What is Cirrhosis?
Cirrhosis is a condition where normal liver tissue is replaced by scarred tissue (fibrosis). As the scar tissue gradually builds up, the normal liver cells die. This affects the functioning of the liver, including the blood flow .
This can cause back pressure changes in the blood vessels supplying blood to liver resulting in portal hypertension.
What are the causes of cirrhosis?
There are many causes of cirrhosis, however the
Commonest causes are
- Viral hepatitis B and C.
- Non alcoholic steatohepatitis
- Autoimmune hepatitis: the immune system of the body produces antibodies to the liver cells
- Metabolic conditions:
- Wilsons disease: abnormal built up of copper in the liver
- Hemochromatosis: abnormal built up of iron in the liver
- Diseases that cause blockage of bile ducts: primary biliary cirrhosis, Primary sclerosing cholangitis, congenital problems of the bile duct
- Poisons and environmental toxins
- Certain types of medicines can cause cirrhosis eg methotrexate
- Severe heart failure : Cardiac cirrhosis, due to back pressure changes causing congestion in the liver.
What are the symptoms of cirrhosis?
In the early stages there are no symptoms, however as more liver cells die and as scarring progresses, liver is not able to perform its functions. This may cause symptoms such as :
- Swelling in feet (oedema) and abdominal distension (ascites)
- Loss of appetite, nausea , vomiting
- Jaundice, itching due to built up of toxins
- Tendency to bruise easily
- Mental health changes: alteration of sleep pattern, personality and behaviour changes
What are the complications?
- Hematemesis (vomiting blood) or black stool (malena) due to portal hypertension
- Liver cancer
- Ascites (filling of fluid in abdomen) and spontaneous bacterial peritonitis (SBP: infection in the fluid)
- Hepatorenal syndrome: poor kidney function due to liver disease
- Hepatic encephalopathy: confusion, reversal of sleep pattern due to built up of toxins
How is cirrhosis diagnosed?
Sometimes history and clinical examination alone can raise suspicion of the diagnosis. However tests are done to confirm the same.
- Blood tests: Liver function tests, Viral markers, autoimmune profile.
- Imaging: Ultrasound, CT scan of liver
- Fibroscan: non invasive assessment of scarring of liver.
- Liver biopsy: sample of liver tissue, usually done to confirm etiology when this is not certain after blood tests.
What is the Treatment?
Treat the cause:
Cirrhosis gets progressively worse if underlying cause persists. It is possible to slow the progress of scarring by treating the cause. Any damage already occurred is usually not reversible. Example:
- Stop drinking alcohol.
- Antiviral medication for Hepatitis B and C.
- Steroids for autoimmune hepatitis.
- Medication for removing excess copper in case of Wilsons disease.
Treat underlying complications:
- Adequate food intake including caloric and protein intake are important to prevent excess weight loss and muscle wasting.
- Zinc supplement : due to zinc deficiency.
- Calcium supplement: due to osteoporosis commonly associated with cirrhosis.
- Ascites: Salt restricted diet, fluid restriction, diuretics (water tablets). When the fluid continues to accumulate despite these measures and causes discomfort, this can be drained (paracentesis).
- Hepatic encephalopathy: usually triggered by constipation, electrolyte imbalance, infection. Avoid constipation, lactulose syrup to aim for 2-3 soft stools per day.
- Treatment of varices due to portal hypertension: medicines can be given such as betablockers. May need endoscopy to block them in some cases.
- Screening/Surveillance for detection of liver cancer: Blood tests (AFP) and ultrasound every 6 months.
- In advanced stage, liver transplant may be the only option.