Cirrhosis of the Liver: All you need to know

What is cirrhosis of the liver?

Cirrhosis is a late-stage liver disease in which healthy liver tissue is replaced with scar tissue and the liver is permanently damaged. Scar tissue keeps your liver from working properly.

Cirrhosis of the liver causes scarring of the liver with visible bumpy nodules throughout the tissue. Cirrhosis causes scarring and nodules to form throughout the liver.

Many types of liver diseases and conditions injure healthy liver cells, causing cell death and inflammation. This is followed by cell repair and finally tissue scarring as a result of the repair process.

The scar tissue blocks the flow of blood through the liver and slows the liver’s ability to process nutrients, hormones, drugs and natural toxins (poisons). It also reduces the production of proteins and other substances made by the liver. Cirrhosis eventually keeps the liver from working properly. Late-stage cirrhosis is life-threatening.

A normal liver, brown to reddish-brown in color, has a smooth exterior surface.

Common causes include alcohol abuse, hepatitis and nonalcoholic fatty liver disease.

Treatment depends on the cause of cirrhosis and how much damage exists. Liver transplantation may be an option if your liver is failing.

How common is cirrhosis?

According to the latest WHO data published in 2017, liver disease deaths in India reached 259,749 or 2.95% of total deaths, accounting for one-fifth (18.3%) of all cirrhosis deaths globally.

You are more likely to get cirrhosis of the liver:

• Drinking/Abusing alcohol for many years
• Viral hepatitis
• Diabetes
• Obesity
• Inject drugs using shared needles
• History of liver disease
• Unprotected sex

Cirrhosis of the liver isn’t cancer. However, most people who have liver cancer have cirrhosis. If you have cirrhosis, you have an increased risk of liver cancer. If you have hepatitis B or hepatitis C, you have an increased risk of liver cancer because these diseases often lead to cirrhosis. Any cause of liver disease can lead to cirrhosis, which increases your chance of liver cancer. (Even if you have hepatitis B or fatty liver disease without cirrhosis, you are at increased risk of liver cancer.)

Cirrhosis itself is not an inherited/genetic (passed from parent to child) disease. However, some of the diseases that can cause liver damage that lead to cirrhosis are inherited diseases.

If you have been told you have cirrhosis, you have late-stage liver disease and the damage that is already done is permanent. There are many liver diseases and complications of liver diseases that can lead to cirrhosis. If your liver disease or complication is caught early and successfully managed, it may be possible to slow or stop the progression of the disease.

Having a diagnosis of cirrhosis of the liver doesn’t mean you have an immediately fatal condition. However, as cirrhosis continues, more scarring occurs and liver function continues to decline. Eventually, your failing liver may become a life-threatening condition. Yet there’s still hope. You and your Liver Disease Expert Team will discuss if you are a candidate for a liver transplant. If so, you will begin the process of being placed on a national liver transplant recipient list.

What are the symptoms of cirrhosis?

Early symptoms and signs of cirrhosis include:

• Loss of appetite
• Feeling weak or tired
• Nausea
• Fever
• Unexpected weight loss

As liver function gets worse, other more commonly recognized symptoms of cirrhosis appear including:

• Easy bruising and bleeding
• Yellow tint to your skin or the whites of your eyes (jaundice)
• Itchy skin
• Swelling (edema) in your legs, feet and ankles
• Fluid buildup in your belly/abdomen (ascites)
• Brownish or orange color to your urine
• Light-colored stools
• Confusion, difficulty thinking, memory loss, personality changes
• Blood in your stool
• Redness in the palms of your hands
• Spider-like blood vessels that surround small, red spots on your skin (telangiectasias)
• In men: loss of sex drive, enlarged breasts (gynecomastia), shrunken testicles
• In women: premature menopause (no longer having your menstrual period)

Cirrhosis can be painful, especially as the disease worsens. Pain is reported by up to 82% of people who have cirrhosis and more than half of these individuals say their pain is long-lasting (chronic).

Most people with liver disease report abdominal pain. Pain in your liver itself can feel like a dull throbbing pain or a stabbing sensation in your right upper abdomen just under your ribs. General abdominal pain and discomfort can also be related to swelling from fluid retention and enlargement of your spleen and liver caused by cirrhosis.

Pain can come both from the diseases that lead to cirrhosis and/or cirrhosis can make the pain from existing diseases worse. For instance, if you have non-alcoholic fatty liver disease and are obese, you may also have osteoarthritis and cirrhosis makes your bone and joint pain worse. Cirrhosis also causes an inflammatory state in your entire body. Inflammation and your body’s reaction to inflammation can cause general pain.

To diagnosis cirrhosis, your provider will perform a physical exam and may order one or more of the following tests:

Physical exam: Your doctor will examine you, looking for the signs and symptoms of cirrhosis including: the red, spider-like blood vessels on your skin; yellowing of your skin or whites of your eyes; bruises on your skin; redness on your palms; swelling, tenderness or pain in your abdomen; enlarged firmer-feeling, bumpy texture to the lower edge of your liver (the part of your liver below the rib cage that can be felt).

Imaging tests: Imaging tests show the size, shape and texture of the liver. These tests can also determine the amount of scarring, the amount of fat you have in your liver and fluid in your abdomen. Imaging tests of your liver that could be ordered include computerized tomography (CT) scan, abdominal ultrasound and magnetic resonance imaging (MRI).

A special ultrasound, called a transient elastography, measures the fat content and amount of stiffness in your liver. Two different types of endoscopies might be ordered: an endoscopic retrograde cholangiopancreatography to detect bile duct problems, and/or upper endoscopy to detect enlarged veins (varices) or bleeding in your esophagus, stomach or intestines.

Biopsy: A sample of liver tissue (biopsy) is removed from your liver and examined under the microscope. A liver biopsy can confirm a diagnosis of cirrhosis, determine other causes or extent of liver damage or enlargement or diagnose liver cancer.

Are there stages of cirrhosis?

If you have been diagnosed with cirrhosis of the liver, you are already beyond the early stages of liver disease. Having cirrhosis means your liver has scar tissue in it because it has been damaged.

Liver specialists and researchers have developed many different scoring systems to predict outcome and to guide treatment for chronic liver disease. Some specific liver diseases also have their own scoring systems. However, not every liver disease has a scoring system and there’s no scoring system if you happen to have more than one liver disease at the same time.

For these reasons, perhaps it’s easier to talk about cirrhosis according to a classification system you are more likely to hear from your healthcare provider. He or she may refer to you having either compensated cirrhosis or decompensated cirrhosis.

Compensated cirrhosis means you have cirrhosis but you don’t yet have noticeable symptoms (you are asymptomatic). Your lab work and imaging findings may not be abnormal. A liver biopsy may be the only way to confirm a diagnosis of cirrhosis. Median survival in patients with compensated cirrhosis is approximately nine to 12 years. (Median is the middle point in the set of numbers, so an equal number of individuals survived less than 9 to 12 years as the number of individuals who survived over this time range.)

Decompensated cirrhosis means your cirrhosis has worsened to the point that you have noticeable symptoms. Your healthcare provider recognizes your condition based on your history, physical and lab findings. You have at least one complication, which includes jaundice, ascites, hepatic encephalopathy, hepatorenal syndrome, variceal bleeding or liver cancer. You are usually admitted to the hospital for care. Median survival in patients with decompensated cirrhosis is approximately two years.

Is there a cure for cirrhosis of the liver?

No, there is no cure for cirrhosis. The damage already done to your liver is permanent. However, depending on the underlying cause of your cirrhosis, there may be actions you can take to keep your cirrhosis from getting worse. These actions include:

• Stop drinking alcohol
• Treat chronic hepatitis (if you have it)
• Avoid medications that stress the liver
• Eat a healthy, well-balanced, low-fat diet, such as the Mediterranean diet
• Follow other tips listed under the Prevention section in this article.

What are the goals of cirrhosis treatment?

The goals of treatment for cirrhosis of the liver are to:

• Slow further damage to your liver
• Prevent and treat symptoms
• Prevent and treat complications
• How is cirrhosis of the liver treated?
• Treatment depends on what’s causing your cirrhosis and how much damage exists

Although there is no cure for cirrhosis, treatments can delay or stop its progress and reduce complications.

How can I prevent cirrhosis of the liver?

• Don't abuse alcohol. If you do drink alcohol, limit how much you drink and how often. If you drink more than two drinks a day if you are a man or more than one if you are a woman, you are increasing your risk.
• Eat a well-balanced, low-fat diet, such as the Mediterranean diet. A well-balanced healthy diet consists of fruits, vegetables, lean proteins and whole grains.
• Don’t eat raw seafood, especially oysters and clams. These foods can contain a bacteria that can cause serious illness.
• Cut back on the amount of salt in your diet. Use other seasonings to flavor your foods.
• Healthy body habits: Maintain a healthy weight. Excess body fat can damage your liver. Ask your healthcare provider for a weight loss plan if you are overweight.
• Exercise regularly
• See your healthcare provider regularly for check-ups. Follow medical recommendations to control obesity, diabetes, hypertension (high blood pressure) and cholesterol (high bad cholesterol [LDL] and/or low good cholesterol [HDL]) and high triglycerides.
• Quit smoking if you smoke.

What type of healthcare providers will treat my cirrhosis?

Depending on the stage of your cirrhosis, different healthcare providers may be involved in your care. Healthcare professionals likely to be part of your care team include:

• Gastroenterologist (doctor who specializes in conditions of your digestive tract).
• Hepatologist (doctor who specializes in conditions of your liver).
• Nephrologist (doctor who specializes in conditions of your kidney).
• Dietitian

Cirrhosis of the liver is a late-stage result of liver disease and its complications. Cirrhosis causes your liver to not function properly. Your liver plays a vital role in many of the processes and functions that keep you alive.

Although scarring from liver disease causes permanent damage, it’s still possible to live a long life. Depending on the underlying cause, it’s possible to slow or stop cirrhosis from worsening. Many of the causes and complications that lead to cirrhosis are treatable or manageable. If you drink alcohol, stop. If you have nonalcoholic fatty liver disease, lose weight and control your metabolic risk factors. If you have diabetes, make sure you are following your healthcare provider’s management recommendations. Take all medications for all your medical conditions as directed by your healthcare team. Get vaccinated for hepatitis A and B.

If you have end-stage cirrhosis, don’t lose hope. You and your healthcare team will work together to closely manage your condition and put you on a waitlist for a donor's liver.

Dr. Chirayu Chokshi & team is an expert in treating Cirrhosis of the Liver. For more information, visit our website www.gastrovadodara.com or call us on 9081333897 / 9825795257 to book an appointment.