Liver cirrhosis is the chronic long term scarring (fibrosis) of the liver that is not reversible. Untreated or poor management of liver cirrhosis can lead to death. In 2015, cirrhosis affected 2.8 million people worldwide, and 1.3 million people died from the people affected. Liver cirrhosis is a severe condition that requires severe and prolonged treatment.
Here are the common causes of cirrhosis:
- Hepatitis B infection
- Hepatitis C infection
- Nonalcoholic fatty liver disease: is excess fat build-up in the liver
- Diabetes mellitus
- Primary biliary cholangitis
- Cholelithiasis (Gallstones)
- Autoimmune hepatitis
- Cystic fibrosis
- Wilson’s disease
- Primary sclerosing cholangitis
- Paracetamol overdose
The two major causes of cirrhosis are long term alcohol consumption and hepatitis C.
Here are the signs and symptoms of liver cirrhosis:
The signs of liver cirrhosis depend on the stage of the condition. The symptoms are asymptomatic at first, but over time, the progression of scar tissue formation becomes severe. The following symptoms may occur:
- Jaundice of skin and eyes
- Fatigue (severe weakness)
- Loss of appetite
- Easy bruising
- Gastrointestinal bleeding
- Vomiting blood
- Palmar erythema
- Edema of the legs
- Spider angioma (spider looking blood vessels on the skin)
- Dark stool due to bleeding
- Shortness of breath
- Caput Medusae (dilated, engorged superficial epigastric veins)
- Flapping tremor
- Fetor hepaticus (strong, musty sweet smell perceive from breath)
- Male Infertility
- Low sex drive and testicular atrophy
- Muscle wasting (cachexia)
Here are the risk factors of liver cirrhosis:
- Long term intravenous drug users.
- Infectious diseases, such as syphilis
- Long term use of methotrexate and isoniazid
What are stages of cirrhosis of the liver?
The five stages of cirrhosis formation caused by hepatitis C are:
- Stage O: no fibrosis.
- Stage 1: mild fibrosis with no walls of scarring.
- Stage 2: Mild to moderate fibrosis with minimal walls of scarring
- Stage 3: bridging fibrosis with scarring that has spread to different parts of the liver without cirrhosis.
- Stage 4: generalized scarring of liver tissue (cirrhosis)
The most common complication of cirrhosis Include:
- Portal hypertension
- Spontaneous bacterial peritonitis
- Massive Infections
- Hepatorenal syndrome
- Esophageal varices
- Gastrointestinal bleeding
- Hepatic encephalopathy
- Hepatocellular carcinoma
Doctors will diagnose cirrhosis based on:
- Medical history and a physical exam
- Liver biopsy (know as the gold standard for diagnosis)
- Blood analysis (elevated bilirubin, low platelet, elevated AST and ALT, low albumin, elevated prothrombin time, decrease WBC, elevated alkaline phosphatase, elevated globulins, increased glucagon, elevated lipids and cholesterol)
- Serology for hepatitis viruses and autoantibodies to check immune involvement
- Abdominal ultrasound
- Elastography: is a method that measures the elastic properties and stiffness of the liver
- Abdominal computed tomography (CT scan)
- Magnetic resonance cholangiopancreatography (MRCP)
- Endoscopic retrograde cholangiopancreatography (ERCP)
Treatment of liver cirrhosis
Liver Cirrhosis is nonreversible. The management of liver cirrhosis is aimed at symptom management, treatment of the probable cause, and complications.
Treatment of cause:
- Removal of the cause, for example; alcohol and paracetamol
- Antiviral for hepatitis B and C
- Corticosteroids for autoimmune hepatitis
- Chelation therapy for Wilson’s disease, for instance, penicillamine
- Weight loss for obese patients
- Proper management of diabetes
- Acetylcysteine for paracetamol overdose
Treatment of symptoms and complications:
- Liver transplantation
- Diuretics and paracentesis for ascites and edema
- Antibiotics for bacterial infections
- Hepatic encephalopathy prevention (Laxatives): Lactulose
- Rehydration therapy for patients who are bleeding
- Portal hypertension/esophageal variceal bleeding: beta-blockers and transjugular intrahepatic PorPortosystemicunting (TIPS)
Note: Any self-medication is unacceptable in the liver cirrhosis condition, make sure to consult a doctor.
Lastly, this is an informational piece about liver cirrhosis. If you encounter any cirrhosis symptoms, make sure to discuss it with your doctor for proper checkup.