Cirrhosis

Cirrhosis is an abnormal condition where healthy tissue of the liver is replaced by scar tissue. The formation of scar tissue is irreversible and it eventually blocks the flow of blood through the liver. Cirrhosis is a slow progressing condition that occurs over years of liver damage. Cirrhosis, if not diagnosed early, can lead to advanced cirrhosis and liver cancer.

Symptoms

Cirrhosis is often dormant until extensive damage of the liver occurs, which determines the severity of symptoms. Some of the symptoms include fatigue, easy bleeding and bruising, ascites (accumulation of fluid in the abdomen), jaundice (yellowing of the eyes and skin), nausea, loss of appetite, weight loss, leg swelling and itchy skin.

Complications

Cirrhosis of the liver can lead to portal hypertension (high blood pressure in the blood vessels connecting the liver to digestive organs), which can cause bleeding in other blood vessels. Hepatic encephalopathy (high concentration of toxins in the blood) may also occur, secondary to the inability of the liver to detoxify the body. Some of the other complications include infections, kidney failure, diabetes, alteration in blood counts, enlargement of breasts in men, loss of muscle volume, premature menopause, and reduced oxygen in the blood.

Causes

Any damage to the liver can lead to cirrhosis. Viral infections such as hepatitis B, C or D, chronic alcohol abuse, and non-alcoholic steato-hepatitis (fatty liver disease) linked to diabetes and obesity are the most common causes of cirrhosis. Other causes may include:

• Primary biliary sclerosis and primary sclerosing cholangitis that lead to damaged bile ducts (tubes that connect liver to intestine)
• Haemochromatosis, where excessive amounts of iron are deposited in the liver
• Wilson’s disease, where excessive amounts of copper are deposited in the liver
• Sugar metabolism diseases like diabetes
• Long-term dependence on prescription drugs
• Cystic fibrosis (inherited disease of sweat glands and mucus)

Diagnosis

Cirrhosis is often first detected during routine blood work. The usual diagnosis for cirrhosis may include liver function tests using blood samples, imaging studies (MRI, CT, and ultrasound), and biopsy where a sample of the liver is obtained and analysed under a microscope. Periodic imaging and blood tests are recommended to detect liver cancer.

Treatment

The primary treatment for cirrhosis is to keep progression of liver damage in check, and treat the underlying cause. Severe cirrhosis may require you to be hospitalized. You will be instructed to stop drinking or enrol into a de-addiction program if your cirrhosis is because of alcohol dependency. You will need to control your blood sugar levels and lose weight if you are suffering from cirrhosis caused due to fatty liver disease. Your doctor will prescribe medication to treat hepatitis and other symptoms.

• Your doctor may recommend the following approaches to treat complications of cirrhosis:
• Fluid build-up in the body can be managed by medications and following a low-sodium diet. In severe cases, surgery may be required.
• High blood pressure can be controlled with blood pressure medications, and bleeding varices (abnormally bulged blood vessel) can be managed surgically by band ligation procedures.
• Infections can be treated with antibiotics.
• Hepatic encephalopathy (build-up of toxins in the body) can be controlled with medications.
• Liver transplant surgery can be performed when the cirrhosis progresses to an extent where the liver ceases to function. Liver transplant is a procedure where the diseased liver is replaced wholly or partially with a healthy liver.

Prevention

Cirrhosis can be prevented by:

• Avoiding or limiting alcohol intake
• Eating a plant-based healthy diet and avoiding fried and fatty foods
• Maintaining healthy weight
• Reducing the risks of developing liver diseases, such as hepatitis

Cirrhosis and surgery

• It is important to try and optimise the condition of the liver prior to any abdominal surgery, so as to decrease the potential complications following surgery.