Liver cirrhosis

Symptoms Of Liver Cirrhosis

Cirrhosis is usually asymptomatic, especially in the initial stages. Some of the initial symptoms if your liver becomes more severely damaged are:

• Tiredness and weakness
• Feeling sick
• Insomnia
• Nausea and vomiting
• Loss of appetite
• Weight loss
• Redness in the palms of the hands
• Mild pain or discomfort in the upper right side of the abdomen

If the liver cirrhosis progresses further, some of the symptoms can include:

• Small spider-like veins underneath the skin 
• Severe itching
• Nose bleeding
• Gingivitis (bleeding gums)
• Jaundice (yellowing of the skin)
• Vomit containing blood
• Dark urine or tarry-looking stool
• Edema (swelling of legs, ankles, and feet)
• Ascites (fluid build-up in the stomach)
  
  

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Stages of Liver Cirrhosis

Liver cirrhosis has four stages which will tell the person the seriousness of the liver damage:

Stage 1: Inflammation 

This is the initial stage of liver cirrhosis. The person may feel fatigued or lack vigor or energy. There are no notable symptoms or signs yet at this stage. 

Stage 2: Fibrosis 

The second stage of liver cirrhosis shows an increase in scar tissue that replaces the healthy liver cells. This leads to the rise in blood pressure within the system of veins in the liver called portal hypertension. 

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 indicates liver damage. 

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.

Causes Of Liver Cirrhosis 

Conditions that damage the liver and cause liver cirrhosis include: 

1. Long-term hepatitis infections (chronic)

• A chronic liver infection can lead to damaged liver cells over 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. 
  
  

3. Non-alcoholic fatty liver (or steatohepatitis)

• Non-alcoholic fatty liver disease (NAFLD) or its severe form, non-alcoholic steatohepatitis (NASH), can cause liver cirrhosis by leading to long-term liver damage. 

• In NASH, excess fat buildup in the liver triggers inflammation and scarring (fibrosis). 

• Over time, repeated damage and scarring can progress to cirrhosis.
  
  

4. Toxic substances or medications

• Some medications such as Alpha- methyldopa, Amiodarone, Methotrexate, Isoniazid, or certain poisons and environmental toxins can contribute to scarring and damage. 
  
  

5. Inherited (genetic) disorders

• Some genetic conditions affect the liver’s ability to process iron (hemochromatosis) and copper (Wilson’s disease), leading to damage.

• Other inherited disorders like cystic fibrosis, alpha-1 antitrypsin deficiency, and glycogen storage diseases can also impact liver function.
  
  

6. Autoimmune liver disease

• Autoimmune infections occur when instead of attacking invasive organisms the body’s immune system attacks healthy tissues in the body.

• Autoimmune hepatitis damages liver cells instead of fighting an infection and causes scarring.
  
  

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. 
  
  

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8. Biliary cirrhosis

• Bile is a substance produced by the liver to help the body digest fats and biliary cirrhosis 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.
  
  

9. Infections

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

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10. Idiopathic/miscellaneous causes

• Idiopathic portal fibrosis: A rare liver condition causing scarring in the portal vein without known causes.

• Indian childhood cirrhosis: A severe liver disease in young children, linked to excessive copper buildup in the liver.

• Polycystic liver disease: A genetic disorder where multiple fluid-filled cysts develop in the liver, sometimes affecting its function.

Risk Factors For Liver Cirrhosis 

The risk factors of liver cirrhosis are:

• High cholesterol (due to high cholesterol, the liver can’t be able to break the fatty deposit that can lead to damage to the liver)

• Obesity

• Excessive alcohol consumption

• Pre-existing viral hepatitis

• Hypertension (high blood pressure)

• Sleep apnea

• Gout (it is a form of arthritis caused by the buildup of uric acid crystals in the joints)

• Long-term treatment with corticosteroids

• Chronic exposure to environmental toxins like arsenic.

Diagnosis Of  Liver Cirrhosis 

The general diagnostic procedure consists of the following steps:

1. Medical history 

• Your doctor will discuss all the obvious symptoms, the level of severity, the duration of time a you have been experiencing the symptoms, along with a complete medical history. 

• Your doctor will also assess necessary family history details and any signs of genetic history. 
  
  

2. Physical examination 

During a physical examination, your doctor will look for any physical signs of impaired liver function. Also, your doctor will check your abdomen to look for an enlarged spleen or liver.

3. Blood tests 

• Liver function test (LFT): This test can show abnormal liver enzyme levels, which may be a sign of liver damage. 
  
  

• Kidney function test (KFT): This test will assess creatinine levels. Creatinine is a waste product that will help to determine the normal or abnormal function of the kidneys which can indicate liver damage 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

• Ultrasound (whole abdomen): Abdominal ultrasound is a noninvasive, widely available modality that allows for the evaluation of blood flow to and from the liver. 
  
  

• 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. 
  
  

• 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 to assess the damage.
  
  

• 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): It 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 liver cirrhosis.
  
  

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5. Liver biopsy

• In liver biopsy, small tissue samples are taken from the liver with a needle or during surgery. 

• It is usually considered when other tests have failed to confirm a diagnosis of cirrhosis and the benefit of biopsy outweighs the risk. 

Prevention Of Liver Cirrhosis 

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

1. Limit alcohol intake

• Alcohol should always be consumed in moderation. 

• However, it is always better to completely abstain from alcohol especially in case someone is having some liver disease. 
  
  

2. Dietary considerations

• Your diet should include fruits, vegetables, whole grains, lean protein sources, unsalted nuts and seeds, and low-fat dairy products.

• Salt intake should be limited.

• Unsaturated fats should be consumed instead of saturated fats and trans fats.

• If someone has Hemochromatosis, iron supplements, multivitamins with iron, and Vitamin C supplements need to be avoided.

• If someone has Wilson's Disease, foods high in copper need to be eliminated from the diet. These foods include shellfish, organ meats, nuts, chocolate, etc.
  
  

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.

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4. Reduce the risk of hepatitis

• Avoid unprotected sex 

• Avoid sharing of needles

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

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5. Get vaccinated

It is recommended that all infants and high-risk individuals like healthcare providers and rescue personnel should be vaccinated against hepatitis B. 

Specialist To Visit

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

• Gastroenterologist

• Hepatologist

A gastroenterologist specializes in digestive health and helps manage liver cirrhosis by addressing related gastrointestinal issues and complications.

A hepatologist focuses specifically on liver diseases, providing expert care for cirrhosis, including diagnosis, treatment, and advanced liver management.

Early care leads to better health outcomes. Consult an expert doctor today for the right diagnosis and treatment of liver cirrhosis. 
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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 medicines 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 medicines. 

• 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. Examples include norfloxacin and ciprofloxacin.

• 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 levels.

• 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 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 

Some home remedies may support liver health and aid in managing liver cirrhosis, but they are not a substitute for medical treatment. A conventional approach is essential, so always consult your doctor before trying anything new. Some of them include:

• Papaya (papita) seeds: According to Ayurveda, papaya seeds can help in the treatment of cirrhosis of the liver by aiding liver detoxification.
  
  How To Use It?
  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 function.
  
  
• Vitamin C: It can have protective effects against liver damage. It can also prevent fatty buildup and cirrhosis.
  
  How To Use It?
  Include vitamin C-rich foods like blackberries, lemons, and oranges in your diet.
  
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• Turmeric (haldi): It is a rich source of antiseptics, with antibacterial, antifungal, and antioxidant properties and can do wonders in managing symptoms of liver diseases.
  
  How To Use It?
  Add a tablespoon of turmeric in hot milk with honey and drink it regularly to see results.
  
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• Apple cider vinegar (ACV): The ACV can help improve fat metabolism. It can also work as a detoxifying agent for the liver. 
  
  How To Use It?
  Take a glass of water and add a tablespoon of ACV and a teaspoon of honey to it. Drink this mixture for a healthy liver.
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• Green tea: It is loaded with antioxidants and has a protective effect against liver diseases.
  
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• Milk thistle: It is a Mediterranean herb, that has been used for centuries to treat liver problems. It can help in removing toxins from the body that are processed through the liver.

Living With Liver Cirrhosis 

The diagnosis of liver cirrhosis can be an emotional ride for most people. Some essential tips that can help those living with liver cirrhosis include:

Follow a liver-friendly diet 

Eat a balanced diet rich in fruits, vegetables, whole grains, and lean proteins while avoiding processed foods, excess salt, and unhealthy fats.

Limit alcohol and avoid toxins 

Completely avoid alcohol and be cautious with medications, as the liver processes them. Always consult your doctor before taking any new medications or supplements.

Be mindful of your water and salt intake

Drink plenty of water to support liver function and overall health. Reduce salt consumption to prevent fluid retention and swelling (ascites).

Schedule regular check-ups 

This can help catch any new symptoms and manage complications early.

Practice good hygiene 

Wash hands regularly and follow hygiene practices to reduce the risk of infections.

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Take care of your mental health 

Chronic illness can be emotionally challenging. Seek support from healthcare providers, counsellors, or support groups.

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Complications Of Liver Cirrhosis

If cirrhosis progresses it can lead to complications like:

• Portal hypertension: Cirrhosis slows blood flow through the liver, increasing pressure in the portal vein, which carries blood from the digestive organs.
  
  

• Swollen or bleeding veins: Increased portal pressure redirects blood to smaller veins, causing swelling in the esophagus or stomach, which may lead to bleeding.
  
  

• Fluid retention in the tummy or legs: Portal hypertension and reduced blood proteins like albumin cause fluid buildup in the abdomen (ascites) and legs (edema).
  
  

• Hepatic encephalopathy: The liver struggles to remove toxins, leading to their buildup in the brain, causing confusion, drowsiness, and concentration issues.
  
  

• Bleeding: Cirrhosis impairs clotting factor production, increasing the risk of excessive bleeding from cuts, surgeries, or dental procedures.
  
  

• Splenomegaly (Enlarged spleen): Portal hypertension enlarges the spleen, trapping white blood cells and platelets, often detected through blood tests.
  
  

• Jaundice: Cirrhosis prevents bilirubin elimination, leading to yellowing of the skin, eyes, and mucous membranes.
  
  

• Infections: Weakened immunity from cirrhosis increases infection risk, and fluid retention in the abdomen can cause bacterial peritonitis.
  
  

• Osteoporosis: Some cirrhosis patients experience bone loss, raising their risk of fractures.
  
  

• Diabetes: Cirrhosis can worsen type 2 diabetes by increasing insulin resistance, making blood sugar harder to control.
  
  

• Liver cancer: Cirrhosis raises the risk of hepatocellular carcinoma (HCC), making regular screenings essential for early detection.

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