Cirrhosis

Overview of Cirrhosis

Causes

Cirrhosis can result from various conditions that damage the liver over time, including:

1. Chronic Alcohol Abuse:

   • Excessive and prolonged alcohol consumption is a common cause of liver cirrhosis.

2. Chronic Hepatitis B and C:

   • Long-term viral infections can lead to chronic inflammation and scarring of the liver.

3. Non-Alcoholic Fatty Liver Disease (NAFLD):

   • Associated with obesity, diabetes, and metabolic syndrome. It can progress to non-alcoholic steatohepatitis (NASH) and cirrhosis.

4. Autoimmune Hepatitis:

   • A condition where the immune system attacks liver cells, causing inflammation and damage.

5. Genetic Disorders:

   • Hemochromatosis: Iron buildup in the liver.
   • Wilson’s Disease: Copper accumulation in the liver.

6. Primary Biliary Cholangitis (PBC):

   • A chronic disease that destroys the bile ducts within the liver.

7. Primary Sclerosing Cholangitis (PSC):

   • A disease that causes scarring and inflammation of the bile ducts.

8. Medications and Toxins:

   • Long-term use of certain medications or exposure to toxic substances can contribute to liver damage.

9. Chronic Hepatitis D:

   • Occurs only in those infected with hepatitis B, causing additional liver damage.

10. Biliary Atresia:

• A condition in infants where the bile ducts are blocked or absent, leading to liver damage.

Symptoms

Symptoms of cirrhosis can vary and may develop gradually. Early stages might be asymptomatic or show mild symptoms, but as the disease progresses, symptoms can become more pronounced:

• Fatigue: Persistent tiredness and weakness.
• Jaundice: Yellowing of the skin and eyes due to elevated bilirubin levels.
• Abdominal Pain or Discomfort: Especially in the upper right side of the abdomen.
• Ascites: Fluid buildup in the abdomen, causing swelling and discomfort.
• Edema: Swelling in the legs and ankles.
• Easy Bruising and Bleeding: Due to decreased production of clotting factors.
• Dark Urine: Darker than usual, often resembling tea or cola.
• Pale Stools: Stools may be lighter in color.
• Nausea and Vomiting: Possible due to liver dysfunction.
• Itchy Skin: Caused by bile salts deposited in the skin.
• Confusion or Cognitive Changes: Known as hepatic encephalopathy, affecting mental function and cognition.

Diagnosis

Diagnosing cirrhosis involves a combination of medical history, physical examination, and diagnostic tests:

1. Medical History and Physical Examination:

   • Assessment of symptoms, risk factors (e.g., alcohol use, viral hepatitis), and physical signs of liver disease.

2. Blood Tests:

   • Liver Function Tests: Measure levels of liver enzymes (ALT, AST), bilirubin, and proteins (albumin).
   • Complete Blood Count (CBC): Can show anemia or signs of bleeding disorders.
   • Coagulation Tests: Assess clotting ability, often abnormal in cirrhosis.

3. Imaging Studies:

   • Ultrasound: Detects liver size, texture, and complications such as ascites or liver tumors.
   • CT Scan/MRI: Provides detailed imaging of the liver and helps assess the extent of cirrhosis and any associated complications.

4. Liver Biopsy:

   • A procedure where a small sample of liver tissue is examined to assess the degree of fibrosis and liver damage.

5. FibroScan (Transient Elastography):

   • A non-invasive test to measure liver stiffness, indicating the degree of fibrosis or cirrhosis.

6. Endoscopy:

   • May be performed to check for varices (enlarged veins) in the esophagus or stomach, which can develop due to portal hypertension.

Treatment

The treatment of cirrhosis focuses on managing the underlying cause, alleviating symptoms, and preventing complications:

1. Managing the Underlying Cause:

   • Alcohol Abstinence: For alcohol-related cirrhosis, stopping alcohol consumption is crucial.
   • Antiviral Medications: For hepatitis B or C, antiviral drugs can reduce viral load and liver inflammation.
   • Lifestyle Changes: For NAFLD, weight loss, and managing diabetes or cholesterol levels are important.
   • Immunosuppressants: For autoimmune hepatitis, medications to suppress the immune response may be used.

2. Medications:

   • Diuretics: To manage ascites by reducing fluid buildup.
   • Lactulose: For hepatic encephalopathy, helps reduce ammonia levels in the blood.
   • Beta-Blockers: To reduce portal hypertension and prevent variceal bleeding.

3. Procedures and Surgical Interventions:

   • Paracentesis: To remove excess fluid from the abdomen in cases of severe ascites.
   • Endoscopic Band Ligation: To manage esophageal varices and prevent bleeding.
   • TIPS (Transjugular Intrahepatic Portosystemic Shunt): A procedure to relieve portal hypertension.

4. Liver Transplant:

   • Considered for end-stage cirrhosis or when other treatments are ineffective. A liver transplant can be a life-saving option.

5. Monitoring and Follow-Up:

   • Regular check-ups and monitoring to assess liver function, manage symptoms, and screen for liver cancer.

Prevention

Preventing cirrhosis involves addressing risk factors and managing liver health:

• Avoiding Excessive Alcohol: Limiting alcohol intake to prevent alcohol-related liver damage.
• Vaccination: Vaccinating against hepatitis B and C if at risk.
• Healthy Diet and Weight Management: Preventing NAFLD by maintaining a healthy weight and managing diabetes or cholesterol levels.
• Safe Medical Practices: Using sterile equipment and practicing safe injection and sexual practices.

Prognosis

• Varies by Individual: The prognosis depends on the stage of cirrhosis, the underlying cause, and response to treatment.
• With Treatment: Effective management of the underlying cause and complications can improve quality of life and prevent further liver damage.
• Without Treatment: Cirrhosis can progress to liver failure, liver cancer, and other serious complications. Early diagnosis and treatment are essential for improving outcomes.