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Cirrhosis is defined histologically as a diffuse hepatic process characterized by fibrosis and conversion of the normal liver architecture into structurally abnormal nodules. The progression from a liver injury to cirrhosis may occur over a few weeks to years. Hepatitis and chronic alcohol abuse are frequent causes. Liver damage caused by cirrhosis can’t be undone, but further damage can be limited.
Initially, patients may experience fatigue, weakness, and weight loss. During later stages, patients may develop jaundice (yellowing of the skin), gastrointestinal bleeding, abdominal swelling, and confusion. Treatments focus on the underlying cause. In advanced cases, a liver transplant may be required.
According to the National Institutes of Health (NIH), the inflammation of the liver is the 12th leading cause of death due to disease in the United States. It’s more likely to affect men than women.
Liver cirrhosis has many possible causes; sometimes more than one cause is present in the same person. Globally, 57% of cirrhosis is attributable to either hepatitis B (30%) or hepatitis C (27%). Alcohol consumption is another major cause, accounting for about 20% of the cases.
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How Does Cirrhosis Affect Your Body?
Cirrhosis develops when the factors that damage the liver (such as alcohol and chronic viral infections) are present over a long period of time. When this happens, the liver becomes injured and scarred. A scarred liver cannot function properly and ultimately results in cirrhosis. Inflammation of the liver causes it to shrink and harden. This makes it difficult for nutrient-rich blood to flow into the liver from the portal vein. The portal vein carries blood from the digestive organs to the liver. The pressure in the portal vein rises when blood cannot pass into the liver. The end result is a serious condition called portal hypertension, in which the vein develops high blood pressure. The unfortunate consequence of portal hypertension is that this high-pressure system causes a backup, which leads to esophageal varices (like varicose veins), which can then burst and bleed.
What Are The Causes of Cirrhosis?
Common causes of cirrhosis are:
- Alcoholic Liver Disease (ALD) – Alcoholic cirrhosis develops in 10–20% of individuals who drink heavily for a decade or more. Alcohol causes injury to the liver by blocking the normal metabolism of protein, fats, and carbohydrates. This injury happens due to the formation of acetaldehyde from alcohol which itself is reactive, but which also leads to the accumulation of other reactive products in the liver.
- Non-Alcoholic Steato Hepatitis (NASH) – In NASH, fat builds up in the liver and eventually causes scar tissue. This type of hepatitis is associated with obesity (40% of NASH patients), diabetes, protein malnutrition, coronary artery disease, and treatment with steroid medications.
- Chronic Hepatitis C – Infection with the hepatitis C virus causes inflammation of the liver and a variable grade of damage to the organ. Over several decades, this inflammation and damage have resulted in cirrhosis.
- Chronic Hepatitis B – The hepatitis B virus causes liver inflammation and injury that lead to Inflammation of the liver. Hepatitis D is dependent on the presence of hepatitis B and accelerates cirrhosis in co-infection.
- Primary Biliary Cholangitis – The bile ducts become damaged by an autoimmune process, leading to secondary liver damage. Patients may be asymptomatic or have fatigue, pruritus, and non-jaundice skin hyperpigmentation with hepatomegaly.
- Primary Sclerosing Cholangitis – PSC is a Progressive Cholestatic Disorder presented with pruritus, steatorrhea, fat-soluble vitamin deficiencies, and metabolic bone disease. There is a strong association with the inflammatory bowel disease (IBD), especially ulcerative colitis.
- Autoimmune hepatitis – This disease is caused by an attack of the liver by lymphocytes, which eventually leads to scarring and inflaming of the liver.
- Hereditary Hemochromatosis – Usually presents with a family history of cirrhosis, skin hyperpigmentation, diabetes mellitus, pseudogout, or cardiomyopathy, all due to signs of iron overload.
- Wilson’s disease – Autosomal recessive disorder characterized by low serum ceruloplasmin and increased hepatic copper content on liver biopsy and elevated 24-hour urine copper. May also have Kayser-Fleischer rings in the cornea and altered mental status.
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What Are The Risk Factors of Cirrhosis?
Risk factors of Cirrhosis include:
- Chronic hepatitis B
- Chronic hepatitis C
- Chronic excessive alcohol intake
- Fatty liver disease (non-alcoholic steatohepatitis)
- Autoimmune liver disease (autoimmune hepatitis, primary biliary cirrhosis or primary sclerosing cholangitis)
- Wilson disease, hemochromatosis, and other rare inherited liver diseases
What Are The Symptoms of Cirrhosis?
Patients with early liver cirrhosis (compensated cirrhosis) often have no detectable symptoms or signs of disease. Such patients may feel completely well and healthy and are often diagnosed based on abnormal blood tests or liver scans. Those who are diagnosed thus have, on an average, a survival rate of more than 10 years.
Patients with more advanced liver cirrhosis may develop the following signs and symptoms:
- Swelling of the abdomen due to the accumulation of fluid (ascites)
- Swelling of the ankles and feet (pedal edema)
- Dilated blood vessels on the upper chest and arms (spider naevi)
- Enlarged spleen (splenomegaly)
- Drowsiness or confusion due to the inability of the liver to break down toxins in the blood (hepatic encephalopathy)
- Swollen veins in the esophagus and stomach that develop due to obstruction of blood flow in the liver (varices)
- Vomiting of blood or passage of black stools due to bleeding from ruptured varices (variceal bleeding)
- Yellowing of the eyes and skin (jaundice) associated with dark, tea-colored urine
- Development of liver cancer
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How is Cirrhosis Diagnosed?
Tests for diagnosing cirrhosis include:
- Liver function – Blood is checked for excess bilirubin, which is a product of red blood cells breaking down, as well as for certain enzymes that may indicate liver damage.
- Kidney function – Blood is checked for creatinine as kidney function may decline in later stages of cirrhosis (decompensated cirrhosis).
- Tests for hepatitis B and C – Blood is checked for the hepatitis viruses.
- Clotting – The International Normalized Ratio (INR) is checked for the blood’s ability to clot.
- Magnetic Resonance Elastography or Transient elastography – These noninvasive imaging tests detect hardening or stiffening of the liver.
- Biopsy – A tissue sample (biopsy) is not necessarily needed to diagnose the inflammation of the liver. However, the doctor may use it to identify the severity, extent, and cause of liver damage.
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How to Prevent And Control Cirrhosis?
Cirrhosis can be prevented by following these guidelines –
- Do not drink alcohol – In the wake of any liver disease even if it is not cirrhosis, the doctor must be consulted about whether alcohol is permissible.
- Eat a healthy diet – Choose a plant-based diet that’s full of fruits and vegetables. Select whole grains and lean sources of protein. Reduce the amount of fatty and fried foods. Caffeinated coffee may protect against fibrosis and liver cancer.
- Maintain a healthy weight – An excess amount of body fat can damage the liver. TA weight-loss plan can be of help.
- Reduce the risk of hepatitis – Sharing needles and having unprotected sex can increase the risk of hepatitis B and C. One must consult the doctor about hepatitis vaccinations.
Treatment of Cirrhosis
There is no specific treatment to cure cirrhosis. However, treatment can be given for the diseases that cause cirrhosis so as to keep it from getting worse.
- Alcoholic liver disease – In the case of alcoholic liver disease, doctors will recommend complete stoppage of alcohol consumption.
- Nonalcoholic fatty liver disease – In the case of non-alcoholic fatty liver disease, doctors recommend losing weight. Weight loss through healthy eating and regular physical activity can reduce fat in the liver, inflammation, and scarring.
- Chronic hepatitis C – In the case of chronic hepatitis C, doctors may prescribe one or more medicines that have been approved to treat hepatitis C.
- Chronic hepatitis B – For chronic hepatitis B, doctors may prescribe antiviral medicines that slow or stop the virus from further damaging the liver.
- Autoimmune hepatitis – Doctors treat autoimmune hepatitis with medicines that suppress or decrease the activity of the immune system.
- Diseases that damage, destroy, or block bile ducts – Doctors usually treat diseases that damage, destroy, or block bile ducts with medicines such as ursodiol (Actigall, Urso). Doctors may use surgical procedures to open bile ducts that are narrowed or blocked. Diseases that damage, destroy, or block bile ducts include primary biliary cholangitis and primary sclerosing cholangitis.
- Inherited liver diseases – Treatment of inherited liver diseases depends on the disease. Treatment most often focuses on managing symptoms and complications.
Cirrhosis – Lifestyle Tips
A patient with cirrhosis should follow these tips:
- Avoid alcohol if the liver problems are alcohol-related
- Lose weight in case of obesity
- Exercise regularly to reduce muscle wasting
- Practice good hygiene to reduce the chances of developing infections
What Are The Recommended Exercises For a Person With Cirrhosis?
There is evidence to suggest that exercise itself (with or without weight loss) can prevent and reverse fatty liver disease. One must spend 150-300 minutes or more each week doing any of the exercises like walking, cycling, jogging, football, yoga, tai chi, pilates, dancing or even gardening. A doctor or a health care professional can be asked for advice on the type of exercise that must be performed.
Cirrhosis And Pregnancy – Things to Know
As the treatment of cirrhosis improves, pregnancy in patients with cirrhosis is likely to become more common. Although maternal and fetal mortality is expected to similarly improve, pregnant patients with cirrhosis face unique risks. These include higher rates of spontaneous abortion and prematurity, and a risk for life-threatening variceal hemorrhage, hepatic decompensation, splenic artery aneurysm rupture, and postpartum hemorrhage. Pregnancy outcome may be influenced by the underlying etiology of liver disease, as in viral and autoimmune hepatitis. Medications also impact the course of pregnancy and must be tailored appropriately during this time.
Common Complications Related to Cirrhosis
Various types of complications of cirrhosis include:
- High blood pressure in the veins that supply the liver (portal hypertension) – Cirrhosis slows the normal flow of blood through the liver, thus increasing pressure in the vein that brings blood from the intestines and spleen to the liver.
- Swelling in the legs and abdomen – Portal hypertension can cause fluid to accumulate in the legs (edema) and in the abdomen (ascites). Edema and ascites may also result from the inability of the liver to make enough of certain blood proteins, such as albumin.
- Enlargement of the spleen (splenomegaly) – Portal hypertension can also cause changes to the spleen. Decreased white blood cells and platelets in the blood can be a sign of cirrhosis with portal hypertension.
- Bleeding – Portal hypertension can cause blood to be redirected to smaller veins, causing them to increase in size and become varices. Strained by the extra load, these smaller veins can burst, causing serious bleeding. Life-threatening bleeding most commonly occurs when veins in the lower esophagus (esophageal varices), or stomach (gastric varices), rupture. When the liver can’t make enough clotting factors, continued bleeding takes place. Bacterial infections are a frequent trigger for bleeding.
- Infections – In the case of cirrhosis, the body may have difficulty fighting infections. Ascites can lead to spontaneous bacterial peritonitis, which is a serious infection.
- Malnutrition – Cirrhosis may make it more difficult for the body to process nutrients, leading to weakness and weight loss.
- Buildup of toxins in the brain (hepatic encephalopathy) – A liver damaged by cirrhosis is not able to clear toxins from the blood as well as a healthy liver can. These toxins can then build up in the brain and cause mental confusion, and concentration difficulties. Hepatic encephalopathy symptoms may range from fatigue and mild impairment in cognition to unresponsiveness or coma.
- Jaundice – Jaundice occurs when the diseased liver doesn’t remove enough bilirubin, a blood waste product, from the blood. Jaundice causes yellowing of the skin, a yellowish discoloration of the white area of the eyes, and darkening of the urine.
- Bone disease – Some people with cirrhosis lose bone strength and are at greater risk of fractures.
- Increased risk of liver cancer – A large proportion of people who develop liver cancer that forms within the liver itself have cirrhosis.
- Acute-on-chronic liver failure – Some people end up experiencing multiorgan failure. Researchers now believe this is a distinct complication in some people who have cirrhosis, but they don’t fully understand its causes.
Other FAQs About Cirrhosis
Q. I know alcoholism damages the liver. What are the other toxic substances that will do the damage?
A. The most common agent is probably acetaminophen (Tylenol, although it is contained in many OTC medications). It remains the safest medication for fevers, aches, and pains, but only taken in small recommended amounts. Amounts greater than those recommended can result in liver damage or failure. Acetaminophen overdose is a common reason for considering a liver transplant.
A serious problem occurs in patients who drink alcohol on a daily basis, particularly more than 2 drinks. In those situations, normal doses of Tylenol (3 – 4 times a day) can produce severe liver damage. The same problem can occur in patients with other liver diseases such as viral hepatitis. Additionally, more common toxins tend to be those that are inhaled, such as cleaning solvents, aerosolized paints, thinners, etc, which are more dangerous with an underlying condition.
Q. Can liver damage be reversed?
A. The liver is a unique organ. It is the only organ in the body that is able to regenerate. With most organs, such as the heart, the damaged tissue is replaced with a scar, like on the skin. The liver, however, is able to replace the damaged tissue with new cells. If up to 50 – 60 percent of the liver cells may be killed within 3 – 4 days in an extreme case like a Tylenol overdose, the liver will repair completely after 30 days if no complications arise.
Complications of liver disease occur when regeneration is either incomplete or prevented by the progressive development of scar tissue within the liver. This occurs when the damaging agent such as a virus, a drug, alcohol, etc., continue to attack the liver and prevent complete regeneration. Once a scarred tissue has developed, it is very difficult to reverse that process. Severe scarring of the liver is known as cirrhosis. The development of cirrhosis indicates a late stage liver disease and is usually followed by the onset of complications.
Q. How long can I go on drinking every day before it affects my liver?
A. The largest risk factor for liver disease from alcohol is the amount and the length of time the individual has been drinking. Males often develop complications that appear to be on a gender basis as well. Each individual is entirely different. Complications can develop after 5 – 10 years, though it mostly takes 20 – 30 years. Many individuals appear to never develop end-stage liver disease from alcohol. Many other factors such as other diseases, hepatitis C, exposure to other toxins, and the individual’s own genetic makeup, also play a role.