Liver Cirrhosis - Causes, Symptoms, Diagnosis, Prevention & Treatment
Health Education

Liver Cirrhosis

Dr.Shamsudin  Mohamed Rela profile Authored by Dr.Shamsudin Mohamed Rela on 22 May 2014 - 21:23.

Liver  is the largest solid organ in the human body. It is located in the right upper part of abdominal cavity. It performs many vital metabolic and synthetic functions. These functions can be grouped as follows:

  • Digestive functions: Secretion of bile for digestion and absorption of food.
  • Synthetic functions: Synthesis of various proteins, immunoglobulin’s, and clotting factors.
  • Homeostatic function: Storage and maintenance of blood level of glucose, fat, vitamins and nutrients.
  • Metabolism function: Detoxification of alcohol, drugs and toxins.
  • Immune function: Removal of bacteria and toxins from blood.

Liver has large functional reserve and any deterioration in liver function will manifest as disease only after considerable damage to liver has already occurred. Repeated or prolonged insult to the liver by various factors such as infection, toxins and alcohol cause damage to liver tissue. As a result of this, normal liver tissue is gradually replaced by fibrous tissue or scar tissue, referred to as ‘Cirrhosis of Liver’.

This rate of fibrosis depends on the underlying disease process. As cirrhosis develops, function of liver deteriorates, stiffness increases and resistance to flow of blood through liver increases. Increase in resistance to blood flow from intestine to liver will cause increase in pressure of blood in the portal vein (which takes blood from intestine to liver and spleen) causing portal hypertension.

Portal hypertension leads to enlargement of spleen and opening of alternate drainage veins called collaterals and may cause internal bleeding in esophagus or stomach. Spectrum of symptoms of cirrhosis depends on stage of disease and can vary from fatigue, weakness or loss of appetite to frank liver failure. Patients with advanced liver failure may have one or more symptoms like jaundice, accumulation of fluid in abdomen, swelling of legs, internal bleeding, depressed consciousness and death. 

Cirrhosis of liver can be caused by one or combination of following factors:

  • Infections like Hepatitis B and hepatitis C
  • Significant alcohol consumption over long time
  • Drugs and toxins.
  • Deposition of excessive fatty tissue in liver as in Non Alcoholic Fatty Liver Disease
  • Genetic diseases like Wilson’s disease, Cystic fibrosis and Haemochromatosis
  • Autoimmune hepatitis where body starts forming antibodies which damages liver tissue.
  • Congenital or acquired obstruction to flow of bile within or outside liver or both (Biliary atresia)
  • Medications include use of alternative medicines and toxins.
  • Congestion of liver due to heart failure or obstruction in flow of blood away from liver i.e. Budd Chiari Syndrome due to various causes
  • Cirrhosis of unknown origin (Cryptogenic cirrhosis).

Symptoms of cirrhosis depend on cause and amount of fibrous replacement of liver tissue. This is a dynamic process. Liver has considerable physiological reserve and regenerative capacity, hence initial manifestations are vague and frank disease symptoms appear after significant damage to liver.  The common signs and symptoms of liver cirrhosis are:

  • Anorexia, nausea and fatigue
  • Jaundice (yellowish discoloration of urine, eyes, skin and body secretions)
  • Itching, passage of pale stools
  • Weight loss
  • Easy bruising
  • Swelling of legs and body
  • Distension of abdomen due to fluid accumulation (Ascites)
  • Abnormal behavior or progressive drowsiness (hepatic encephalopathy)
  • Internal bleeding as indicated by blood mixed vomitus or coffee ground vomitus or black foul smelling tarry stool.
  • Development of complications like kidney failure (hepatorenal syndrome), fluid accumulation in pleural cavity (hepatic hydrothorax)
  • Infection of ascites, pleural effusion, blood or urine.

Due to relatively non-specific symptoms, it is difficult to diagnose cirrhosis in early stage. High degree of clinical acumen and suspicion is required to make this diagnosis. One must focus on obvious risk factors which may lead to development of cirrhosis. Diagnostic tests like blood and urine test along with sonography is of great help. These tests need to be performed in intelligent combinations and need to be judiciously interpreted. Diagnostic tests done for liver disease and cirrhosis are as follows:

  • Complete blood count: This may show low hemoglobin and platelets suggestive of portal hypertension, chronic disease or internal bleeding.
  • Liver function tests: Set of blood tests done to assess function of liver like bilirubin, liver enzymes, serum protein and albumin.
  • Renal function test: To assess status of kidney function.
  • Alfa feto protein: It is a tumor marker and raised level indicated possible hepato cellular carcinoma.
  • Tests for etiology: Viral study for HBV and HCV, Metabolic studies, autoimmune markers etc, as indicated by history.
  • Imaging tests: Like USG and triple phase contrast CT scan to assess size, shape, stiffness of liver, portal hypertension and hepatocellular carcinoma. Other imaging tests include Transient Elastography, MRI and angiography.
  • Liver biopsy: Test to identify the cause and severity of liver disease.  

Treatment of cirrhosis primarily involves slowing the disease process and treating complications, since extensive damage to the liver cannot be reversed. Early diagnosis of cirrhosis will help in achieving these goals. Treatments of liver cirrhosis involve withdrawal of offending agents like alcohol, medications etc, change in life style and diet for weight reduction and blood sugar control as in NAFLD and drugs like antivirals to treat viral infections. Choice of treatment and duration will depend on extent of disease and complications. Ultimate treatment is liver transplant in selected patients.

Liver transplant

Liver transplant is a procedure of replacing a damaged liver with a healthy liver (whole or portion of the liver). Liver transplant is of two types based on the source of liver: Live donor, who can donate part of his/her liver safely to the patient and Cadaver organ.  A live donor is a healthy close relative of recipient with compatible blood group.  Cadaveric organs are harvested from brain dead donors. Success rate of liver transplantation in high volume centers are as high as 90 percent.

 

Prevention is always better than cure. To avoid development of liver disease one most follow healthy practices.

  • Stop alcohol consumption.
  • Healthy diet, regular exercise and maintain optimum weight for age and height.
  • Vaccination against hepatitis B
  • Avoid over the counter drugs and alternative medications
  • Periodical health check up
  • Regular evaluation in diagnosed cases and strict follow up.
  • Treatment of other systemic diseases which can affect liver, like heart failure, diabetes and metabolic disorders.
*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.