Author: Dr Dipankar Das, Consultant Gastroenterology

What is cirrhosis?

The liver is a very important vital organ in the upper right side of the abdomen. Cirrhosis is a disease that causes scarring of the liver usually as a result of many years of continuous injury due to various causes. In earlier stages, cirrhosis may be reversible if the underlying cause diagnosed & treated. In its advanced stages, cirrhosis is usually irreversible, so treatment may involve supportive management and liver transplant.

What are the symptoms of cirrhosis?

Patients with early cirrhosis may be asymptomatic or they may report nonspecific symptoms, such as anorexia, weight loss, weakness, and fatigue. Later on as the disease progresses patient might complain with other symptoms like:

• Swelling in the belly and legs, and fluid accumulation in the lungs
• Bleeding from blood vessels in the esophagus (the food-pipe that join the mouth to the stomach) in the form of blood vomiting or malena.
• Bruising or bleeding easily
• Difficulty in breathing
• Trouble getting enough sleep or sleeping too much
• Yellowing of the skin & eyes, called as jaundice
• Confusion that can start suddenly

Cirrhosis makes immune system weaker, so patient is more likely to get infections. Also cirrhosis increases the risk of liver cancer.

What causes cirrhosis?

There are multiple factors which can lead to development of cirrhosis. Among them the most common are Heavy alcohol use, Chronic hepatitis caused by Hepatitis B or hepatitis C virus, Nonalcoholic steatohepatitis ("NASH") -which means injury to liver cells due to fat deposition. Presently as the prevalence of diabetes, Obesity, Hypertension are increasing, number of patients with Non alcoholic fatty liver disease (newly known as Metabolic associated steatotic liver disease or MASLD) has also increased drastically. Other causes of cirrhosis are due to many hepatotoxic drugs related liver injury, certain genetic diseases, Autoimmune hepatitis and other uncommon metabolic diseases.

How to test for cirrhosis:

Certain tests can help to diagnose cirrhosis. Several laboratory abnormalities may be seen in patients with cirrhosis.

• Liver function tests (LFT): LFTs include the enzyme tests (principally the serum aminotransferases (SGOT?SGPT), alkaline phosphatase (ALP), and gamma-glutamyl transpeptidase (GGT), the serum bilirubin, and tests of synthetic function (principally the serum albumin concentration and prothrombin time (PT/INR).
• Complete blood count: Patients with cirrhosis commonly have a number of hematologic abnormalities, including varying degrees of decreased blood cells. Decreased platelet count is the most common hematologic abnormality, while low WBC count and anemia develop later in the disease course
• Abdominal imaging: An abdominal ultrasound suggest diagnosis of the cirrhosis that shows a liver that appears shrunken, irregular, and nodular. Sometimes computed tomography scan (CT) and magnetic resonance imaging may be of help.
• Liver Biopsy: Biopsy may be needed sometime only for selected cases for diagnosis of specific causes of cirrhosis so that disease specific treatment can be provided. Also to evaluate the underlying cause of cirrhosis, we do different other tests of the patient.

Treatment:

Treatments depend on the cause of cirrhosis, how severe it is, and what symptoms the patients have. Though cirrhosis is irreversible in most cases, management of the patient includes treating the cause, preventing & managing different complications of cirrhosis.

• Treat the cause: Treatments exist for some causes of cirrhosis. For example, people with cirrhosis caused by heavy alcohol use can stop drinking alcohol. Oral medicines are available that can suppress Hepatitis B and cure chronic Hepatitis C. For individuals who are overweight or obese, weight loss of at least 10% is necessary.
• Lower the risk of bleeding: The blood vessels surrounding the oesophagus, or food pipe, may enlarge or even burst due to cirrhosis. This is prevented by certain medications known as "beta blockers." These medications lower the blood pressure in the liver and lessen the possibility of bleeding. Additionally, we must encircle the enlarged blood vessels with tiny bands. We refer to this process as "variceal band ligation."
• Decrease fluid accumulation in the abdomen: In order to reduce fluid accumulation, we prescribe specific medications known as "diuretics." These medications cause frequent urination. Patients also need to restrict added salt in their diet along with high protein intake. Sometimes we need to remove the fluids with a needle, that procedure is known as “Therapeutic paracentesis.”
• Treat or prevent infection: Individuals who have cirrhosis are more susceptible to infections. Antibiotics are therefore occasionally required by those who have cirrhosis in order to either treat or prevent infection. To avoid frequent illnesses, the majority of patients with cirrhosis should also receive additional vaccinations, including the flu shot.
• Treat confusion: Hepatic encephalopathy, a condition caused by cirrhosis, can result in disorientation. To address the confusion, we recommend several medications.

Liver transplantation:

Surgery to get a new liver portion may be necessary for some patients with severe cirrhosis or complications. We refer to this as a "liver transplant." The indications, accompanying risks, possible advantages, and post-transplant prognosis are thoroughly evaluated for both the patient and the potential donor.

Can cirrhosis be prevented?

Preventing cirrhosis from recognised and potentially reversible causes is the optimal approach. You may protect your liver from being damaged and developing cirrhosis by abstaining from alcohol, being tested for hepatitis, not sharing needles and syringes, practicing safe sexual behaviour, keeping your weight within a normal BMI, and making dietary and lifestyle adjustments.