Liver Cirrhosis

What is Live Cirrhosis?

Cirrhosis is a condition of the liver that occurs when inflammation and damage gradually replace healthy liver cells with fibrotic scar tissue. Normal liver cells become necrotic when they are constantly injured or damaged. This dead tissue then becomes fibrotic, which means it thickens and forms scar tissue.

Alternate Name

Cirrhosis, hepatic cirrhosis, and end-stage of liver disease.

Liver Cirrhosis Causes

In a chronic state of liver cell inflammation, the liver can become scarred and damaged to an irreversible point. It then becomes fibrotic which is referred to as "cirrhosis." It may be caused due to several etiological factors such as

• Fatty liver which is not detected and treated appropriately can lead to liver stiffening.
• Alcoholic liver disease: Excessive alcohol intake for a prolonged period, causes damage to the liver.
• Chronic viral infections: Untreated viral infections like hepatitis B and C can cause liver cirrhosis.
• Autoimmune diseases like AIH/PSC/PBC
• Metabolic disorders like Wilsons' disease
• Vascular causes like Budd chiary , HVOTO
• Cryptogenic liver cirrhosis
• Drug-induced cirrhosis.

Liver Cirrhosis Symptoms

1. Compensated liver cirrhosis: In this condition, the liver is cirrhotic, but the patient does not exhibit any complications(jaundice, ascites, upper GI bleeding for encephalopathy). A cirrhotic liver is only detected when a patient undergoes an ultrasound of the abdomen.

2. Decompensated liver cirrhosis: complications include:

• Swelling of the abdomen or ascites
• Jaundice due to a decrease in albumin
• Hepatic encephalopathy leading to confusion
• Easy bruising from low coagulation factors
• Swelling of the face or facial edema
• Swelling of legs or pedal edema

Stages Of Liver Cirrhosis

• Stage 1: Cirrhosis in its early stages is characterized by some scarring of the liver but few symptoms. This is known as compensated cirrhosis, and there are no complications at this stage.
• Stage 2: Cirrhosis in stage 2 is characterized by worsening portal hypertension.
• Stage 3: Cirrhosis in its third stage is characterized by abdominal swelling and advanced liver scarring. This stage denotes decompensated cirrhosis, which can lead to serious complications and liver failure.
• Stage 4: Cirrhosis in stage 4 can be fatal, and people have developed the end-stage liver disease (ESLD), which is fatal without a transplant.

Pathophysiology Of Liver Cirrhosis

Cirrhosis leads to portal hypertension and accumulation of peritoneal fluid that can result in complications like congestive splenomegaly and hypersplenism. Renal vasoconstriction decreases blood flow through the kidneys. Decreased filtration leads to hepatorenal failure, and kidney failure follows liver failure

Possible Complications Of Liver Cirrhosis

• Esophageal varices: Blood vessels within the food pipe can become bigger and can bleed.
• Blood vessels in the stomach can become bigger and can cause bleeding.
• Ascites and spontaneous bacterial peritonitis
• Hepatic encephalopathy: A coma-like condition or mental confusion can set in. This is due to the increased amount of toxins that are built up and which enters the brain, causing encephalopathy or confusion.
• Hepatorenal syndrome
• Hepatopulmonary syndrome
• The patient is very fragile, immunity is very low, and can get a serious infection quite quickly.

Therefore, it's important to prevent the condition at the earliest by identifying and treating the issue.

Diagnosis Test For Liver Cirrhosis

Doctors diagnose liver cirrhosis by asking about the patient's medical history, symptoms, and physical examination, followed by a diagnostic tissue biopsy and lab results.

• The most common test is a liver biopsy. This is done by taking a tiny sample of the liver tissue and examining it under a microscope.
• Blood tests: Lab findings include elevated serum bilirubin, elevated liver enzymes, thrombocytopenia, or low platelet count.
• Ultrasound of the abdomen, endoscopy, CT, and MRI

Prevention Of Liver Cirrhosis

Primary Prevention

Since this is primarily a lifestyle disease, initial treatment involves basic lifestyle modifications.

• Avoid alcohol intake. Some studies have shown that complete abstinence from alcohol even for a year can regenerate the liver to some extent and make the patient relatively better.
• Control obesity by keeping your weight in check.
• Control comorbidities like keeping a check on sugar levels.
• Control hepatitis infections. By preventing transmission of viral hepatitis by screening. Taking hepatitis immunizations on time.

Secondary Prevention

It's important to prevent continued liver damage by identifying the underlying cause and treating the cause.

• Stop alcohol intake. The doctor might suggest you for the de-addiction program.
• Lose weight if liver cirrhosis is caused by fat build-up.
• Control diabetes mellitus.
• Hepatitis infections: Take regular medications if you have viral infections such as B and C, or any abnormalities regarding the liver. Decompensated liver cirrhosis can be pushed to compensate for liver cirrhosis with treatment, and the patient can appear relatively normal.
• Low salt intake.
• Consume a high-protein and high-calorie diet.
• Consult specialist regularly
• Hepatocellular carcinoma related to liver cirrhosis is very common and requires monitoring by blood tests and ultrasound abdomen
• Take medications prescribed by a specialist for the management of constipation and ascites.
• Have regular follow up

Cirrhosis Of The Liver Treatment

Once liver cirrhosis has been diagnosed, the treatment depends on whether it is compensated or decompensated.

1. In compensated liver cirrhosis, no treatment is required; only preventive measures and symptomatic treatment are given. It's important to have a regular check and follow-up with your doctor every 3 to 6 months. Liver function tests, ultrasound of the abdomen, and endoscopy are required every 3 to 6 months.

2. In decompensated liver cirrhosis, specific treatment is required.

• Lifestyle modifications: Quit alcohol, lose weight, and eat less salt.
• Medications: Medications are primarily used to treat complications of liver cirrhosis.
• Surgery: Liver transplantation is the only effective treatment for advanced liver cirrhosis. Although it is major surgery, it is now very effective due to advanced technology and surgical skills.

Expected Prognosis Of Liver Cirrhosis

Once liver cirrhosis sets in, both the quality and quantity of life span can be reduced. Cirrhosis in its early stages is characterized by some scarring of the liver but few symptoms. This is known as compensated cirrhosis, and there are no complications and the prognosis may be favorable if treated at this stage. With advanced cirrhosis, it may be fatal, and the liver may stop functioning. A liver transplant might be the only option at this stage.

Natural Progression Of Liver Cirrhosis

As cirrhosis is usually not reversible, it is often referred to as end-stage or late-stage liver damage. Because of cirrhosis, the blood flow through the liver is disturbed, which can lead to portal hypertension, ascites, and liver failure. This progression may be life-threatening and may lead to end-stage liver disease, which is fatal without a transplant.