The liver is one of the most vital organs in the human body, performing essential roles in metabolism, detoxification, blood clotting, and protein synthesis. When chronic injury or inflammation leads to replacement of normal liver tissue with fibrotic scar tissue, the condition is called cirrhosis.
Cirrhosis is considered the end stage of chronic liver disease, regardless of the underlying cause. It represents irreversible liver damage that disrupts normal liver function and often leads to life-threatening complications.
Functions of a Healthy Liver
The liver is essential for maintaining the body’s homeostasis. Its major functions include:
- Detoxification: Removes harmful toxins, drugs, and metabolic byproducts.
- Clotting Support: Produces clotting factors that help stop bleeding.
- Drug Metabolism: Breaks down medications to make them effective or excrete them.
- Albumin Synthesis: Produces albumin, a protein that maintains blood volume and prevents fluid leakage.
When cirrhosis develops, these functions are progressively impaired, leading to systemic effects.
Stages of Liver Damage
Cirrhosis develops gradually, often through well-defined stages:
- Healthy Liver: Normal structure and function.
- Fatty Liver: Accumulation of fat deposits, often from alcohol or obesity.
- Fibrosis: Scar tissue begins forming, reducing liver efficiency.
- Cirrhotic Liver: Extensive fibrosis with destruction of normal liver cells, leading to irreversible damage.
Pathology of Cirrhosis
Cirrhosis occurs when liver cells (hepatocytes) are destroyed due to chronic injury and replaced with fibrotic scar tissue. Over time, this disrupts the architecture of the liver, leading to:
- Loss of normal metabolic functions.
- Portal hypertension due to obstruction of blood flow.
- Impaired detoxification, resulting in toxin accumulation such as ammonia.
Causes of Cirrhosis
Cirrhosis can result from multiple underlying conditions:
- Alcohol consumption (ETOH): Long-term heavy drinking is a leading cause.
- Non-alcoholic fatty liver disease (NAFLD): Associated with obesity, diabetes, and high cholesterol.
- Viral hepatitis B & C: Chronic infection causes progressive liver scarring.
- Autoimmune hepatitis: Body’s immune system attacks liver cells.
- Hepatotoxic drugs and toxins: Medications like methotrexate or toxins can injure the liver.
- Parasitic infections: Liver flukes and other parasites may contribute.
Signs and Symptoms of Cirrhosis
Cirrhosis often remains asymptomatic in early stages, with symptoms appearing as the disease advances.
- Neurological signs: Asterixis (flapping tremor) due to hepatic encephalopathy.
- Jaundice: Yellow discoloration of the skin and eyes from bilirubin accumulation.
- Ascites: Fluid accumulation in the abdominal cavity.
- Edema: Swelling in legs and ankles.
- Abdominal pain and distension.
- Chronic dyspepsia (GI upset).
- Pruritus (itchy skin).
- Bleeding tendency: Due to low platelets and clotting factors.
- Fatigue, weakness, and anorexia.
- Increased bilirubin and ammonia levels.
Complications of Cirrhosis
Advanced cirrhosis can lead to several life-threatening complications:
- Portal Hypertension: Narrowing of veins in the liver increases pressure, leading to collateral circulation.
- Gastrointestinal bleeding: Varices (esophageal or gastric) rupture due to high venous pressure.
- Splenomegaly: Enlargement of the spleen from portal hypertension.
- Hepatic encephalopathy: Brain dysfunction caused by elevated ammonia, leading to confusion, drowsiness, or coma.
- Anemia and malnutrition.
- Gynecomastia: Breast development in men due to hormonal imbalance.
- Hepatorenal syndrome: Kidney failure secondary to severe liver disease.
- Acute liver failure: A final stage that requires urgent transplantation.
Diagnosis of Cirrhosis
Cirrhosis diagnosis is made using a combination of clinical evaluation, imaging, and laboratory investigations.
| Test | Findings |
|---|---|
| Liver function tests (LFTs) | Elevated AST, ALT, bilirubin |
| Albumin levels | Decreased due to impaired synthesis |
| Prothrombin time (PT/INR) | Prolonged, indicating clotting problems |
| Ultrasound/CT scan | Irregular liver surface, splenomegaly, ascites |
| Liver biopsy | Confirms fibrosis and cirrhosis |
Treatment of Cirrhosis
Cirrhosis is irreversible, but early treatment can slow progression and manage complications.
Lifestyle modifications:
- No alcohol consumption.
- Adequate rest.
- Low-sodium diet to reduce ascites and edema.
Preventive measures:
- Vaccinations (hepatitis A and B, influenza, pneumococcal).
- Avoid acetaminophen and hepatotoxic drugs.
- Bleeding precautions (soft toothbrush, electric razor, careful venipuncture).
Medications for Cirrhosis
Pharmacological management includes:
- Antacids: For gastric irritation.
- Vitamin supplements: To correct deficiencies.
- Diuretics: Reduce fluid overload and ascites.
- Lactulose: Reduces ammonia levels by promoting excretion through stool.
- Avoid narcotics and sedatives: As the diseased liver cannot metabolize them effectively.
Prognosis and Long-Term Outlook
Cirrhosis prognosis depends on the underlying cause, extent of liver damage, and presence of complications. Early intervention can significantly improve survival. However, advanced cirrhosis carries a high risk of liver failure and death without transplantation.
Frequently Asked Questions (FAQ)
Q1. Can cirrhosis be reversed?
No, cirrhosis is irreversible, but its progression can be slowed if diagnosed early and managed properly.
Q2. What is the difference between fatty liver and cirrhosis?
Fatty liver is an early, reversible stage of liver damage, whereas cirrhosis is advanced and irreversible with fibrotic scarring.
Q3. What foods should be avoided with cirrhosis?
Avoid alcohol, high-sodium foods, fried and fatty meals, and processed foods.
Q4. Is liver transplant the only cure for cirrhosis?
Yes, liver transplant is the definitive treatment for end-stage cirrhosis.
Q5. Can cirrhosis cause cancer?
Yes, cirrhosis significantly increases the risk of hepatocellular carcinoma (liver cancer).
Q6. How long can you live with cirrhosis?
Life expectancy depends on stage and complications. With proper treatment and lifestyle changes, patients can live for many years, but advanced cirrhosis without a transplant has a poor prognosis.
