Cirrhosis

Introduction

Cirrhosis is a late-stage liver disease characterized by scarring (fibrosis) of the liver tissues. It can occur due to multiple reasons such as hepatitis, alcoholism, fatty liver, etc. Your liver tissues have the ability to repair themselves after being damaged. During this repair process, fibrous tissues form as a consequence. If this continues for a long time, your liver gets scarred beyond damage and loses normal functioning. Due to this reason, cirrhosis is irreversible in majority of the cases. If diagnosed early, it can be reduced, and the liver can be allowed to function normally.

 

Causes

Any factor that causes damage to your liver can lead to cirrhosis. Chronic alcoholism, hepatitis B and C, and non-alcoholic fatty liver disease are among the most common causes of cirrhosis. The longer a factor persists, the higher the chance of cirrhosis. Cirrhosis can also be caused by genetic diseases, which include Alpha-1 antitrypsin deficiency, Wilson’s disease, hemochromatosis, cystic fibrosis, Alagille syndrome, glycogen storage diseases, etc. These diseases may start to damage your liver from a young age.

In some cases, your immune system cells perceive liver cells as dangerous and start attacking them. This is known as autoimmune hepatitis, which can also lead to cirrhosis. Damage or blockage of the bile ducts (tubes that deliver bile from the liver to the digestive tract) can also cause cirrhosis. This can occur due to primary biliary cholangitis, primary sclerosing cholangitis, biliary atresia, or direct bile duct blockage. Chronic heart failure can also increase the burden on your liver. Some medications may also cause cirrhosis if used for a long duration, such as methotrexate, isoniazid, sulfasalazine, etc.

 

Risk Factors and Epidemiology

Long-term alcohol abuse is one of the leading causes of cirrhosis. The risk of cirrhosis is higher among chronic alcoholics. Those with chronic hepatitis B or C infection are also prone to develop this condition. Obesity and diabetes are among other risk factors because they can contribute to the development of non-alcoholic fatty liver disease. Those with a family history of genetic diseases that cause cirrhosis are also at high risk of developing this condition.

Cirrhosis has been observed frequently among elders over the age of 50. In most cases, more than one factor is responsible for leading up to this condition. Cirrhosis is more predominant in males than females. In Pakistan, chronic hepatitis B, hepatitis C, and fatty liver disease are among the leading causes of cirrhosis.

 

Signs and Symptoms

The signs and symptoms of this disease worsen as it progresses. In the beginning stages, you may not develop any visible signs or symptoms. Even if you do, they are often confused with other diseases. These may include nausea/vomiting, loss of appetite, fatigue, fever, generalised weakness, or unexplained weight loss.

As your liver continues to get scarred, the symptoms get worse. You may experience abdominal pain, jaundice, persistent itching, light-colored stools, dark urine, fluid buildup in your feet and around the abdomen, spider-like vessels on your skin, redness in your palms, confusion, memory loss, and difficulty in performing cognitive tasks. Cirrhosis can also affect men and women in different ways. It can lead to loss of sex drive, breast enlargement, and testicular atrophy in men. Women may suffer from the absence of periods at an early stage which is not related to menopause.

 

Diagnosis

The diagnosis procedure of cirrhosis begins with taking a detailed medical history. Your history can point toward the possible cause of liver damage. A thorough physical examination follows this to check for signs of this disease such as jaundice, tenderness in the upper right quadrant, enlarged or rough texture of liver, spider angiomas, redness in palms, etc.

The conformational diagnosis of cirrhosis is made based on multiple tests. These can include complete blood count (CBC), liver function tests (LFTs), INR, hepatitis tests, renal function tests (RFTs), and other suitable tests according to the suspected cause. Imaging tests are also done to visualize the extent of this disease. These can include CT scans, abdominal ultrasounds, and MRI. Transient elastography can be done to measure the stiffness of the liver. Endoscopic tests are required if damage to the bile duct or portal hypertension is suspected. A liver biopsy can be done if there is a risk of liver cancer.

 

Differential Diagnosis

Cirrhosis can occur due to many different underlying causes, making it difficult to differentiate the original cause. Its symptoms can also resemble a few other diseases, such as constrictive pericarditis, portal vein thrombosis, etc. Differentiation should be done on the basis of history, physical examination, and diagnostic tests.

 

Treatment

Cirrhosis has no cure because it is an irreversible process in most cases. The goal of treatment is to stop the progression of this disease and restore the normal functioning of the liver as much as possible. Treatment depends on the cause and severity of your condition. Chronic alcoholics are recommended for the treatment of alcohol addiction. Those with hepatitis B or C are given medications and suitable guidelines to limit the extent of liver damage. People with fatty liver disease are suggested to lose weight and maintain a healthy diet to reduce the stress on their liver. Those with genetic conditions are treated based on the underlying cause. If you have severe liver damage, you might be hospitalized until you are better to live on your own. If the liver damage has exceeded beyond compensation and cannot function on its own, a liver transplant will be the last option for this condition.

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Medication

Medications are given according to the underlying cause of cirrhosis. In many cases, supportive medications are given to reduce symptoms such as pain, swelling, itching etc. No medicines should be taken without a prescription from your doctor as they increase the risk of liver damage.

 

Prognosis

The prognosis of a patient with cirrhosis depends on the underlying cause and severity of the disease. Cirrhosis due to chronic alcoholism has a worse prognosis compared to hepatitis and other causes. Lack of proper treatment can increase the risk of future complications and mortality.

 

Prevention

Cirrhosis can be prevented by preventing its common causes. Reduce alcohol consumption and do not intake alcohol if you are at high risk of liver disease. Eat a balanced diet, exercise regularly, and maintain a healthy weight to reduce the stress on your liver. Get hepatitis vaccinations and avoid unprotected sex or sharing needles with unknown people. If you have someone with a history of genetic diseases that cause cirrhosis, consult your doctor and ask about the possible risk of this disease