Cirrhosis of the liver
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Cirrhosis of the liver is a severe form of liver disease that occurs when the liver’s healthy tissue is gradually replaced by scar tissue. This condition can arise from various liver diseases and factors, such as chronic alcoholism or hepatitis.
Whenever the liver is harmed, whether by excessive alcohol consumption or other factors like infections, it attempts to repair itself, leading to the formation of scar tissue. As cirrhosis progresses, more scar tissue forms, hampering the liver’s ability to function properly. Advanced cirrhosis can be life–threatening.
The liver damage caused by cirrhosis is generally irreversible. However, if cirrhosis is detected early and its underlying causes are treated, further damage can be limited. In rare cases, it may be reversed.
Symptoms
Cirrhosis often develops without noticeable symptoms until significant damage to the liver has occurred. When symptoms do appear, they may include:
- Tiredness.
- Reduced appetite.
- Nausea.
- Accumulation of abdominal fluid (ascites).
- Swelling (edema) in the legs, feet, or ankles.
- Unexplained weight loss.
- Red palms.
- Itchy skin.
- Jaundice, evident from yellowing of the skin and eyes.
- Pale fingernails, particularly in the thumb and index finger.
- Spider–like blood vessels on the skin.
- Confusion, drowsiness, or slurred speech.
- Fingers becoming rounder at the tips (clubbing).
- Irregular or absent periods unrelated to menopause in females.
- Diminished sex drive, testicular shrinkage, or breast enlargement (gynecomastia) in males.
- Increased tendency to bleed or bruise.
If you notice any of these symptoms, it’s advisable to make an appointment with a healthcare provider.
Causes
Cirrhosis, characterized by liver damage, can result from a variety of diseases and factors. Some of these contributing factors include:
- Persistent viral hepatitis (hepatitis B, C, and D).
- Prolonged and excessive alcohol consumption.
- Nonalcoholic fatty liver disease, where fat accumulates within the liver.
- Hemochromatosis, leading to an excess of iron in the body.
- Autoimmune hepatitis, an immune system–triggered liver ailment.
- Cystic fibrosis.
- Abnormal bile duct development, referred to as biliary atresia.
- Inherited disorders affecting sugar metabolism, like galactosemia or glycogen storage disease.
- Alagille syndrome, an inherited digestive disorder.
- Damage to bile ducts due to primary biliary cholangitis.
- Fibrosis and narrowing of bile ducts caused by primary sclerosing cholangitis.
- Wilson’s disease, characterized by copper accumulation in the liver.
- Alpha–1 antitrypsin deficiency.
- Infections like syphilis or brucellosis.
- Certain medications, including methotrexate or isoniazid.
Risk factors
Several risk factors may contribute to a higher risk of cirrhosis, such as:
- Age: People over the age of 50 are at a higher risk of this condition.
- Excessive alcohol consumption: Heavy alcohol use significantly increases one’s risk of cirrhosis.
- Obesity: Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis are conditions that can lead to cirrhosis and being obese increases one’s risk of developing them.
- Having chronic viral hepatitis infection: This condition is one of the primary causes of liver disease worldwide.
Diagnosis
Individuals in the early stages of cirrhosis often do not experience noticeable symptoms. Typically, cirrhosis is initially detected during routine medical examinations or through standard blood tests. To confirm the diagnosis, a combination of both laboratory and imaging assessments is commonly conducted.
Your healthcare provider may request a series of tests to assess the condition of your liver, including:
- Laboratory tests: Blood tests may be ordered to identify indications of liver dysfunction, such as elevated bilirubin levels or specific enzymes. Additionally, kidney function is evaluated by assessing creatinine levels, and your blood count is measured. Screening for hepatitis viruses is carried out, along with an assessment of your international normalized ratio (INR) to measure blood clotting efficiency.
- Imaging tests: Certain non–invasive imaging tests, like transient or magnetic resonance elastography (MRE), might be recommended. These tests determine the liver’s stiffness or hardening. Other imaging techniques such as magnetic resonance imaging (MRI), computed tomography (CT) scans, and ultrasound may also be utilized.
- Biopsy: While not always necessary for diagnosis, a tissue sample (biopsy) can be employed by your provider to determine the extent of liver damage and its underlying causes.
For cases of cirrhosis, your healthcare provider will likely suggest regular monitoring tests to track disease progression and detect potential complications, notably esophageal varices and liver cancer. Non–invasive tests are increasingly accessible for ongoing liver disease assessment.
Treatment
The treatment approach for cirrhosis depends on the underlying cause and the extent of liver damage. The treatment goals include slowing the progression of liver scarring, managing cirrhosis–related symptoms and complications, and potentially requiring hospitalization for severe liver impairment.
Treating the underlying cause of cirrhosis involves:
- Alcohol Dependency: For cirrhosis due to excessive alcohol use, quitting drinking is crucial. Consider an alcohol addiction treatment program if needed, as any alcohol intake harms the liver.
- Weight Management: Nonalcoholic fatty liver disease–related cirrhosis can be mitigated by weight loss and blood sugar control.
- Hepatitis Control: Treating hepatitis B or C with specific medications can limit liver cell damage.
- Managing Other Causes and Symptoms: Medications can slow cirrhosis progression. Early treatment of conditions like primary biliary cholangitis delays cirrhosis. Medications also alleviate symptoms like itching and fatigue. Nutritional supplements counter malnutrition and prevent osteoporosis.
Management of cirrhosis complications involves addressing various issues that may arise, such as:
- Fluid Accumulation: To control ascites (fluid buildup) and swelling, a combination of a low–sodium diet and medication may be used. In more severe cases, fluid drainage procedures or pressure–relieving surgery might be necessary.
- Portal Hypertension: Blood pressure medications can help regulate elevated portal hypertension, which affects the veins supplying the liver. Regular upper endoscopy examinations are performed to detect potentially bleeding enlarged veins (varices) in the stomach or esophagus. Medications can lower bleeding risk from varices. In cases of bleeding or high risk, band ligation procedures can be performed to halt bleeding or prevent recurrence. Severe instances might require a transjugular intrahepatic portosystemic shunt (TIPS) placement to decrease liver blood pressure.
- Infections: Treatment with antibiotics and other therapies is employed to manage infections. Vaccinations for influenza, pneumonia, and hepatitis are recommended to prevent infections.
- Elevated Liver Cancer Risk: Regular blood tests and ultrasound scans are advised to monitor for potential liver cancer development.
- Hepatic Encephalopathy: Medications may be prescribed to mitigate toxin buildup caused by compromised liver function, which leads to hepatic encephalopathy.
Liver transplant surgery
In advanced cirrhosis cases where the liver functions poorly, a liver transplant may be the only solution. This procedure involves replacing the damaged liver with a healthy one from a deceased or living donor. Cirrhosis, often due to alcohol–related damage, is a primary reason for such transplants. Rigorous assessments determine the transplant suitability, especially for those with alcoholic cirrhosis. Recent research indicates that well–chosen individuals with severe alcoholic cirrhosis can achieve survival rates similar to recipients with other liver issues. However, they must commit to lifelong alcohol abstinence and meet program criteria for the transplant to be considered.
