Is your liver at risk? Everything about cirrhosis of the liver in simple terms

The liver is a very important organ in our body, isn't it? It's like a small factory in our body. But this liver can also develop diseases. Sometimes you have heard stories like "the liver is hard", "the liver is damaged". One such serious condition is called cirrhosis of the liver. Let's talk about this in a little more detail today, because it is very important to be aware of this.

Let's first look at what cirrhosis of the liver is.

Simply put, cirrhosis of the liver is a condition where the liver has been damaged for a long time and healthy liver cells have been replaced by scar tissue . Just like a scar forms on our skin when we have a wound, if there is a continuous inflammation in the liver, or what we call hepatitis , this scar tissue forms as the liver tries to heal itself. But when this scar tissue builds up, the liver cannot function properly. This is the final stage of the liver gradually failing (chronic liver failure ).

Are there different stages of cirrhosis?

Yes, cirrhosis is not something that happens suddenly. It develops gradually, over time.

• Early stage (Compensated Cirrhosis): At this stage, your liver function is slightly reduced, but your body adapts to it, so you may not experience any major symptoms. You may not even realize it.
• Later stage (Decompensated Cirrhosis):As liver damage increases, liver function decreases further. That's when you start to see clear symptoms. This is a bit more serious.

What happens to the liver and body due to cirrhosis?

This scar tissue in the liver blocks the flow of blood and oxygen through the liver. What happens then?

• The liver's ability to purify the blood, process nutrients, and filter toxins decreases.
• The production of bile and essential blood proteins produced by the liver decreases.
• This scar tissue can compress the blood vessels inside the liver. Especially when important veins, such as the portal vein system, are compressed, a condition called portal hypertension can occur. This is also a serious consequence of cirrhosis.

How common is cirrhosis?

Cirrhosis is a relatively common disease. It is considered a leading cause of hospitalization and death, especially after middle age. This is because it is increasing rapidly. For example, in the United States, about 0.25% of adults and about 0.50% of adults between the ages of 45 and 54 are said to have cirrhosis. This situation cannot be underestimated in Sri Lanka. Cirrhosis is a major health problem globally.

What are the symptoms of cirrhosis of the liver?

The symptoms of cirrhosis depend on the severity of the disease. In the early stages, there may be no symptoms at all. Or there may be only a few vague symptoms that are similar to other diseases. Symptoms become more apparent as the liver function decreases. For example, there are symptoms that appear when bile does not flow properly and accumulates in other parts of the body.

What are the first symptoms of cirrhosis?

In the early stages, you may see symptoms like:

• Nausea or loss of appetite .
• Fatigue , tiredness.
• Malaise is a general feeling of unwellness.
• Pain in the upper abdomen, especially on the right side.
• Spider angiomas are blood vessels that look like spider webs on the skin.
• Redness of the palms (palmar erythema).

What are the symptoms as the disease progresses?

Symptoms that appear as cirrhosis progresses can be divided into two categories: symptoms caused by decreased liver function and symptoms caused by portal hypertension.

Symptoms caused by decreased liver function:

• Yellowing of the skin and eyes is called jaundice.
• Itchy skin (Pruritus) (without a clear rash).
• Dark urine and light stools.
• Digestive problems, especially with fatty foods.
• The appearance of small yellow fat deposits on the skin or eyelids.
• Unexplained weight loss and muscle wasting.
• Effects on brain function (Hepatic Encephalopathy) – such as memory loss, confusion, and mood changes.
• Motor dysfunction – twitching, tremors.
• Irregularities in the menstrual cycle in women.
• Breast enlargement and testicular shrinkage in men.

Symptoms caused by Portal Hypertension:

• Abdominal bloating, water retention (ascites).
• Swelling of the hands, feet, legs and/or face (edema).
• Easy bleeding and bruising (coagulopathy).
• Vomiting blood or passing blood in the stool.
• Decreased urine output (may be due to chronic kidney failure).
• Difficulty breathing (may be due to chronic respiratory failure).

What are the causes of liver cirrhosis?

Cirrhosis is a condition of gradual scarring of the liver caused by chronic inflammation. Any disease that causes chronic inflammation of the liver (chronic hepatitis) can lead to cirrhosis. Some of the main causes are:

• Alcohol-induced hepatitis: Liver damage caused by excessive alcohol consumption over a long period of time. Although alcohol is the most common cause of cirrhosis, there are many non-alcoholic causes.
• Non-alcoholic steatohepatitis (NASH): Chronic damage caused by excess fat in the liver. It is caused by metabolic factors such as high blood fat, high blood sugar levels (such as diabetes), and high blood pressure.
• Chronic hepatitis C infection: Hepatitis C is a viral infection. For many people, it becomes a chronic condition. It can now be treated with antiviral drugs. But many people don't know they have it.
• Chronic hepatitis B infection: Hepatitis B is also a viral infection. In a small number of people, it can become chronic. If so, it is lifelong. There is treatment, but it cannot be completely cured.

There are also reasons why it is less common:

• Autoimmune biliary disease: Some autoimmune diseases can cause chronic inflammation of the liver. Examples include autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis.
• Genetic disorders: Some hereditary disorders can cause liver damage by causing toxins to build up in the liver. Examples include glycogen storage disease, cystic fibrosis, and Wilson disease.
• Toxic hepatitis: Long-term exposure to certain environmental toxins or continued use of certain medications (even over-the-counter painkillers) can damage the liver.
• Cardiovascular disease: Liver damage can also be caused by diseases that cause blood to pool in the liver (such as congestive heart failure) or diseases that prevent blood from reaching the liver (such as chronic ischemia).

Who is most at risk for this condition?

You may be at higher risk of developing cirrhosis of the liver if you:

• If you are over 50 years old.
• If you have a history of heavy drinking.
• If you have a chronic viral hepatitis infection.
• If you have metabolic syndrome ( i.e., the combination of conditions such as overweight, high blood pressure, high blood sugar, and high cholesterol).

What are the complications of cirrhosis?

There are many side effects caused by cirrhosis and portal hypertension.

Common complications:

• Feeling sick, tired, and mentally foggy due to toxins accumulating in the body.
• Decreased immunity, delayed wound healing.
• Swelling due to fluid leaking from blood vessels.
• Hormonal imbalances and deficiencies.
• Digestive problems, malabsorption of nutrients, and malnutrition.
• Minor impairments in brain function and problems with muscle control.

Severe complications that can be life-threatening:

• Gastrointestinal varices and gastrointestinal bleeding.
• Spontaneous bacterial peritonitis.
• Kidney failure (Hepatorenal syndrome).
• Respiratory failure (Hepatopulmonary syndrome).
• Chronic liver failure.
• Liver cancer.

How is cirrhosis of the liver diagnosed?

A doctor will first examine you physically to check for signs of cirrhosis. They will ask you questions about when your symptoms started and whether they have changed over time. They will also ask about your medical history, the medications, herbs, and supplements you take, your diet, and your lifestyle. They will look for signs of liver disease or liver damage.

Only then will medical tests be performed to confirm whether cirrhosis is present. These may include:

• Blood tests:Liver function tests can show signs of liver disease and liver failure. These measure things like liver enzymes, protein, and bilirubin levels. Blood tests can also show things like decreased blood clotting.
• Imaging tests: Tests such as an abdominal ultrasound, CT scan, or MRI can show the size, shape, and condition of the liver. A special imaging test called elastography can measure stiffness or fibrosis in the liver.
• Liver biopsy: This is a minor procedure. A small sample of tissue is taken from the liver and examined in a laboratory. This sample is usually taken using a hollow needle. Although not always necessary, a biopsy can help confirm cirrhosis and possibly find the cause.

Can cirrhosis of the liver be reversed or cured?

However, it is possible to stop or control the progression of cirrhosis . It depends on what caused the disease, how well it can be treated, and how well you respond to treatment.

How do doctors treat cirrhosis?

Treatment for cirrhosis includes:

• If possible, control the cause of the disease (reduce or stop the damage).
• Simple dietary and lifestyle changes to reduce the strain on the liver.
• Managing or screening for complications of cirrhosis.
• As a last resort, liver transplantation .

Treating the cause

Some liver diseases can be treated with medications. For example, antivirals can cure chronic hepatitis C, but chronic hepatitis B can only be controlled (not cured). Corticosteroids and immunosuppressants can help control some autoimmune diseases.

If the liver is damaged by alcohol or other toxins, the only treatment is to eliminate those toxins from your life. Some people may also need to receive substance use disorder treatment. If the liver is damaged by non-alcoholic causes (such as NASH), controlling metabolic factors such as cholesterol, blood sugar, and excess weight may help.

Food and lifestyle

Even if your liver disease is caused by something else, avoiding alcohol and drugs that are harmful to the liver can help protect your liver for longer. So can metabolic stressors. Doctors recommend that anyone with any type of liver disease eat a healthy diet and try to maintain a healthy weight. Some people may also need to take dietary supplements to address nutritional deficiencies.

Treatment of complications

Once your doctor has diagnosed you with cirrhosis, they will also check for common side effects. Portal hypertension is the most common side effect. It also has its own complications, each of which requires specific treatment.

You may need things like:

• A minor procedure to seal a bleeding vein.
• Blood transfusion to restore blood cell count.
• Kidney dialysis.
• Oxygen therapy.
• Paracentesis and antibiotics to remove fluid from the abdomen (ascites).
• Laxatives help absorb and expel toxins from the diet.

Liver cancer

Hepatocellular carcinoma is another dangerous complication of cirrhosis. Not everyone with cirrhosis will develop liver cancer, but many people who develop liver cancer have cirrhosis. If cancer develops with cirrhosis, cancer treatments such as radiation or chemotherapy may be given. Or, your doctor may decide that a liver transplant is the best option.

Liver Transplantation

Doctors recommend a liver transplant when they think your health will get worse without a transplant. This may be the case if you have active liver failure, have liver cancer, and/or are not responding to treatment for your liver disease. If you are eligible for a liver transplant, you will be placed on a national waiting list.

Can cirrhosis be prevented?

Liver disease can often be prevented from progressing to cirrhosis by early intervention . It depends on whether you are aware of it and what steps you can take to prevent it. Since many people do not have symptoms in the early stages, it can be detected during a routine health checkup. This gives you the opportunity to make important changes or start treatment.

Can the liver recover after cirrhosis?

Once you have cirrhosis, your liver doesn't get better. But it doesn't necessarily get worse either . If you still have symptoms (compensated cirrhosis), you can stay that way for a while. If you can stop or reduce the inflammation that causes cirrhosis, the disease may not progress to the decompensated stage. But you will have to take care of your liver for the rest of your life.

What is the life expectancy when living with cirrhosis?

Life expectancy when living with cirrhosis varies depending on many factors:

• Severity of the disease (compensated or decompensated).
• The complications you are having.
• Survival and success of treatments.
• Your overall health or whether you have any other illnesses.

Doctors use scoring systems such as the Child-Turcotte-Pugh (CTP) system and the Model for End-Stage Liver Disease (MELD) to assess your condition and determine your place on the liver transplant waiting list.

In the early stages of ``compensated cirrhosis``, life expectancy can be more than 15 years. When portal hypertension develops, it reduces life expectancy due to the risk of internal bleeding. The average life expectancy of ``decompensated cirrhosis`` is about seven years. This time can be even shorter due to severe, incurable diseases and other complications. For some people, it can be less than two years. But it is important to remember that these statistics are not the same for everyone.

How do I take care of myself while living with cirrhosis of the liver?

These things can help extend the life of your liver:

• Eat healthy, whole foods and lean proteins .
• Avoid alcohol, tobacco, and medications taken without medical advice as much as possible.
• Take medications only as directed by your doctor. Talk to your doctor about any medications you take.
• Do not miss scheduled medical tests and screenings for complications.