Everything you need to know about cirrhosis

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With early cirrhosis, there are often no symptoms. But, as scar tissue accumulates, it undermines the liver’s ability to function properly.

A person may notice:

• fatigue
• nausea
• loss of appetite
• weight loss and loss of muscle mass
• patches of small, red blood vessels on the upper trunk and the palms of the hands

As the disease progresses, they may experience:

• swelling in the legs and abdomen due to a buildup of fluid
• an enlarged spleen
• infections
• confusion
• jaundice, where the whites of the eyes take on a yellow tinge
• dark-colored urine
• tarry stools
• itching
• internal bleeding
• low sex drive

In time, fibrous scar tissue replaces healthy liver tissue. Regenerative nodules may also form. These are lumps that appear as the liver tries to heal the damage.

With an early diagnosis, treating the underlying cause or complications can limit damage to the liver and complications.

Lifestyle changes

if a person has a diagnosis of cirrhosis, they will need to protect their liver, for example, by:

• avoiding raw or undercooked meat and shellfish, which increase the risk of an infection
• avoiding alcohol consumption
• limiting the intake of salt, fat, and protein, if a doctor recommends it
• using diet and exercise to manage body weight, if appropriate

Treating underlying causes

Some treatment options will depend on the underlying cause.

For example:

• Alcohol-related liver disease: A doctor will recommend taking no alcohol. In some cases, they may recommend a special treatment program for people with alcohol dependency.
• Hepatitis B or C: A doctor will prescribe antiviral medications.
• Non-alcoholic-related fatty liver disease (NAFLD): Lifestyle changes, such as a change in diet, may help manage NAFLD.

Treatment for symptoms

The person may also need treatment for symptoms of cirrhosis, such as:

• Portal hypertension: Medication can reduce high blood pressure in the portal vein, which supplies the liver with blood.
• Esophageal varices: Swollen blood vessels can burst, causing bleeding to appear in vomit or stools. This needs urgent medical attention. Various strategies can help stem the bleeding.
• Infections: Antibiotics can treat bacterial infections.
• Hepatic encephalopathy: Medications can help manage high toxin levels in the blood.

Screening

A doctor may also recommend screening for liver cancer, as the risk is higher among people with cirrhosis. People living with cirrhosis may need regular blood tests and imaging scans.

Liver transplant

Widespread scarring may be irreversible. In these cases, the person may need a liver transplant. It can take time to find a suitable donor, and this procedure is often a last resort.

Doctors grade cirrhosis in various ways, such as the Childs-Pugh score.

Using scores from various tests, it puts the liver into one of three categories:

• A: The liver is working well.
• B: There is moderate damage.
• C: Damage is advanced or severe.

The score helps give an idea of the person’s outlook. Category C, or end-stage liver disease, is potentially fatal.

Cirrhosis can also be either compensated or decompensated.

With compensated cirrhosis, the liver can function effectively despite the damage. People with compensated cirrhosis often have no symptoms.

With decompensated cirrhosis, the liver cannot function effectively, and symptoms may be noticeable.

Common causes of cirrhosis are:

• hepatitis, a viral infection
• long-term high alcohol consumption
• non-alcohol-related steatosis, a type of fatty liver disease
• exposure to toxins
• genetic diseases

Hepatitis

Globally, hepatitis B and C are the leading causes of cirrhosis. People can get either type after exposure to blood that contains the virus, for example, through needlestick injuries or sharing needles.

Vaccines can protect against hepatitis B but not hepatitis C.

In autoimmune hepatitis, the person has an autoimmune disease. In this type of disease, the immune system mistakenly attacks healthy cells. Sometimes, an autoimmune disease can affect the liver, leading to hepatitis and cirrhosis.

Alcohol-related fatty liver disease

The liver breaks down toxins, including alcohol. But, if toxin levels are too high, the liver will be unable to process them effectively, and damage to liver cells will result.

There are three stages of alcohol-related liver disease:

1. Alcohol-related fatty liver or steatosis: Small fat droplets accumulate in the liver.
2. Alcohol-related hepatitis: There is inflammation in the liver cells, causing swelling. At this stage, stopping alcohol consumption may repair the liver.
3. Cirrhosis: Irreversible damage can lead to potentially life threatening complications.

People who consume 30–50 grams (g) of alcohol per day for 5 years have a risk of alcohol-related liver disease. Males who consume more than 21 units per week and females who consume more than 14 units per week are at risk of steatosis due to alcohol consumption.

In the U.S., alcohol consumption is the leading cause of liver disease.

Non-alcohol-related fatty liver disease

Doctors diagnose non-alcohol-related fatty liver disease (NAFLD) when fat accumulates in over 5% of liver cells, and there is no other explanation.

NAFLD included non-alcohol-related fatty liver (NAFL) and non-alcohol-related steatosis (NASH). In NAFL, there are fatty deposits. In NASH, inflammation and cell damage are also present.

NAFLD is more likely to affect people with:

• metabolic syndrome, including obesity, diabetes, high cholesterol, and high blood pressure
• polycystic ovary syndrome (PCOS)
• genetic conditions, such as Wilson’s disease, when copper accumulates in the liver and other parts of the body
• conditions involving a nutritional imbalance, such as kwashiorkor

Other conditions

Other diseases and conditions that can contribute to cirrhosis include:

• cystic fibrosis
• primary sclerosing cholangitis, or hardening and scarring of the bile ducts
• galactosemia, or inability to process sugars in milk
• schistosomiasis, a parasitic disease
• biliary atresia, which affects the formation of bile ducts before birth
• glycogen storage disease, when the body has problems storing and releasing the energy release that is vital for cell function
• hemochromatosis, when iron accumulates in the liver and other parts of the body
• Budd-Chiari syndrome, when blood clots in the hepatic vein lead to liver enlargement and the development of new blood vessels
• cancer of the bile ducts or pancreas, which can lead to blockages in the bile ducts

Symptoms rarely appear in the early stages, so diagnosis often occurs when testing for another condition or disease.

If a doctor suspects cirrhosis, they will:

• carry out a physical examination, including checking for swelling in the upper abdomen
• ask the person about their personal and family medical history
• ask about their lifestyle, including dietary habits and alcohol consumption

They may also recommend the following tests:

• blood tests to check liver function
• imaging tests such as an ultrasound, CT, or MRI scan to look for signs of enlargement, scarring, or nodules
• a biopsy, which takes a tissue sample for testing in a laboratory

Cirrhosis can affect a range of body organs, including the:

• gastrointestinal system
• blood and cardiovascular system
• kidneys
• lungs
• skin and nails
• hormones

It can lead to several other conditions, some of which are life threatening.

Ascites or edema

Ascites is a buildup of fluid in the abdomen, and edema is a buildup of fluid in the legs. A low-salt diet and diuretics, or water pills, can help manage fluid levels. In severe cases, a doctor may need to drain the fluid repeatedly.

Varices and portal hypertension

Large, swollen veins develop in the esophagus and stomach. They can put pressure on a blood vessel called the portal vein, which carries blood from the spleen and bowel to the liver, leading to portal hypertension. Varices can rupture, causing bleeding and clots.

Hepatic encephalopathy

This refers to high levels of toxins in the blood where the liver can no longer filter them effectively.

Hepatocellular carcinoma

This is the most common type of liver cancer and can result from cirrhosis due to hepatitis B or C infection. Research from 2013 suggests it is becoming more common in the U.S. and globally and has a high fatality rate.

Hepatopulmonary syndrome

Hepatopulmonary syndrome (HPS) refers to a combination of:

• liver disease
• dilated blood vessels in the lungs
• problems with the exchange of gases in the lungs

HPS is a potentially life threatening condition.

Coagulation disorders

Cirrhosis can cause problems with blood clotting, leading to bleeds and clots that can sometimes be fatal.

There is no cure for cirrhosis, and it can be life threatening.

How long a person will survive with cirrhosis depends on various factors, including:

• the cause
• the severity of the scarring
• their age and overall health
• how they treat the condition

As the disease progresses, the prognosis worsens. People with compensated cirrhosis, when the liver can still function, have a 47% chance of surviving another 10 years compared with people who do not have cirrhosis. Once cirrhosis starts to affect liver function, the chance of surviving another 10 years falls to around 16%.

People who consumed alcohol before their diagnosis and then quit have a better outlook, especially if they stopped in the earlier stages.

In the United States, 4.5 million people, or 1.8% of the adult population, have liver disease. Cirrhosis accounts for 15.8 deaths in every 100,000.

Cirrhosis is not always avoidable, but some tips can help lower the risk:

• Follow a varied diet that is low in processed foods and added fats.
• Keep within the recommended guidelines for the consumption of alcohol.
• Use diet and exercise to maintain a suitable weight and avoid obesity.
• Use a condom during sex to lower the risk of hepatitis.
• Never share needles and take care when dealing with blood.
• Avoid alcohol if any stage of liver disease is present.
• Ask about vaccinations for hepatitis B if you are at risk.

Here are some answers to questions people often ask about cirrhosis.

What are the stages of cirrhosis?

There are different ways to describe the progression of cirrhosis. The Child-Pugh system describes three stages, based on test results.

In this system:

• Stage A: The liver is working well.
• Stage B: There some impact on liver function.
• Stage C: Liver function is severely affected.

Doctors also refer to compensated cirrhosis, where damage is present, but the liver is functioning; and decompensated cirrhosis, where damage affects liver function.

Can a person survive cirrhosis?

The outlook will depend on various factors, including the cause of cirrhosis and the stage at diagnosis.

A person who receives a diagnosis in the early stage can continue to live a healthy life, but they may need to take measures, such as avoiding alcohol and maintaining a suitable weight. Once cirrhosis starts to affect liver function, the impact on a person’s outlook becomes more severe.

What are the early warning signs of cirrhosis?

Often, a person will not notice any symptoms until a later stage, when cirrhosis begins to affect liver function.

As it progresses, cirrhosis can cause a wide range of symptoms, including fatigue, nausea, low appetite, jaundice, swelling, and itchy skin.

Cirrhosis results when tissue damage causes scarring in the liver. Possible causes include a hepatitis infection, high consumption of alcohol, some genetic conditions, and inflammation that occurs with obesity and metabolic disorder.

In the early stages, damage is present and scarring start to appear, but the liver continues to function. In time, scarring becomes widespread. Eventually, the liver is unable to function.

Some ways of reducing the risk include limiting alcohol consumption, maintaining a moderate body weight, and taking measures to prevent infection with hepatitis B and C.

For people with early-stage cirrhosis, lifestyle changes — such as avoiding alcohol consumption, protecting against infection, and managing body weight — can improve their outlook.

When cirrhosis starts to affect liver function, it can become life threatening. For this reason, it is best to take measures to prevent cirrhosis where possible.

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