Liver cirrhosis is a chronic, progressive disease in which scar tissue (fibrosis) gradually replaces healthy liver tissue, leading to the eventual loss of liver function. It is the final stage of numerous liver disorders, including long-term alcohol abuse and chronic hepatitis. Cirrhosis is a major global health concern due to its complications such as portal hypertension, liver failure, and an increased risk of liver cancer.
Causes of Liver Cirrhosis
Several chronic liver conditions can lead to cirrhosis, including:
- Chronic Alcoholism: Prolonged alcohol misuse leads to alcoholic hepatitis, causing inflammation and scarring.
- Hepatitis B, C, and D: Chronic infections with these viruses can result in liver inflammation and scarring over time.
- Non-Alcoholic Fatty Liver Disease (NAFLD): Fat buildup in the liver, not related to alcohol, can lead to cirrhosis, especially in people with obesity, diabetes, or high cholesterol.
- Autoimmune Hepatitis: The immune system attacks healthy liver cells, causing inflammation and scarring.
- Biliary Diseases: Conditions like primary sclerosing cholangitis and biliary cirrhosis lead to scarring due to bile duct inflammation or blockage.
- Genetic Disorders: Diseases like hemochromatosis (excess iron) and Wilson’s disease (excess copper) can damage the liver over time.
- Medications and Toxins: Long-term use of certain medications, such as isoniazid or methotrexate, and exposure to toxins can cause liver damage.
Pathophysiology
Cirrhosis develops from repeated liver injury over time. Damaged liver cells are replaced by fibrous tissue, altering the liver’s structure and reducing blood flow. The liver attempts to regenerate, forming abnormal nodules, but its function is gradually lost.
Key Elements:
- Hepatocyte Necrosis: Liver cells die, causing inflammation.
- Fibrosis and Scarring: Prolonged inflammation results in the buildup of scar tissue, disrupting liver architecture.
- Portal Hypertension: Scar tissue obstructs blood flow, increasing pressure in the portal vein, leading to complications like varices and ascites.
- Loss of Liver Function: Scar tissue impairs the liver’s ability to detoxify, produce proteins, and regulate hormones.
Symptoms and Signs
In early stages, cirrhosis may not cause symptoms. As the disease progresses, signs include:
- Fatigue and weakness
- Loss of appetite and weight loss
- Pruritus (itchy skin)
- Abdominal pain
- Edema (swelling in the ankles, feet, and legs)
- Spider angiomas (visible blood vessels under the skin)
- Easy bruising and bleeding
Advanced Symptoms:
- Ascites (fluid accumulation in the abdomen)
- Esophageal varices (enlarged veins that can bleed)
- Hepatic encephalopathy (confusion or coma due to toxin buildup)
- Splenomegaly (enlarged spleen due to portal hypertension)
- Hepatorenal syndrome (kidney failure due to liver dysfunction)
- Increased risk of hepatocellular carcinoma (liver cancer)
Diagnosis
Diagnosis relies on a combination of medical history, physical exams, laboratory tests, and imaging studies.
- History and Examination: Includes risk factors like alcohol use, hepatitis, and family history of liver disease. Physical signs may include ascites, jaundice, or an enlarged liver.
- Lab Tests: Liver function tests (LFTs) show elevated liver enzymes, bilirubin, and prolonged prothrombin time (PT). A complete blood count (CBC) may reveal anemia or low platelets. Low serum albumin indicates impaired liver function.
- Imaging: Ultrasound, CT, or MRI can show liver texture, size, and the presence of portal hypertension. FibroScan measures liver stiffness related to fibrosis.
- Liver Biopsy: Sometimes necessary to assess the degree of fibrosis and confirm cirrhosis.
Management and Treatment
Cirrhosis treatment focuses on halting the underlying cause, managing symptoms, and preventing complications.
General Measures:
- Alcohol Abstinence: Essential in alcohol-related cirrhosis to prevent further damage.
- Nutritional Support: A balanced diet is crucial, as malnutrition is common.
Medications:
- Diuretics: To reduce fluid retention in edema and ascites.
- Beta-blockers: To lower portal hypertension and prevent variceal bleeding.
- Lactulose: To reduce ammonia levels and treat hepatic encephalopathy.
- Antivirals: In viral hepatitis-related cirrhosis, antivirals slow disease progression.
Endoscopic and Surgical Interventions:
- Variceal banding: To prevent esophageal variceal bleeding.
- Liver Transplant: The only curative treatment for end-stage cirrhosis.
Prognosis
The prognosis depends on the cause and stage of cirrhosis. Compensated cirrhosis (with preserved liver function) has a better prognosis than decompensated cirrhosis (with complications like ascites or encephalopathy), which carries a higher risk of mortality.
Prognostic Scoring Systems:
- Child-Pugh Score: Assesses prognosis based on liver function tests and complications.
- MELD Score: Predicts survival and is used to prioritize liver transplantation.
Prevention
Preventive measures include:
- Limit Alcohol: Avoid heavy alcohol use to reduce the risk of alcoholic cirrhosis.
- Hepatitis Vaccination: Hepatitis B vaccination and antiviral treatment for hepatitis C can prevent liver damage.
- Healthy Lifestyle: Maintaining a healthy weight, controlling diabetes, and managing cholesterol can prevent NAFLD.
- Safe Practices: Avoid needle sharing and unprotected sex to prevent hepatitis infections.
Conclusion
Liver cirrhosis is a serious, progressive disease that severely impacts quality of life and survival. Lifestyle changes, early diagnosis, and treatment of the underlying causes can slow the disease’s progression and improve the prognosis.
