Cirrhosis

Cirrhosis is a condition in which your liver cells are irreversibly replaced by fibrous or scar cells.

It may be caused by medical conditions, such as hepatitis and chronic alcohol abuse.

Your liver is a large organ that removes harmful chemicals from your body, purifies your blood and manufactures a variety of nutrients.

When diagnosed and treated early, further liver damage can be prevented.

Progression of cirrhosis can form more scar tissue which deteriorates liver function.

Advanced cirrhosis is a fatal condition.

Signs and symptoms which appear in advanced cirrhosis, include:

• Extreme tiredness
• Tendency to bleeding easily
• Easy bruising
• Itchy skin
• Jaundice (yellowish discoloration in the skin and eyes)
• Build up of fluid in your abdomen (ascites)
• Loss of appetite
• Nausea
• Swelling in your legs (edema)
• Weight loss
• Confusion, drowsiness and slurred speech (due to hepatic encephalopathy)
• Spider-like blood vessels on your skin

When to see a doctor?

Visit your doctor if you have any of the signs or symptoms.

There are several causes of cirrhosis.

Liver, after every injury, repairs itself. On repeated and prolonged injury, normal tissues are replaced by fibrous or scar tissues leading to cirrhosis.

As cirrhosis progresses, your liver loses its ability to function properly. Liver cirrhosis occurs secondary to some underlying causes. So, early detection and treatment of these causes can prevent liver damage.

Some of the inherited causes of cirrhosis are:

• Hemochromatosis: Accumulation of iron in the body
• Cystic fibrosis
• Wilson's disease: Excessive deposition of copper in the liver
• Narrowed or blocked bile ducts (biliary atresia)
• Genetic disorders of sugar metabolism (galactosemia or glycogen storage disease)
• Genetic digestive disorder (Alagille syndrome)
• Liver disease due to host immune response (autoimmune hepatitis)

Some other causes of liver cirrhosis are:

• Chronic alcohol abuse
• Hepatitis C, Hepatitis B
• Accumulation of fat in the liver (nonalcoholic fatty liver disease)
• Destruction of bile ducts (primary biliary cirrhosis)
• Hardening and scarring of the bile ducts (primary sclerosing cholangitis)
• Parasitic infection (schistosomiasis)

There may be more than one cause for cirrhosis, for instance, alcohol abuse and viral hepatitis. If cirrhosis can't be linked to any cause, it's called cryptogenic cirrhosis.

Cryptogenic cirrhosis accounts for approximately 20 percent cirrhosis sufferers.

Making a diagnosis of cirrhosis is done by performing several tests.

You are likely to be referred to a gastroenterologist (a doctor who specializes in disorders of digestive system) or a hepatologist (doctor who specializes in treating liver disease).

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. List out all the symptoms.

Write down your key medical information.  Write down the names of all your medications, vitamins or supplements.

Make a list of the questions to ask your doctor. Some typical questions can be:

• What could be possible causes of my cirrhosis?
• Can medications slow or stop my liver damage?
• What are my treatment options and side effects of each option?
• What can I do to protect my liver from further damage?
• Are some medications harmful to my liver?
• Are there any signs and symptoms of complications that I need to look at closely?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor.

Your doctor might ask you typical questions like:

• When did your symptoms start appearing and severe are they?
• Have your symptoms been continuous or occasional?
• Does anything improve or aggravate your symptoms?
• Do you drink alcohol, how often?
• Have you been exposed to or taken toxic drugs?
• Has anyone from your family suffered from liver disease, hemochromatosis or obesity?
• Do you have a history of a viral hepatitis?
• Do you use injection drugs?
• Have you had blood transfusion?
• Do you have any tattoos?

Generally, no symptoms are experienced at early stage of cirrhosis. Most cases of cirrhosis are revealed during routine blood test or check up.

Your doctor may perform following tests

• Laboratory tests: Your blood is checked to determine how you liver is functioning. Liver damage is indicated by higher amount of bilirubin and certain enzymes in blood.

• Kidney function: Your kidney function is determined by measuring creatinine level of blood is checked.

• Tests for hepatitis B and C: Blood test reveals if you are infected by the hepatitis viruses.

• Clotting: Your international normalized ratio (INR) is checked to assess your clotting time.

• Imaging tests: Magnetic resonance elastography (MRE) is non-invasive and sophisticated imaging test used to check whether the liver has hardened or stiffened. Other imaging tests: MRI, CT and ultrasound are used to obtain image of the liver.

• Biopsy: A tissue sample (biopsy) of liver may be used to diagnose the severity, extent and cause of liver damage.

If you have cirrhosis, your doctor regularly monitors the progression of disease and complication, particularly esophageal varices and liver cancer.

The choice of treatment for cirrhosis depends upon the cause and extent of liver damage.

Treatment is focused on delaying scarring of the tissues in your liver as well as preventing or treating symptoms and complications of cirrhosis. If your liver is severely damaged hospitalization is necessary.

The various treatment approaches are:

Treatment of cause of cirrhosis

Diagnosis cirrhosis in the early stage can decrease liver damage by treating the cause of cirrhosis.

• Treatment for alcohol dependency: Excessive alcohol intake can cause cirrhosis. So, you should avoid alcohol. Your doctor may suggest treatments that help you quit alcohol.

• Weight loss: Nonalcoholic fatty liver, a cause of cirrhosis can be managed by losing weight and reduing blood sugar.

• Medications to control hepatitis: Medications are given to control liver damage due to hepatitis B or C.

• Medications to control other causes and symptoms of cirrhosis: Medications may delay the progression of certain types of liver cirrhosis. Other medications can be given to provide relief from certain symptoms, such as itching, fatigue and pain.

• To correct malnutrition and prevent osteoporosis (weakening of bones) caused by cirrhosis, nutritional supplements can be recommended.

Treatment of complications of cirrhosis

Your doctor will treat complications of cirrhosis such as:

• Excess fluid in your body: Edema or ascites are controlled by limiting sodium intake and medication to prevent accumulation of fluid in the body. You may require processes for drainage of fluid or surgery to reduce pressure if there is excess fluid accumulation.

• Portal hypertension: Blood pressure medications are prescribed to treat high pressure in the veins supplying the liver (portal hypertension) and reduce severe bleeding. Portal hypertension can also cause enlarged veins in esophagus or stomach (varices). Frequent examination can help detect any such varices.

• Infections: If you are suffering from infections, antibiotic or similar treatments may be prescribed. Your doctor can suggest you to get immunized against influenza, pneumonia and hepatitis.

• Liver cancer: Regular blood tests and ultrasound examination may be performed to check if there are any indications of liver cancer.

• Hepatic encephalopathy: You may be prescribed medications that eliminate toxins from your blood since liver is unable to function efficiently.

• Liver transplant surgery: When your liver damage is severe, replacing the diseased liver with a healthy liver from a donor is the ultimate option. A person undergoing surgery should have good health and refrain from alcohol 6 months prior to surgery.

You can prevent cirrhosis of liver by taking care of it properly. Following tips can help to minimize your risk of developing cirrhosis

• Drink in moderation: If you drink, drink no more than the safe limits. Talk to your to know how much is safe for you.
• Follow a healthy diet that is rich in fruits and vegetable, whole grains and lean sources of protein. Avoid fatty and fried foods.
• Maintain a healthy weight: Being obese or overweight can increase your risk of liver damage. Follow a healthy diet and exercise regimen to keep weight in check.
• Don’t share needles and indulge in unprotected sexual contact
• Immunize with hepatitis vaccines

Consult with your physician before starting any alternative and homeopathic remedies for cirrhosis.

A wide variety of alternative medicines for treatment of liver diseases are available.

Milk thistle (silymarin) is common and extensively studied substance.

Herbs like licorice root (glycyrrhizin), schisandra and astragalus are also used.

There are different ways to adapt your lifestyle in coping with cirrhosis.

If you have cirrhosis, be careful to avoid further liver damage. Following measures could be helpful:

• Don’t drink: Alcohol causes further liver damage.

• Limit sodium intake: Fluid retention due to excess can promote swelling of your abdomen and legs.

• Follow a healthy diet: Take a diet rich in fruits and vegetables, lean protein, such as legumes, poultry or fish to treat cirrhosis associated malnutrition. Eating raw seafood may be harmful.

• Avoid infections: Cirrhosis weakens your disease-fighting capacity. Properly wash your hands several times a day with soap and water and stay away from possible sources of infection.

• Get hepatitis A and B, influenza, and pneumonia vaccines.

• Use over-the-counter medications carefully: Liver is the major organ involved in drug metabolism. Reduced liver function due to cirrhosis can cause extra load on the liver. Consult your doctor to know if some medications are safe for you. Aspirin, acetaminophen and ibuprofen should be avoided or used in low doses.

There are several complications associated with cirrhosis.

Complications related to blood flow:

• Portal hypertension (Increased blood pressure in the veins supplying the liver): It is caused due to impaired blood flow from intestines to your liver.
• Swelling in the legs and abdomen: Fluid buildup in legs may occur due to portal hypertension. Reduced production of blood protein, albumin, by your liver can also cause edema and ascites.
• Splenomegaly (enlarged spleen): Portal hypertension can cause enlargement of the spleen.
• Bleeding: Smaller veins may burst due to portal hypertension and result in serious bleeding. Veins may also be enlarged due to high blood pressure causing fatal bleeding in the esophagus (esophageal varices) or the stomach (gastric varices). Cirrhosis can also result in reduced production of chemicals that help the blood to clot during injury.

Some other complications are: 

• Infections: Cirrhosis can weaken your immunity. Fluid collected in your stomach can lead to a serious infection, bacterial peritonitis.
• Malnutrition: Reduced nutrient production and impaired digestion can result in loss of weight and physical weakness.
• Hepatic encephalopathy: Due to reduced ability of your liver to clear toxins from the body, the toxins may accumulate in the brain causing mental confusion and concentration problems. Of not treated, hepatic encephalopathy can advance to coma.
• Jaundice: Jaundice may occur due to accumulation of bilirubin, a waste product of blood, in your body.
• Bone disease: Bones can become weak and prone to fracture due to cirrhosis.
• Gallstones and bile duct stones: Impaired bile flow can cause stones in your gall bladder or bile ducts.
• Increased risk of liver cancer: Advanced cirrhosis may cause liver cancer.
• Acute-on-chronic cirrhosis: People with cirrhosis are likely to develop multi-organ failure. However, researchers have not been able to explain the cause of multi-organ failure.