octreotide (sandostatin).
• Sclerotherapy or band ligation is done to prevent bleeding.
• Transjugular intrahepatic portosystemic shunt (TIPS) – non-surgical procedure to decrease pressure in the portal vein
• Distal Splenorenal Shunt (DSRS) - surgical operation to create a shunt (passage)
• Edema and Ascites
  • Restrict salt intake.
  • Diuretics such as spirinolactone may be prescribed.
  • abdominal paracentesis - used to draw out the ascitic fluid directly from the abdomen
• Hepatic encephalopathy
  • low protein diet and oral lactulose
  • If symptoms of encephalopathy persist, oral antibiotics such as neomycin or metronidazole (Flagyl) can be added to the treatment regimen.
• Hypersplenism
  • Avoid using Aspirin or other Nonsteroidal anti-inflammatory drugs if you have a low platelet count.
  • Avoid performing splenectomy or surgical removal of spleen, if possible, because of the risk of excessive bleeding during operation.
• Spontaneous bacterial peritonitis (SBP)
  • Paracentesis – to examine white blood cell and culture for bacteria
  • intravenous antibiotics such as ampicillin, gentamycin, and cephalosporin

3. Prevention and early detection of liver cancer

Most patients with cirrhosis, particularly Hepatitis B and C, are screened yearly or every 6 months with ultrasound examination of the liver and measurements of cancer-produced proteins in the blood, e.g. alpha fetoprotein. These methods in screening are only partially effective, identifying at best only 50% of patients at a curable stage of their cancer.


4. Liver Transplantation

If the disease is far advanced, liver transplantation often becomes the only option for treatment. About 80% of patients with liver cirrhosis who received transplants are alive after 5 years. But not all patients with liver cirrhosis are candidate for liver transplantation. In addition to this, there is also a shortage of livers to transplant, and usually there is a long months or years wait before the liver for transplanting can be available so measures to retard the progress and prevent complication is of utmost importance.


Vejthani Hospital’s Gastroenterology and Hepatology Center is committed to provide quality health care to patients suffering from diseases such as liver cirrhosis. Our physicians are trained both locally and internationally to ensure the high standard of care needed by patients. Having received the Joint Commission International (JCI) Accreditation 2010, Vejthani Hospital is indeed one of the finest hospitals in the world that offer international standards when it comes in giving medical and surgical care.

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