Causative & risk factors
Any substance or disease that damages the liver cells can lead to cirrhosis. The leading causes of cirrhosis are chronic alcoholism and viral hepatitis (esp Hep B and C) and non-alcoholic fatty liver disease. Other causes of cirrhosis include cystic fibrosis, hemochromatosis, Wilson’s disease etc. Diseases of the biliary system such as biliary atresia or primary sclerosing cholangitis can also cause cirrhosis. Rarer causes of cirrhosis include autoimmune hepatitis, schistosomiasis and other inherited liver disorders. Certain medications, when taken over the long term, can also lead to liver cirrhosis.
Clinical presentation
Mild or moderate cirrhosis is usually asymptomatic. When symptoms are present, they include jaundice, easy tendency to bruise or bleed, weakness, loss of appetite, nausea and loss of weight. The skin may become itchy and spider like blood vessels may appear on the skin. The patient develops pedal edema and ascites. Sometimes the patient may become confused and disoriented and develop a slurred speech.
Advanced cirrhosis can give rise to complications like splenomegaly, portal hypertension and formation of esophageal or gastric varices. Other complications include hepatic encephalopathy, a higher fracture risk, frequent infections, malnutrition, formation of hepato-biliary stones and a higher risk of developing liver cancer.
Investigations
People with early-stage cirrhosis of the liver usually don’t have symptoms. Often, cirrhosis is first detected through a routine blood test or checkup. Your doctor may order one or more tests or procedures to diagnose cirrhosis.
Laboratory tests:
Liver function. Your blood is checked for excess bilirubin and certain enzymes that may indicate liver damage.
Kidney function. Your blood is checked for creatinine.
Tests for hepatitis B and C. Your blood is checked for the hepatitis viruses.
Clotting. Your international normalized ratio (INR) is checked for your blood’s ability to clot.
Imaging and other tests:
Magnetic resonance elastography (MRE). This noninvasive advanced imaging testdetects hardening or stiffening of the liver.
Other imaging tests. MRI, CT and ultrasound can image the liver.
Biopsy. A tissue sample (biopsy) is not necessarily needed for diagnosis. However, your doctor may use it to identify the severity, extent and cause of liver damage.
Treatment
Treatment for cirrhosis depends on the cause and extent of your liver damage. The goals of treatment are to slow the progression of scar tissue in the liver and to prevent or treat symptoms and complications of cirrhosis. You may need to be hospitalized if you have severe liver damage.
Treatment for the underlying cause of cirrhosis
In early cirrhosis, it may be possible to minimize damage to the liver by treating the underlying cause. The options include:
Treatment for alcohol dependency. People with cirrhosis caused by alcohol abuse should try to stop drinking. If stopping alcohol use is difficult, your doctor may recommend a treatment program for alcohol addiction.
Weight loss. People with cirrhosis caused by nonalcoholic fatty liver disease may become healthier if they lose weight and control their blood sugar levels.
Medications to control hepatitis. Medications may control damage to liver cells caused by hepatitis B or C.
Medications to control other causes and symptoms of cirrhosis. Medications may slow the progression of certain types of liver cirrhosis. For example, people with primary biliary cirrhosis that is diagnosed and treated early may never experience symptoms.
Other medications can relieve certain symptoms, such as itching, fatigue and pain. Nutritional supplements may be prescribed to counter malnutrition associated with cirrhosis and to prevent osteoporosis (weak bones).
Liver transplant surgery
In advanced cases of cirrhosis, when the liver ceases to function, a liver transplant may be the only treatment option. A liver transplant is a procedure to replace your liver with a healthy liver from a deceased donor or with part of a liver from a living donor. Cirrhosis is the most common reason for a liver transplant.
Extensive testing is needed before a liver transplant to ensure that a candidate is in good enough health to have the transplant operation. Additionally, transplant centers typically require some period of abstinence from alcohol, often at least six months, before transplantation for people with alcohol-related liver disease
If you have cirrhosis, be careful to limit additional liver damage:
Don’t drink alcohol. Whether your cirrhosis was caused by chronic alcohol use or another disease, avoid alcohol. Drinking alcohol may cause further liver damage.
Eat a low-sodium diet. Excess salt can cause your body to retain fluids, worsening swelling in your abdomen and legs. Use herbs for seasoning your food, rather than salt. Choose prepared foods that are low in sodium.
Eat a healthy diet. People with cirrhosis can experience malnutrition. Combat this with a healthy plant-based diet that includes a variety of fruits and vegetables. Choose lean protein, such as legumes, poultry or fish. Avoid raw seafood.
Avoid infections. Cirrhosis make sit more difficult for you to fight off infections. Protect yourself by avoiding people who are sick and washing your hands frequently. Get vaccinated for hepatitis A and B, influenza, and pneumonia.
Use over-the-counter medications carefully. Cirrhosis makes it more difficult for your liver to process drugs. For this reason, ask your doctor before taking any medications, including nonprescription drugs. Avoid drugs such as aspirin and ibuprofen (Advil, Motrin IB). If you have liver damage, your doctor may recommend you avoid acetaminophen (Tylenol, others) or take it in low doses for pain relief.
