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Cirrhosis

Overview

Liver cirrhosis is a chronic condition in which healthy liver tissue is replaced by scar tissue (i.e., progression of fibrosis), leading to impaired liver function, which can have serious health implications. 

As with all other manifestations of ALD, chronic alcohol abuse is one of the most common causes of liver cirrhosis. Other causes include:

  • Fatty liver disease (N/AFLD): This condition—linked to obesity, diabetes, and metabolic syndrome—can promote cirrhosis.
  • Chronic viral hepatitis: Hepatitis B and C can promote cirrhosis.
  • Autoimmune hepatitis: In this condition, the immune system attacks the liver cells.
  • Biliary diseases: Diseases that affect the gall bladder and bile ducts, such as primary biliary cholangitis or primary sclerosing cholangitis, can lead to cirrhosis.
  • Genetic conditions: Hemochromatosis (iron overload) and Wilson’s disease (copper buildup) can also cause cirrhosis.
  • Medications and toxins: Long-term use of certain drugs or toxins can also cause cirrhosis; they can also serve as risk factors.
  • Infections: Schistosomiasis or other parasitic infections can also cause cirrhosis.
  • Obesity: Increases risk of N/AFLD, and by extension cirrhosis.
  • Diabetes and insulin resistance: These factors can serve as risk factors for liver cirrhosis.
  • Family history: A family history of liver diseases (genetic predisposition) can also serve as a risk factor.

Cirrhosis shares many symptoms with N/AFLD, N/ASH, and liver fibrosis. The same has been enumerated below.

  • Fatigue
  • Loss of appetite
  • Nausea (urge to vomit)
  • Weight loss
  • Jaundice
  • Ascites (fluid accumulation in the abdomen)
  • Oedema (swelling in the legs)
  • Oesophageal varices (enlarged veins prone to bleeding)
  • Hepatic encephalopathy (confusion, memory problems, drowsiness)
  • Spider angiomas (spider-like blood vessels on the skin)

As cirrhosis shares many symptoms with N/AFLD, N/ASH, and liver fibrosis, it also shares the diagnostic modalities; the same have been enumerated below.

  • Blood tests:
    • Liver function tests (ALT, AST, bilirubin, albumin)
    • Coagulation profile (INR, PT)
    • Platelet count
  • Imaging studies:
    • Ultrasound (detects liver size, texture, ascites)
    • CT or MRI (detailed liver structure)
    • Elastography (evaluates the extent of fibrosis by measuring liver stiffness)
  • Liver biopsy: To confirm the diagnosis in uncertain cases.
  • Endoscopy: To check for oesophageal varices.
  • Serology and genetic tests: To identify underlying causes.

Cirrhosis treatment generally focuses on managing the underlying cause, slowing down disease progression, and preventing complications. The strategies used have been enumerated below.

  • Lifestyle changes:
    • Alcohol cessation
    • Weight loss and dietary management (low sodium, balanced diet)
  • Medications:
    • Antivirals for hepatitis B or C
    • Diuretics for ascites (spironolactone, furosemide)
    • Lactulose or rifaximin for hepatic encephalopathy
    • Beta-blockers for oesophageal varices (e.g., propranolol)
  • Management of complications:
    • Paracentesis for ascites
    • Endoscopic treatment for variceal bleeding
  • Advanced therapies:
    • Liver transplantation: For end-stage liver disease. (advanced cirrhosis and liver cancer).
    • TIPS (transjugular intrahepatic portosystemic shunt): For refractory ascites or variceal bleeding.
  • Nutritional support: Adequate protein intake and vitamin supplementation to manage cirrhosis-associated liver damage.

Strategies for cirrhosis prevention have been enumerated below.

  • Vaccination against hepatitis A and B.
  • Avoidance of excessive alcohol consumption.
  • Regular screening and early management of viral hepatitis.
  • Healthy lifestyle with balanced diet and exercise.
  • Avoiding hepatotoxic drugs and chemicals.
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