The liver is an amazing organ in our body. It is like a big factory. It performs many important functions such as filtering out toxins, helping to digest food, and storing energy. However, this precious liver can become damaged for various reasons. When the liver is continuously damaged over time, scar tissue begins to form instead of healthy cells. That is the condition we call cirrhosis.
What exactly is cirrhosis?
Imagine if you had a wound on your skin that healed and left a scar, right? That's what happens to the liver. If there is inflammation in the liver for a long time, the liver tries to heal itself. In this process, hard, dysfunctional scar tissue forms instead of healthy, soft liver tissue.
Simply put, cirrhosis is the final stage of chronic liver disease. At this point, most of the healthy parts of the liver have become scarred. As this scar tissue builds up, the liver becomes unable to do its normal job of cleaning the blood and processing nutrients. Eventually, this can lead to liver failure .
The most important thing is that the scars caused by cirrhosis cannot be reversed, that is, completely cured. But don't worry. With the right treatment, we can control or slow down the worsening of this condition.
Are there stages of cirrhosis?
Yes, cirrhosis also gets worse gradually. Let's talk about it by dividing it into two main stages.
1. Compensated Cirrhosis: This is the first stage. At this stage, even though the liver has been damaged, the remaining healthy part of the liver is still able to compensate for the damage, or 'compensate', and keep the body functioning. This is why you may not have any symptoms at all. Many people don't even know they have this condition.
2. Decompensated Cirrhosis: Over time, as the amount of scar tissue in the liver increases, the liver can no longer repair the damage. This is when symptoms begin to appear. Symptoms such as fluid in the abdomen and yellowing of the eyes and skin are seen in this stage. This is the most severe stage of the disease.
What symptoms should we look out for?
Symptoms of cirrhosis do not appear immediately. They often appear only after the disease has become more severe. Let's distinguish between early and late symptoms as follows.
| Early symptoms (Compensated Stage) | Later severe symptoms (Decompensated Stage) |
|---|---|
| - Constant fatigue and weakness | - Yellowing of the eyes and skin (Jaundice) |
| - Loss of appetite | - Dark urine and pale stools |
| - Nausea | - Itchy skin (even if the spots are not visible from the outside) |
| - Pain in the upper abdomen | - Swelling of the abdomen, legs and ankles (due to fluid retention - Ascites ) |
| - Redness of the palm | - Weight loss and muscle wasting |
| - Spider-like appearance of blood vessels on the skin surface | - Bleeding and delayed clotting even from a minor injury |
Why does cirrhosis develop? What are the main causes?
Any chronic disease that causes long-term inflammation of the liver can eventually lead to cirrhosis. These are some of the most common causes in our country and the world.
1. Excessive alcohol consumption (Alcohol-induced Hepatitis)
This is the most common and well-known reason. Excessive alcohol consumption over a long period of time causes significant damage to the liver. This causes inflammation of the liver, which over time can lead to cirrhosis.
2. Fatty liver disease (MASH)
The full name for this is Metabolic dysfunction-associated steatohepatitis (MASH). Simply put, it is a serious condition caused by the accumulation of fat in the liver in people who do not drink alcohol. People with metabolic factors such as diabetes, high cholesterol, high blood pressure, and obesity are at higher risk.
3. Chronic hepatitis B and C virus infections
Hepatitis is the medical name for inflammation of the liver. Hepatitis C virus infection can become a chronic condition in many people. Although there are now effective treatments for this, many people do not even know they have the virus. Hepatitis B virus can also become chronic in some people. Both viruses can damage the liver and cause cirrhosis when they are present for a long time.
Other less common causes
In addition to the above reasons, there are several other less common reasons:
- Autoimmune Disease: Sometimes our own immune system mistakenly attacks the liver cells. For example, conditions like `(Autoimmune Hepatitis)` and `(Primary Biliary Cholangitis)`.
- Genetic Disorders: Some hereditary diseases can cause toxic substances to accumulate in the liver and cause damage. Examples of these diseases are `(Wilson Disease)` and `(Cystic Fibrosis)`.
- Certain medications and toxins (Toxic Hepatitis): Excessive use of certain painkillers (NSAIDs, Acetaminophen) for a long time or exposure to certain toxic chemicals in the environment can damage the liver.
- Cardiovascular Disease: Congestive Heart Failure (CHF) can cause damage to the liver due to a lack of blood supply or a decrease in the amount of blood reaching the liver.
How do doctors find this?
If you think you have symptoms of cirrhosis, you should definitely see a doctor. He or she will examine you and ask about your medical history, medications you take, and lifestyle. Then, they may order several tests to confirm the diagnosis.
1. Blood Tests: Liver Function Tests can give an idea of whether there is liver damage and how severe it is. They also check for decreased blood clotting ability.
2. Imaging Tests: An ultrasound scan can look at the size, shape, and condition of the liver. A special type of scan called elastography can measure the stiffness of the liver, which is how much scar tissue there is.
3. Liver Biopsy: Although not always necessary, in some cases, a very small piece of tissue from the liver is taken with a small needle and examined under a microscope to definitively confirm the disease and find the cause.
What are the treatments?
Although the scarring caused by cirrhosis cannot be reversed, treatment has two main goals. One is to stop further damage to the liver. The second is to manage complications caused by the disease.
Treating the cause
- Medications: There are now antiviral medications that can completely cure viral infections like hepatitis C. There are medications to control hepatitis B. Autoimmune diseases are treated with medications that control the immune system.
- Treatment for alcoholism: If alcohol is the cause of cirrhosis, the only and best treatment is to stop drinking alcohol completely. This may require specialized counseling and treatment.
- Managing metabolic factors: If the disease is caused by fatty liver, it is very important to control things like cholesterol, diabetes, and weight loss.
Diet and lifestyle changes
Regardless of the cause of cirrhosis, avoiding alcohol and unnecessary medications is essential to protect the liver.
It is also important to eat a healthy diet, control your weight, and take necessary nutritional supplements as prescribed by your doctor.
Treatment for complications
Complications that occur when the disease becomes severe also need to be treated.
- If the abdomen fills with water (`(Ascites)`), the water is removed with a syringe (`(Paracentesis)`).
- If you are vomiting blood, the bleeding vessels are stopped by endoscopy (sclerotherapy).
- Dialysis may be necessary for conditions such as kidney failure.
Liver Transplantation
When all other treatments have failed and there is a risk of complete liver failure, the last option considered is a liver transplant. This involves removing the diseased liver and replacing it with a healthy one.
Is it possible to have hope for life with this disease?
This is a very sensitive issue. The life expectancy of someone with cirrhosis depends on many factors. Things like how severe the disease is, what complications have developed, how your body responds to treatment, and your overall health.
Doctors use scoring systems such as ``Child-Turcotte-Pugh (CTP)'' and ``Model for End-Stage Liver Disease (MELD)'' to get an idea of the severity of the disease and the future prognosis.
The most important thing is that if the disease is diagnosed at an early stage (compensated stage), the cause is treated correctly , and lifestyle changes are made, many people can stop the disease from getting worse and live a normal life for a long time. So don't give up hope. It is very important to follow the correct medical advice.
Take-Home Message
- Cirrhosis is the formation of scar tissue in the liver due to long-term damage.
- Excessive alcohol consumption, fatty liver disease, and hepatitis B and C viruses are the main causes.
- Since symptoms may not appear in the early stages, it is important to have regular medical checkups if you have risk factors (diabetes, overweight, alcohol use).
- Although the scars cannot be completely cured, treatment can stop or control further progression of the disease.
- If you have any symptoms or are in any doubt, see your doctor immediately for advice.
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