Liver cirrhosis

Symptoms Of Liver Cirrhosis

Cirrhosis is usually asymptomatic, especially in the initial stages. The symptoms in the early stage of cirrhosis are not visible as the liver can still function despite being damaged. The symptoms start appearing after your liver becomes more severely damaged. The initial symptoms if your liver becomes more severely damaged are:

• Tiredness and weakness

• Malaise or feeling sick

• Insomnia

• Nausea and vomiting

• Loss of appetite resulting in weight loss

• Redness in the palms of the hands

• Mild pain or discomfort in the upper right side of the abdomen

If cirrhosis progresses further, some of the symptoms and complications include:

• Small spider-like veins underneath the skin 

• Severe itching

• Easily bleeding or bruising, nosebleeds & bleeding gums

• Yellowing of the skin (jaundice)

• Vomit containing blood

• Dark urine or tarry-looking stool

• Swelling of legs, ankles, and feet (edema)

• Painful swollen stomach from a build-up of fluid (ascites)

• Confusion, drowsiness, memory loss, hallucinations or slurred speech (hepatic encephalopathy)

• In women, heavy menstrual bleeding, irregular periods or absence of periods not related to menopause

• In men, loss of sex drive, breast enlargement (gynecomastia), testicular atrophy or impotence

Causes Of Liver Cirrhosis 

Liver cirrhosis may be caused by a wide range of diseases and disorders. Signs of liver cirrhosis progress gradually over time ultimately resulting in liver failure, if not adequately treated.

1. Long-term hepatitis infections (chronic)

A chronic liver infection can lead to damaged liver cells over a period of several years, resulting in cirrhosis. It is usually hepatitis B and C infections that mostly cause cirrhosis.

2. Chronic alcoholism

Consumption of alcohol causes inflammation to live cells, effectively poisoning them which results in the build-up of scar tissue in the liver. Excessive alcohol consumption (often consistently for more than a decade) leads to cirrhosis. The amount of damage varies from person to person and can also be influenced by familial susceptibility.

3. Non-alcoholic fatty liver (or steatohepatitis)

Fatty build-up in the liver over a prolonged period of time can lead to cirrhosis. Scar tissue which develops as a result is often linked with other conditions such as coronary artery disease, diabetes, obesity, high cholesterol, protein malnutrition, and treatment using corticosteroid medications.

4. Toxic substances or medications

Some medications such as alphamethyldopa, amiodarone, methotrexate, isoniazid or certain poisons, and environmental toxins, which are toxic to the liver, can contribute to scarring and damage. 

5. Inherited (genetic) disorders

Genetic conditions can sometimes interfere with the metabolism process of the liver and its ability to handle accumulation of iron (hemochromatosis) and copper (Wilson’s disease) in the system. Some other disorders include cystic fibrosis, alpha-1 antitrypsin deficiency, tyrosinemia, fructose intolerance, glycogen storage disease, galactosemia, abetalipoproteinemia & urea cycle defects like ornithine carbamoyltransferase deficiency & alagille syndrome.

6. Autoimmune liver disease

Autoimmune infections occur when instead of attacking invasive organisms such as bacteria, allergens, and viruses, the body’s immune system ‘attacks’ healthy tissues in the body, including the organs (in this case, the liver). Autoimmune hepatitis is one example where the body’s immune response malfunctions and fights the normal system of the liver and damages its cells instead of fighting an infection.

7. Cardiac cirrhosis

The inability of the heart to pump effectively can also cause blood to collect in the liver. This chronic, passive congestion causes damage to the liver cells, swelling, and pain. Some of the factors which lead to cardiac cirrhosis are infection of the heart muscle or the sac around the heart, heart valve dysfunction, and smoking.

8. Biliary cirrhosis

Bile is a substance produced by the liver to help the body digest fats. The following conditions can affect the bile ducts, which help to drain bile. This can cause bile to back up and finally cause the breakdown of liver function. It could be due to: 

• Poorly formed bile ducts (biliary atresia)

• Destruction of the bile ducts (primary biliary cirrhosis)

• Hardening and scarring of the bile ducts (primary sclerosing cholangitis)

9. Infections

Infections such as congenital or tertiary syphilis, brucellosis, echinococcosis, schistosomiasis and can cause cirrhosis.

10. Idiopathic/miscellaneous

Some of the common idiopathic causes include: 

• Idiopathic portal fibrosis

• Indian childhood cirrhosis

• Polycystic liver disease

   

Stages Of liver cirrhosis

It is a severe condition that is progressive and could last long-term. Based on the severity of the liver damage, liver cirrhosis can be classified into four stages: 

Stage 1: Inflammation 
This is the initial stage of liver cirrhosis. The person may feel fatigued or lack vigor/energy. There are no notable symptoms or signs yet at this stage. However, if the root cause of liver cirrhosis can be cured and eliminated, there is a possibility of recovery at this stage. 

Stage 2: Fibrosis 
The second stage of liver cirrhosis shows an increase in the amount of scar tissue that replaces the healthy liver cells. This leads to an increase in blood pressure within the system of veins in the liver called portal hypertension. There is still the possibility of partial reversal of liver cirrhosis at this stage.

Stage 3: Liver cirrhosis 
This stage of liver cirrhosis leads to the accumulation of fluid in the abdominal cavity, referred to as ascites. The volume of fluid accumulation gives an indication of liver damage. The symptoms which indicate that the liver is not working properly include eczema, widespread itchiness, weight loss, loss of appetite, confusion, or lower leg swelling, shortness of breath, yellow or pale skin, and changes in blood sugar level. At this stage, cirrhosis becomes irreversible and the patient may be recommended for a liver transplant.

Stage 4: Liver failure 
The final stage of liver cirrhosis results from immense levels of scar tissue present in the liver. Stage 4 liver cirrhosis presents the same symptoms as stage 3, with the addition of intensified confusion, hand tremors, high fever, changes in personality, infection in the abdominal cavities, and kidney failure that results in infrequent urination. The need for a liver transplant becomes urgent by the time a patient reaches this final stage of liver cirrhosis.

Risk Factors For Liver Cirrhosis 

The risk factors of cirrhosis include: 

• High cholesterol (due to high cholesterol liver is unable to break the fatty deposit that can lead to damage to the liver)

• Being overweight or obese

• Excessive alcohol consumption

• Pre-existing viral hepatitis

• Hypertension

• Sleep apnea

• Gout

• Long term treatment with corticosteroids

• Chronic exposure to environmental toxins like arsenic

Diagnosis Of  Liver Cirrhosis 

People with early-stage cirrhosis of the liver usually don't have any symptoms. Cirrhosis is first detected by a routine blood test or checkup. A combination of laboratory and imaging tests are done to confirm a diagnosis. 

The general diagnostic procedure will follow the below steps:

1. Medical history 

A doctor will discuss all the obvious symptoms, the level of severity, the duration of time a person has been experiencing the symptoms, and also note down the complete medical history till date. A doctor will also assess necessary family history details and any signs of genetic history. 

2. Physical examination 

During a physical examination, a doctor will look for any physical signs of impaired liver function like pale skin, jaundice, red palms, impaired or excess breast tissue (in men), small or enlarged testicles, and enlarged liver or spleen. During a physical examination, an enlarged liver can be felt along the lower edge of the right rib cage and an enlarged spleen can be felt just below the left rib cage.

3. Blood tests 

Your doctor may recommend the following blood tests:

• Liver function test (LFT): This test can show abnormal liver enzyme levels, which may be a sign of liver damage. Increased levels of bilirubin, liver enzymes alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP) or decreased levels of blood proteins can signal cirrhosis.

• Kidney function test (KFT):This test will assess creatinine levels, it is a waste product, which will help to determine the normal or abnormal function of the kidneys. During the latter stages of cirrhosis, the kidneys begin to experience loss of function as well.

• Complete blood count (CBC): This test may show signs of infection and anemia that may be caused due to internal bleeding.

• Other blood tests: Antibodies are screened for hepatitis infections (mainly B and C), blood tests for autoimmune liver conditions, which include the antinuclear antibody (ANA), anti-smooth muscle antibody (SMA), and anti-mitochondrial antibody (AMA) tests.

4. Imaging tests

The following imaging tests can show the size, shape, texture, and stiffness of your liver, picking up abnormalities (scarring) on or within the organ.

• Abdominal ultrasound: Abdominal ultrasound is a non-invasive, widely available procedure that uses sound waves to create pictures of the inside of the abdomen and/or pelvis, including images of gross appearance of the liver. Doppler ultrasound allows for evaluation of blood flow to and from the liver. Ultrasound is usually the first radiographic test performed in the evaluation of cirrhosis because it is the least expensive and does not pose a radiation exposure risk.

• Abdominal computed tomography (CT): This procedure combines special x-ray equipment with computers to produce multiple, detailed digital images of the liver. It can help determine the severity of cirrhosis as well as other liver diseases. 

• Body magnetic resonance imaging (MRI): This imaging technique uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of the liver. A dye may be injected into your vein. The dye helps the liver to be seen more clearly on the scan allowing for assessment of damage caused by various liver diseases.

• Magnetic resonance cholangiopancreatography (MRCP): MRCP is a special type of MRI that is used to evaluate a part of the liver and gallbladder.

• Magnetic resonance elastography (MRE): This test assesses the stiffness and severity of scarring in the liver. Elastography can detect stiffness of the liver caused by liver fibrosis earlier than other imaging tests. The test can be performed by ultrasound or MRI.

• Transient elastography (fibroScan): This test helps to quantify liver fibrosis (scarring).

• Upper endoscopy: A lighted flexible camera is inserted through the mouth into the upper digestive tract to view enlarged blood vessels that are at risk of bleeding because of cirrhosis.

5. Liver biopsy

In liver biopsy, small tissue samples are taken from the liver with a needle or during a surgery. It is usually considered when other tests have failed to confirm a diagnosis of cirrhosis and the benefit of biopsy outweighs the risk. The accuracy of diagnosis of cirrhosis ranges from 80 to 100 percent, depending on the number and size of the samples and on the sampling method.

Prevention Of Liver Cirrhosis 

Even though the liver is the only organ in the body having regenerative capacity, it is essential to never abuse it and treat the organ with respect and care. Following steps can be taken for the prevention of liver cirrhosis:

1. Limit alcohol intake

Alcohol should always be consumed in moderation. Men should not have more than two drinks per day while women and elderly are not supposed to consume more than one drink per day. However, it is always better to completely abstain from alcohol, especially in case of liver disease. This includes avoiding all beer, wine, coolers, whiskey, gin, rum, brandy, and liquors.

2. Diet considerations

• Healthy diet plays an important role in prevention of liver diseases. Diet should include fruits, vegetables, whole grains, lean protein sources, unsalted nuts, seeds and low-fat dairy products.

• Salt intake should be limited. If lack of salt affects taste, one can enhance the flavor with lemon juice, vinegar, herbs or spices. Ketchup, pickles, soy sauce, and hot sauces have a high sodium content and should be avoided. Restaurants and fast food, add a lot of salt to their food so try to avoid them or request for the meal to be prepared without salt. Canned vegetables which are loaded with salt should also be avoided.

• Eating foods with healthy fats is also important. Unsaturated fats should be consumed instead of saturated fats and trans fats.

• In case of hemochromatosis, iron supplements and multivitamins with iron and Vitamin C should be avoided.

• In case of Wilson's disease, foods high in copper need to be eliminated from the diet. These foods include shellfish, organ meats, nuts, chocolate, mushrooms, kale, asparagus, parsley, potatoes with skin (both white and sweet), lima beans, soybean, sprouts and spinach.

3. Maintain a healthy weight

An excess amount of body fat can cause damage to your liver. Always consult a doctor regarding maintenance of weight and weight loss plan, if you are obese or overweight.

4. Reduce the risk of hepatitis

By avoiding hepatitis infection (particularly hepatitis B and C), a person reduces the risk of developing liver cirrhosis by many folds. To further lower the risk:  

• Avoid unprotected sex 

• Avoid sharing of needles

• Do not get tattoos or body piercings in an unsterilised environment. Also, make sure the instruments are properly sterilized and needles are not shared.

• Get vaccinated. It is recommended that all infants and high risk individuals like healthcare providers and rescue personnel should be vaccinated against hepatitis B. There is no vaccine for hepatitis C.

Here are a few more tips that can help in the detoxification of the liver.
Click Here!

Specialist To Visit

A general practitioner can evaluate causes of liver abnormalities and refer to the following specialists for assessment:

• Gastroenterologist

• Hepatologist

A gastroenterologist is a specialist in the treatment & management of the disorders of the digestive tract organs including the liver, while a hepatologist specializes in disorders of the liver biliary tract, gall bladder & pancreas. 

If you are facing any symptoms, consult our healthcare professionals. 
Consult Now!

Treatment Of Liver Cirrhosis

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. Cirrhosis cannot be cured but treatment focused on preventing further liver damage, easing symptoms, and reducing the impact of complications.

1. Treatment of alcohol dependence

People with cirrhosis caused by excessive alcohol should stop consumption of alcohol. If stopping alcohol is difficult, a doctor may recommend a treatment program for alcohol addiction. Some programs are as follows:

• Counseling. This helps the individual to focus on how he/she can stop drinking

• Rehab programs: It is a program to get help in case of alcohol addiction.

• Prescribed medications: Disulfiram and acamprosate are used as prescription medicines for controlling alcohol craving and discomfort.

2. Medications

The medication required depends on what has caused the damage to the liver.

• If cirrhosis is from long-term viral hepatitis, you may be prescribed antiviral medicines like lamivudine, entecavir, and tenofovir disoproxil fumarate.  

• If cirrhosis is caused by a copper build-up from Wilson’s disease medicine like D-penicillamine, and trientine are used. 

In addition to any medication that might be used to treat the underlying cause of cirrhosis, certain medications may be used to treat the complications that can result from cirrhosis:

• Portal hypertension: Blood pressure medications can help lower pressure in the portal vein, which brings blood to the liver. Lowering pressure in the portal vein can reduce the risk of internal bleeding and damage to the spleen. Propranolol is one of the commonly used drug. 

• Hepatic encephalopathy: Lactulose is a laxative that can help reduce the absorption of substances that can be harmful to the brain. Antibiotics like rifaximin are also used in hepatic encephalopathy.

• Ascites and edema: Diuretics such as spironolactone or furosemide may be prescribed to reduce the accumulation of fluid in the abdomen or legs.

• Infections: Antibiotics may be prescribed to prevent or treat infections. Intravenous antibiotics can be given to treat peritonitis that can occur with ascites.

• Itching: Drugs that may be used to relieve itching associated with liver cirrhosis include cholestyramine and colesevelam. Both of these drugs are also used to lower high blood cholesterol level.

• Malnutrition and osteoporosis: Nutritional supplements may be prescribed to counter malnutrition associated with cirrhosis and to prevent weak bones or osteoporosis.

3. Transjugular intrahepatic portosystemic shunt (TIPS)

This procedure is used to treat the portal hypertension caused by cirrhosis. A small tube or stent is placed into the liver to bypass blood flow into the liver by directing it back towards the heart.

4. Liver transplantation 

In advanced cases of cirrhosis, when the liver ceases to function, a liver transplant is the last treatment option. A liver transplant is a procedure to replace a liver with a healthy liver from a deceased donor or with part of a liver from a living donor. Candidates for liver transplants have extensive testing to determine whether they are healthy enough to have a good outcome following surgery.

Home-care For Liver Cirrhosis 

Cirrhosis of the liver is a chronic disease that occurs as a result of damage to the liver over several years. It’s a progressive disease in which healthy liver tissue is destroyed and replaced by scar tissue, resulting in poor liver functioning. While undergoing treatment, some home care tips which can be really helpful are: 

1. Lifestyle changes 

If a person is having cirrhosis, several lifestyle changes can be made to reduce the chances of further problems and complications. These include: 

• Quit smoking

• Avoid alcohol

• Practice good hygiene 

2. Dietary changes

• Malnutrition is common in cirrhosis as it makes it more difficult for your body to process nutrients, leading to weakness and weight loss. So it's important to eat a healthy, balanced diet including fruits, vegetables, whole grains, lean protein sources, unsalted nuts and seeds and low-fat dairy products.

• Cutting down on salt can help reduce the swelling in the legs, feet, and tummy caused by the build-up of fluid.

• Eating healthy snacks between meals, or having 3 or 4 small meals each day, rather than 1 or 2 large meals, may help.

Read about food items that you can include in your diet for a healthy liver.
Check Here!

3. Exercise 

Yoga and tai chi may help patients overcome the fatigue that is commonly associated with liver disease. Some light exercises can include a home-based aerobic routine, dancing as a form of exercise, lifting light weights, and yoga such as pranayama.

Complications Of Liver Cirrhosis

If cirrhosis progresses and the liver is no longer able to function (decompensated cirrhosis), may get complications that need treatment.

1. Portal hypertension 

Cirrhosis slows down the normal blood flow through the liver. This leads to portal hypertension which is an increase in the pressure within the portal vein. It is the vein that carries blood from the digestive organs to the liver.

2. Swollen or bleeding veins 

Portal hypertension can cause blood to be redirected to smaller veins. This causes the veins in the food pipe (esophagus) or stomach to become swollen. These are called esophageal varices and gastric varices. Due to the excessive pressure, these smaller veins can burst, causing serious bleeding. If the liver is not able to make enough clotting factors, it can contribute to continuous bleeding.

3. Fluid retention in the tummy or legs 

A build-up of fluid in your tummy area (ascites) or legs and ankles (peripheral edema) is a common complication of elevated portal pressure which causes fluid retention. Edema and ascites can also occur from the incapacity of the liver to make blood proteins like albumin.

4. Hepatic encephalopathy

Cirrhosis of the liver hampers its ability to clear toxins from the blood. These toxins can build up in the brain and cause symptoms like mental confusion, drowsiness and problems concentrating. Long term hepatic encephalopathy can also lead to unresponsiveness or coma.

5. Bleeding 

Cirrhosis can affect the liver's ability to make enough clotting factors. Hence, there is a chance of severe bleeding in case of cuts and wounds, during surgeries or dental work. 

6. Splenomegaly or enlargement of spleen

Portal hypertension can also cause swelling of the spleen along with entrapment of white blood cells and platelets. Reduction in white blood cells and platelets in blood tests could be the first sign of cirrhosis.

7. Jaundice

Cirrhosis of the liver affects its ability of the liver to eliminate bilirubin, a waste product from the blood. This leads to jaundice, a condition in which the skin, whites of the eyes and mucous membranes turn yellow.

8. Infections

Cirrhosis also reduces the body’s immunity to fight infections. Ascites or fluid retention in the abdomen can also cause a serious infection known as bacterial peritonitis.

9. Osteoporosis

Some patients of cirrhosis tend to lose their bone strength and are at a higher risk of bone fractures.

10. Diabetes 

Diabetes may get worse if someone already has type 2 diabetes and develops cirrhosis. This is because, cirrhosis can increase your resistance to insulin, a hormone which controls blood sugar levels.

11. Liver cancer 

Cirrhosis increases the chance of liver cancer, most commonly a type called hepatocellular carcinoma (HCC). Many symptoms of liver cancer are the same as symptoms of cirrhosis, so regular checks for liver cancer are important.

Alternative Therapies For Liver Cirrhosis 

Home remedies

1. Papaya seeds: According to Ayurveda, papaya seeds can help in the treatment of cirrhosis of the liver by aiding liver detoxification.

Tip: Grind some fresh papaya seeds to extract 1 tablespoon of juice, add two tablespoons of lemon juice and drink this mixture twice a day for a month to improve liver functioning.

2. Vitamin C: It has protective effects against liver oxidative damage. It also prevents fatty buildup and cirrhosis.

Tip: Include vitamin C-rich foods like blackberries, lemons, and oranges in your diet.

3. Turmeric: It is a rich source of antiseptics, with antibacterial, antifungal, and antioxidant properties and can do wonders in treating liver disease.

Tip: Add a tablespoon of turmeric in hot milk with honey and drink this once a day for about a month.

4. Apple cider vinegar (ACV): The ACV is good as it helps improve fat metabolism. It also works as a detoxifying agent for the liver. 

Tip: Take a glass of water and add a tablespoon of ACV and a teaspoon of honey to it. Drink this mixture 3 times a day to get a healthy liver.

5. Green tea: It is loaded with antioxidants that reduce oxidative stress, which initiates cirrhosis of tissues. It has a protective effect against liver disease and has antiviral properties that help fight viral hepatitis.

6. Milk thistle: It is a Mediterranean herb which has been used for centuries to treat liver problems. It acts a powerful liver cleanser by rebuilding liver cells, reducing liver damage, and removing toxins from the body that are processed through the liver.

Living With Liver Cirrhosis 

Often, receiving a diagnosis of liver cirrhosis can be a life-altering and challenging situation for patients and their caregivers. Coming to terms with the diagnosis can invoke feelings of feeling loneliness, depression, anger, rage, guilt, and limiting the intake of alcohol. However, it is important to remember that a diagnosis of liver cirrhosis does not necessarily mean the end of life. It is possible to live a happy life even after being diagnosed with liver disease. 

• Make sure that the person understands the diagnosis and its health implications. 

• Motivate the patient to stay socially active such as going to a movie or taking a walk in a park. Engage them in community activities like attending functions or helping them join a support group. 

• Encourage them to spend time with friends and family so that if a person is indulged in alcohol, they can control his mood swings and calm his senses. 

• Love, understanding, patience, and reassurance are cornerstones of living with loved ones.