Hepatic Cirrhosis

What is Hepatic Cirrhosis?

Cirrhosis is a condition where the liver becomes scarred and forms small lumps due to long-term damage. This damage changes the regular function and structure of the liver. Some of the things that can harm the liver include viruses, toxins, inherited diseases, or problems with the body’s immune system.

When the liver is injured, it creates scar tissue, known as fibrosis, but doesn’t immediately stop working properly. However, if the liver is repeatedly harmed over a long period of time, more and more of it becomes scarred. This leads to the liver losing function and developing cirrhosis. See image, labeled ‘Cirrhosis, Liver’.

What Causes Hepatic Cirrhosis?

Chronic liver diseases often get worse and turn into a condition called cirrhosis, where your liver gets scarred and can’t work as well as it should. In developed countries like the United States and most of Europe, the things that most commonly cause cirrhosis are the hepatitis C virus, liver damage due to excessive alcohol use, and a condition called nonalcoholic steatohepatitis (or NASH), which is inflammation and damage to the liver caused by fat buildup.

On the other hand, in developing countries, the hepatitis B virus and the hepatitis C virus are the things that most commonly cause cirrhosis.

There are also less common things that can cause cirrhosis, including autoimmune hepatitis (a condition where the body’s immune system attacks the liver), primary biliary cholangitis and primary sclerosing cholangitis (both are types of liver inflammation that block bile ducts), hemochromatosis (iron build-up in the body), Wilson disease (copper build-up in the body), alpha-1 antitrypsin deficiency (a genetic disorder that can damage the lungs and liver), Budd-Chiari syndrome (a rare liver condition caused by blood clots), drug-induced liver cirrhosis (where certain drugs damage the liver), and chronic right-sided heart failure (a heart condition that causes fluid buildup in the body, which can lead to liver damage).

Finally, “cryptogenic cirrhosis” is a term doctors use when they aren’t sure what caused the cirrhosis.

Risk Factors and Frequency for Hepatic Cirrhosis

The exact number of people with cirrhosis all over the world isn’t known. But, in the United States, it’s estimated that between 0.15% to 0.27% of people have this condition.

Signs and Symptoms of Hepatic Cirrhosis

Cirrhosis, which is a disease that scars the liver, can show up differently in patients depending on the seriousness of their condition. When cirrhosis is “compensated,” this means the liver is handling the damage well, and patients usually won’t have any symptoms. Doctors might only notice it through blood tests, physical exams, or pictures of the body. However, people with “decompensated” cirrhosis have severe damage to the liver, and this leads to a variety of signs and symptoms. These can include fluid buildup in the abdomen, yellowing of the skin or eyes, mental confusion, bleeding from veins in the esophagus, and liver cancer. Changes from compensated to decompensated cirrhosis can lead to other complications such as bacterial infections in the abdomen and kidney damage, especially in patients who also have fluid buildup in the abdomen.

Many organs can be affected by cirrhosis:

Gastrointestinal: Problems include fluid buildup in the abdomen, enlarged liver and spleen, and swollen veins in the abdomen and esophagus. Cirrhosis can also lead to high risk of infection in the small intestine and pancreas, and gallstone formation.
Hematologic: Anemia and blood clotting issues can occur due to various reasons such as folate deficiency, autoimmune destruction of red blood cells, and an enlarged spleen.
Renal: Cirrhosis can cause kidney damage induced by low blood pressure and constrictions in blood vessels which eventually drive renal failure.
Pulmonary: Cirrhosis can cause several lung conditions, lowered oxygen levels, heart-lung disorders, fluid buildup in the chest, and over-breathing.
Skin: People may develop clusters of blood vessels that look like spiders and redness of palms due to hormonal imbalance. Patients can also turn yellow when the liver doesn’t remove enough bilirubin, a waste product of red blood cells.
Endocrine: In cirrhosis, there can be sex hormone imbalance leading to male breast enlargement and other sexual changes in men and women.
Nail Changes: Clubbing, bone and joint enlargement, and contractures of the hand can occur. Azure lunules, white nails and Muehrcke nails are other possible changes.
Others: Cirrhosis can cause a sweet, musty breath smell, hand tremor, loss of muscle mass, muscle cramps, belly button hernia, and several visible signs of chronic liver disease like spider veins, red palms, contractures, male breast enlargement, reduced testicles, fluid buildup in the abdomen, enlarged spleen, protruding veins around the belly button, confusion and sweet, musty breath.

Testing for Hepatic Cirrhosis

When testing for liver cirrhosis, several lab tests are carried out. These include aminotransferase tests, specifically aspartate aminotransferase (AST) and alanine aminotransferase (ALT). These are often mildly to moderately higher than usual, but normal levels don’t necessarily rule out cirrhosis. The AST/ALT ratio is also important – in most types of ongoing liver disease, the ratio is less than 1, but as the disease progresses to cirrhosis this reverses.

Labs may also measure alkaline phosphatase (ALP), 5′-nucleotidase, and gamma-glutamyl transferase (GGT), which increase in cholestatic disorders, disorders in which bile flow is decreased or stopped. The test will also assess Prothrombin time (PT) – this increases due to defects in blood clotting factor and bilirubin, and albumin decreases because the liver synthesizes it, and its working capacity reduces. So, serum albumin and PT are accurate indicators of liver function. Anemia, leukopenia, and thrombocytopenia can also be seen due to alcohol suppression effect on the bone marrow, and immunoglobulins are usually increased due to the liver’s impaired ability to clear them.

Additional specific lab tests could be run depending on the newly diagnosed cirrhosis, including tests for viral hepatitis, autoimmune antibodies, or other diseases such as ceruloplasmin and urinary copper for Wilson’s disease. These additional tests can help pinpoint the underlying cause of the cirrhosis.

In addition to the lab tests, several imaging techniques can help diagnose cirrhosis, including ultrasound, CT scan, MRI, and transient elastography (fibroscan). Each of these provides a different amount of information. For example, An ultrasound can detect changes in the liver’s texture and size, but it is not too specific, as these symptoms may also present in fatty liver diseases. Conversely, MRI can accurately detect lesions and liver fat and iron levels, but it is expensive and not readily available. An endoscopy may also be done to look for varices (enlarged veins) in the esophagus or stomach, suggesting portal hypertension. A liver biopsy, where a small sample of liver tissue is extracted for examination, is sometimes done as it’s the most accurate way to diagnose cirrhosis and assess the inflammation level (grade) and scarring (stage).

However, keep in mind that no single test can fully diagnose cirrhosis. The condition is often diagnosed by combining the results of several tests and considering the patient’s medical history and symptoms.

Treatment Options for Hepatic Cirrhosis

Once the liver is damaged, this is unfortunately permanent. However, the goal is to prevent further harm to your liver to slow down the progress of the disease. General methods to prevent your liver disease from getting worse include not drinking alcohol, getting vaccines for hepatitis B and C, maintaining a balanced diet, losing weight, and treating any triggers like dehydration, low blood pressure, and infections as soon as possible.

Regular monitoring can help with this. Doctors usually check how much fluid you have in your body, how well your kidneys are working, whether you’re developing enlarged veins in the esophagus (varices), and whether you’re showing signs of liver cancer.

There are also specific treatments that target the cause of your liver disease. For example, special antiviral medications are used for viral hepatitis, medications that decrease the body’s immune response (steroids and immunosuppressants) are used for autoimmune hepatitis, and certain acids are used for primary biliary cholangitis, which is a condition that slowly destroys the liver’s bile ducts. For Wilson’s disease and hemochromatosis, which cause harmful amounts of metals to accumulate in the body, treatments would aim to remove this excess metal from the body.

If you have non-alcoholic steatohepatitis (NASH), which is a type of fatty liver disease, losing at least 7% of your body weight can help. And if your liver disease is due to alcohol, it’s extremely important to completely stop drinking.

When a doctor is trying to diagnose liver cirrhosis, they consider other health problems that could cause similar symptoms. These can include:

Acute fatty liver of pregnancy
Poisoning from the Amanita phalloides mushroom
Overdose of the pain reliever acetaminophen
Poisoning from the toxin of the Bacillus cereus bacterium
Fructose intolerance
Galactosemia, a rare genetic disorder
HELLP syndrome, a complication of pregnancy
Infections caused by hemorrhage viruses like Ebola, Lassa, and Marburg
An unexplained reaction to a medication
Neonatal iron storage diseases
Tyrosinemia, a rare genetic disorder

Only after ruling out these possibilities through relevant tests, can a doctor confirm a diagnosis of liver cirrhosis.

What to expect with Hepatic Cirrhosis

Predictive models for liver cirrhosis – a condition where the liver slowly deteriorates and malfunctions – show that people with a stable stage of the disease, also known as compensated cirrhosis, have a 47% chance of living for another 10 years. However, this drops to 16% if complications or worsening of the disease occurs, known as decompensating.

One way doctors assess patients with liver cirrhosis is using the Child-Turcotte-Pugh (CTP) scoring system. This tool uses a combination of tests results – serum albumin and bilirubin (both related to liver health), PT (a measure of how well your blood clots), as well as the presence of ascites (fluid buildup in the abdomen), and hepatic encephalopathy (a brain disorder caused by liver failure). Based on these factors, doctors classify patients into groups A, B, and C.

The survival rates for these groups at 1 and 2 years are 100% and 85% (group A), 80% and 60% (group B), and 45% and 35% (group C).

Another tool used is the Model for End-Stage Liver Disease (MELD) score. It uses a combination of three test results – serum bilirubin, creatinine (a marker of kidney function), and INR (a measure of blood clotting) – to predict a patient’s likelihood of survival over the next 3 months. In the US, it is also used to prioritize who gets a liver transplant.

This brings us to liver transplants. These are typically considered when decompensated cirrhosis doesn’t respond to other treatments. Following a transplant, around 85% of patients live for at least another year, and 72% live for at least another five years. However, there is a risk that the original liver disease can return after a transplant. The long-term use of immunosuppressant drugs required after a transplant also carry their own risks, potentially causing health problems for transplant patients.

Possible Complications When Diagnosed with Hepatic Cirrhosis

Liver cirrhosis can be accompanied by various complications. These may include:

Portal hypertension, which is high blood pressure in the blood vessels supplying the liver
Swelling in the abdomen and lower legs (edema)
Yellowing of skin and eyes (jaundice)
Enlarged spleen (splenomegaly)
Infections
Bleeding (hemorrhage)
Hepatic encephalopathy, a condition that affects brain function due to liver disease

Preventing Hepatic Cirrhosis

While making changes to your lifestyle habits can’t entirely cure cirrhosis, certain changes can help slow down the progression of the disease and provide relief from symptoms. There are several lifestyle factors that you can modify to help in your condition:

The first is to stop consuming alcohol. Alcohol can be damaging to your liver, so avoiding it can help prevent worsening of the disease.

Next is to alter your diet habits. It’s recommended that you avoid eating raw seafood and shellfish. You might also need to start a low-sodium diet to help lessen water retention in your body, but you should always consult with your healthcare provider before making any drastic changes to your diet.

It’s also essential to receive vaccines for pneumonia, influenza, and hepatitis. Being vaccinated can help prevent diseases that might be detrimental to your condition.

Another key factor is to regulate your protein intake according to the directions given by your doctor. The right amount of protein can help your liver to function properly.

Lastly, some doctors may recommend taking a vitamin and mineral supplement to ensure your body gets the necessary nutrients. This should, however, be taken only under the guidance and recommendation of your healthcare provider.

Frequently asked questions

Hepatic Cirrhosis is a condition where the liver becomes scarred and forms small lumps due to long-term damage.

Between 0.15% to 0.27% of people in the United States have hepatic cirrhosis.

Signs and symptoms of Hepatic Cirrhosis include: - Fluid buildup in the abdomen - Yellowing of the skin or eyes (jaundice) - Mental confusion - Bleeding from veins in the esophagus - Liver cancer - Bacterial infections in the abdomen - Kidney damage, especially in patients with fluid buildup in the abdomen In addition to these specific symptoms, cirrhosis can also affect various organs in the body, leading to additional signs and symptoms such as: - Gastrointestinal problems, including enlarged liver and spleen, swollen veins in the abdomen and esophagus, and high risk of infection in the small intestine and pancreas - Hematologic issues, such as anemia and blood clotting problems - Renal damage, caused by low blood pressure and constrictions in blood vessels - Pulmonary conditions, including lowered oxygen levels, heart-lung disorders, and fluid buildup in the chest - Skin changes, such as the development of spider-like blood vessels and redness of palms - Endocrine imbalances, resulting in male breast enlargement and other sexual changes - Nail changes, such as clubbing, bone and joint enlargement, and contractures of the hand - Other visible signs of chronic liver disease, including spider veins, red palms, muscle cramps, and fluid buildup in the abdomen It's important to note that the severity and presentation of symptoms can vary depending on whether the cirrhosis is compensated or decompensated.

Hepatic cirrhosis can be caused by various factors, including the hepatitis C virus, excessive alcohol use, nonalcoholic steatohepatitis (NASH), hepatitis B virus, autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis, hemochromatosis, Wilson disease, alpha-1 antitrypsin deficiency, Budd-Chiari syndrome, drug-induced liver cirrhosis, chronic right-sided heart failure, and in some cases, the cause is unknown (cryptogenic cirrhosis).

The doctor needs to rule out the following conditions when diagnosing Hepatic Cirrhosis: 1. Acute fatty liver of pregnancy 2. Poisoning from the Amanita phalloides mushroom 3. Overdose of the pain reliever acetaminophen 4. Poisoning from the toxin of the Bacillus cereus bacterium 5. Fructose intolerance 6. Galactosemia, a rare genetic disorder 7. HELLP syndrome, a complication of pregnancy 8. Infections caused by hemorrhage viruses like Ebola, Lassa, and Marburg 9. An unexplained reaction to a medication 10. Neonatal iron storage diseases 11. Tyrosinemia, a rare genetic disorder

The types of tests that are needed for Hepatic Cirrhosis include: - Aminotransferase tests, specifically aspartate aminotransferase (AST) and alanine aminotransferase (ALT) - Alkaline phosphatase (ALP), 5'-nucleotidase, and gamma-glutamyl transferase (GGT) - Prothrombin time (PT) and serum albumin - Tests for viral hepatitis, autoimmune antibodies, and other diseases such as ceruloplasmin and urinary copper for Wilson's disease - Imaging techniques such as ultrasound, CT scan, MRI, and transient elastography (fibroscan) - Endoscopy to look for varices in the esophagus or stomach - Liver biopsy to assess inflammation level and scarring It is important to note that no single test can fully diagnose cirrhosis, and the results of several tests need to be combined with the patient's medical history and symptoms.

There are specific treatments for different causes of liver disease. For Hepatic Cirrhosis, the goal is to prevent further harm to the liver and slow down the progress of the disease. General methods to prevent the disease from getting worse include not drinking alcohol, maintaining a balanced diet, losing weight, and treating any triggers like dehydration, low blood pressure, and infections as soon as possible. Additionally, there are specific treatments that target the cause of the liver disease, such as special antiviral medications for viral hepatitis, medications that decrease the body's immune response for autoimmune hepatitis, and certain acids for primary biliary cholangitis.

The side effects when treating Hepatic Cirrhosis can include: - Portal hypertension, which is high blood pressure in the blood vessels supplying the liver - Swelling in the abdomen and lower legs (edema) - Yellowing of skin and eyes (jaundice) - Enlarged spleen (splenomegaly) - Infections - Bleeding (hemorrhage) - Hepatic encephalopathy, a condition that affects brain function due to liver disease

The prognosis for hepatic cirrhosis depends on the stage of the disease and the presence of complications. Here are the survival rates for different stages of hepatic cirrhosis: - Compensated cirrhosis (stable stage): 47% chance of living for another 10 years. - Decompensated cirrhosis (complications or worsening of the disease): 16% chance of living for another 10 years. Liver transplantation can be considered for patients with decompensated cirrhosis that doesn't respond to other treatments. After a transplant, around 85% of patients live for at least another year, and 72% live for at least another five years. However, there is a risk of the original liver disease returning after a transplant, and long-term use of immunosuppressant drugs carries its own risks.

You should see a hepatologist or a gastroenterologist for Hepatic Cirrhosis.

Gut Health Liver Disease Portal Hypertension Pulmonary Hypertension