Liver Cirrhosis

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What Is Liver Cirrhosis?

Liver cirrhosis occurs when healthy liver cells are destroyed and replaced by permanent scar tissue. As cirrhosis progresses, the liver gradually loses its ability to function normally, blood flow through the liver becomes restricted and eventually the liver, which is normally soft, becomes hard and scarred.

Liver cirrhosis is a major cause of liver failure and liver cancer and can become life-threatening when it reaches an advanced stage.

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Normal liver and cirrhotic liver

Major Causes of Liver Cirrhosis

Liver cirrhosis can develop after years of ongoing liver injury caused by different conditions. Major causes include:

  1. Long-term infection with hepatitis B, hepatitis C, or hepatitis D can cause cirrhosis. Hepatitis B and C are commonly spread through infected blood and blood products.
  2. Fatty liver disease can progress to non-alcoholic steatohepatitis (NASH), which causes inflammation and liver damage and may eventually lead to cirrhosis.
  3. Long-term, heavy alcohol consumption can cause progressive liver damage and eventually lead to cirrhosis (alcoholic hepatitis).
  4. Some inherited conditions can damage the liver and cause cirrhosis, including:
    • Wilson disease
    • Hemochromatosis
  5. In autoimmune hepatitis, the body's immune system mistakenly attacks healthy liver cells, causing ongoing inflammation and damage.
  6. Diseases that damage or block the bile ducts can eventually cause cirrhosis. These include:
    • Primary biliary cholangitis (PBC), formerly called primary biliary cirrhosis
    • Primary sclerosing cholangitis (PSC)
  7. Certain birth defects affecting the bile ducts can cause progressive liver damage and cirrhosis in children (biliary atresia).

Symptoms and Complications of Liver Cirrhosis

Cirrhosis is generally divided into two stages:

1. Compensated Liver Cirrhosis

In compensated cirrhosis, some liver cells are damaged while the remaining healthy liver cells continue to work and compensate for the damage. As a result, the liver may continue to perform most of its functions relatively well, and a person may have few or no symptoms. However, this condition may not remain stable indefinitely. Over time, pressure in the blood vessels around the liver can increase, and more liver cells may lose their ability to function.

2. Decompensated Liver Cirrhosis

In decompensated cirrhosis, liver function begins to deteriorate significantly, and several serious complications may develop at the same time. Patients may require various forms of supportive treatment to control these complications. In advanced cases, liver transplantation may be necessary as a life-saving treatment. Both compensated and decompensated cirrhosis can be associated with the development of liver cancer.

Symptoms of Liver Cirrhosis

People with liver cirrhosis may experience:

  • Loss of appetite, nausea, and weight loss
  • Weakness and fatigue
  • Jaundice (which causes the eyes and skin to become yellow)
  • Itchy skin
  • Buildup of fluid in the abdomen (ascites)
  • Swelling of the legs and feet (oedema)
  • Vomiting blood
  • Black, tarry stools (melena) or blood in the stool
  • Excessive sleepiness
  • Confusion or changes in mental awareness (delirium)
  • Loss of consciousness (hepatic coma)

Diagnosing Liver Cirrhosis

Doctors diagnose cirrhosis using a combination of medical history, physical examination, laboratory tests, and imaging studies.

Medical History

The doctor will ask about:

  • Symptoms
  • Previous liver disease
  • Alcohol use
  • Medications
  • Other medical conditions
  • Possible exposure to hepatitis viruses
  • Family history of liver disease

Physical Examination

A physical examination can help identify signs of cirrhosis and its complications, such as:

  • An enlarged or abnormal liver
  • An enlarged spleen
  • Jaundice
  • Ascites
  • Leg swelling

Blood and Liver Tests (Liver Biochemistry)

Blood tests and liver function tests (LFTs) help assess liver function and detect signs of liver injury.

Viral Markers

Blood tests for hepatitis B, hepatitis C, and other viral markers may be performed to identify viral infections that could be causing liver damage, such as:

  • HBsAg
  • Anti-HCV
  • Anti-HBc Total

Abdominal Imaging

Imaging tests can help evaluate the liver and identify complications. These may include:

  • Ultrasound
  • CT scan
  • MRI

FibroScan

A FibroScan can measure liver stiffness and help assess the amount of fibrosis or scarring in the liver.

Liver Biopsy

In some cases, a liver biopsy may be needed. A small sample of liver tissue is removed with a needle and examined to determine the extent and type of liver damage.

Assessing the Severity of Liver Cirrhosis

The severity of advanced liver disease can be assessed using the Model for End-Stage Liver Disease (MELD) score.

The MELD score is calculated using blood test results, including measurements of:

  • Bilirubin
  • Creatinine
  • INR (International Normalized Ratio)
  • Sodium

The MELD score generally ranges from 6 to 40. A higher MELD score indicates more severe liver disease and a higher risk of serious complications and death. The score is also used to help determine the urgency of liver transplantation in appropriate patients.

Treatment of Liver Cirrhosis

Treatment aims to slow or stop further liver damage, manage complications, and treat the underlying cause.

Important measures include:

  • Preventing further liver damage or controlling the cause of liver disease
  • Preventing and treating complications of cirrhosis
  • Providing appropriate treatment for chronic viral hepatitis (HBV, HDV and HCV)
  • Completely avoiding alcohol in people with alcohol-related cirrhosis
  • In people with NASH-related cirrhosis, properly managing conditions such as:
    • Diabetes
    • Hypothyroidism
    • Dyslipidemia (abnormal blood fat levels)
    • Obesity

Maintaining a healthy body weight is important. The source recommends keeping BMI within the normal range of 18.5 to 24.9.

Treatment of Cirrhosis-Related Symptoms and Complications

  • Diuretics, or water pills, may be used to reduce excess fluid buildup in the abdomen.
  • A low-sodium diet and avoiding excess salt are also important.
  • Vomiting blood or passing blood in the stool can be caused by bleeding from esophageal varices and is a medical emergency. Endoscopic variceal ligation (EVL) may be performed to control or prevent bleeding. Other medicines may also be used as appropriate.
  • Severe confusion or loss of consciousness in a person with cirrhosis may be caused by hepatic encephalopathy. Treatment may include: lactulose, antibiotics, enema and other medicines and supportive treatments.

Important Things to Remember If You Have Liver Cirrhosis

People with liver cirrhosis should remember the following:

  • Do not drink alcohol.
  • Avoid adding excessive salt to your food.
  • Do not take aspirin or pain relievers without first consulting your doctor.
  • Avoid sleeping pills or sedative medicines unless specifically prescribed by your doctor.
  • Avoid cough medicines containing codeine unless your doctor recommends them.
  • If you need surgery for any reason, tell both your liver specialist and surgeon that you have cirrhosis.
  • If you ever vomit blood or have black, tarry stools, seek medical attention immediately.
  • Have an abdominal ultrasound about every six months, as recommended by your doctor, to check for ascites and to screen for early signs of liver tumors or liver cancer.
  • Do not smoke.

The Final Treatment for Advanced Cirrhosis: Liver Transplantation

For some people with advanced liver cirrhosis and end-stage liver disease, a liver transplant can be a life-saving treatment. During a liver transplant, the diseased liver is removed and replaced with either a partial or whole donor liver, depending on the type of transplant.

There are two main types of liver transplantation:

  1. Living-Donor Liver Transplantation: A healthy person can donate part of their liver to a close relative or another suitable recipient. This is called a living-donor liver transplant. The liver has a remarkable ability to regenerate. After donation, the remaining liver in the donor and the transplanted portion in the recipient can grow and adapt to meet the body's needs.
  2. Deceased-Donor Liver Transplantation: Another option is a deceased-donor liver transplant. When a person is declared brain-dead and has consented to organ donation according to applicable laws and procedures, their donated liver may be transplanted into a suitable recipient.

According to the figures presented in the original source, the estimated 5-year survival rate is approximately:

  • Living-donor liver transplantation: 75%–100%
  • Deceased-donor liver transplantation: 71%–75.4%

Survival depends on many factors, including the patient's overall health, the cause and severity of liver disease, complications before transplantation, donor and recipient factors, and the quality of post-transplant care.