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Liver cirrhosis is the last stage of chronic liver disease where the liver gets severely damaged and scarred due to long-standing ongoing injury to the liver cells. We will also talk about causes of liver cirrhosis, Sign and symptoms of liver cirrhosis in this article. But first let’s understand the below conditions.
This long-standing injury could be due to the following conditions:
• Excessive alcohol consumption
• Long-standing viral infection of the liver (hepatitis B or C)
• Non-alcoholic fatty liver disease (NAFLD)
The above-mentioned causes are the commonest ones, however, there are other less common causes that are mentioned later. In many people, multiple conditions can contribute to the development of cirrhosis and this could be the reasons of appearing signs and symptoms of liver cirrhosis in many people.
Liver cirrhosis is classically considered as an irreversible condition which can be further divided into two types on the basis of presence or absence of complications:
Compensated cirrhosis: cirrhosis without complications.
Decompensated cirrhosis: cirrhosis where complications develop which results in a significant increased risk of death. These complications can be:
• Ascites (fluid in the abdomen)
• Variceal bleeding (bleeding through dilated blood vessels in the food pipe)
• Hepatic encephalopathy
Cirrhosis with ascites has a death rate of 20% per year, which is also called Stage III of cirrhosis. Whereas, cirrhosis with gastrointestinal bleed has a high death rate of 57% per year also called Stage IV of cirrhosis. so you just need to know all the causes of liver cirrhosis, Signs and symptoms of liver cirrhosis to live carefully.
Cirrhosis without the above complications (compensated cirrhosis) constitutes
Stage I, where there is no evidence of dilated vessels in the food pipe (varices) with a minimal death rate of 1% per year.
Stage II, where cirrhosis is accompanied by the presence of only varices. It has a death rate of 3.4% per year.
There are a number of causes of liver cirrhosis that can cause long-standing damage to the liver and lead to cirrhosis. Some of the causes of liver cirrhosis are common which constitutes a maximum number of cases, while others are less common and constitute only a small number of cases.
• Chronic excessive alcohol consumption
• Chronic viral infection of the liver such as Hepatitis B and C. Hepatitis D less commonly causes cirrhosis.
• Non-alcoholic fatty liver disease (NAFLD), where the accumulation of fat in the liver occurs without any direct cause such as alcohol, medicines, or infection. Know more
• Autoimmune hepatitis
• Cystic fibrosis
• Biliary disease such as primary biliary cirrhosis, primary sclerosing cholangitis, or biliary atresia- common cause in children.
• Inherited disorders such as Wilson’s disease, glycogen storage deficiency, α₁-antitrypsin deficiency, and galactosemia
• Right-sided heart failure
• Drug reactions can be seen with phenytoin, methotrexate, amiodarone, etc.
• Drug toxicity can be seen with vitamin A, acetaminophen, etc.
• Exposure to environmental toxins (eg, mercury, lead, organochlorine pesticides) 8
• Unknown cause (Cryptogenic cirrhosis): cause remains unclear
The cirrhosis usually in the initial phase (compensated) doesn’t have any signs and symptoms of liver cirrhosis. As the damage to the liver increases and more and more liver becomes scarred the signs and symptoms of liver cirrhosis start appearing which represents the development of complications or decompensation of cirrhosis.
A person having early cirrhosis without complication (compensated) often doesn’t have any symptoms and might be unaware of his or her condition. Some people may have mild symptoms of liver cirrhosis which can be:
• Weakness, weight loss, or malnutrition: this occurs due to the inability of the damaged liver to process nutrients and proteins.
• Sleep issues
• Reduced sex drive, breast enlargement or reduced size of the testis in men
• Itching over skin seen in people with primary sclerosing cholangitis or primary biliary cirrhosis
• Esophageal varices: are small dilated veins that are seen in walls of food pipe and stomach which dilates due to backpressure from liver vessels. These are commonly present in patients of compensated cirrhosis however, they do not cause any symptoms of liver cirrhosis.
in the later stages of cirrhosis, the complications develop due to the progressive increase in the blood pressure in the liver and liver dysfunction. These complications can present with the following symptoms of liver cirrhosis:
• General signs and symptoms of liver cirrhosis
– Jaundice– the whites of the eye and skin become yellow. This occurs due to the inability of the damaged liver to remove yellow-colored waste called bilirubin from the blood.
– Loss of appetite
– Worsening fatigue
– Impotence, breast enlargement or reduced size of the testis in men
– Lack of periods in females which is not related to menopause
• Ascites: fluid gets accumulated in the abdomen due to increased blood pressure in the liver (portal hypertension). After this important symptoms of liver cirrhosis, A person may come to know about this by noticing the following changes :
– Increase in abdominal width usually noted as tightness of clothes at the waistline
– Weight gain
– Difficulty in breathing
– Some people with ascites may develop a fever and abdominal pain which may indicate an infection in the abdomen (peritonitis).
• Rupture of esophageal varices can occur due to the development of significant pressure in the dilated veins of the stomach and esophagus. This symptoms of liver cirrhosis may present as –
– Bloody vomiting and/or black colored stools (Melena)
• Hepatic encephalopathy may occur due to the accumulation of toxins in the brain. Here, the person would develop insomnia and forgetfulness initially. Eventually, he may develop confusion, slurred speech drowsiness, and at last coma. So, these all are the major signs and symptoms of liver cirrhosis, just click on the below link to know more about symptoms of liver cirrhosis.
For the diagnosis of liver cirrhosis and its complications extensive diagnostic tests and some procedures are done, which can be categorized into- blood tests, imaging studies, and procedures.
The diagnosis of the liver cirrhosis can be done with the help of the following:
• Blood tests
The prognosis of the disease or how the disease would affect a person depends upon the cause and the development of the complications.
Cirrhosis without major complications (compensated) has a lower death rate. About 20 to 60% of these people can develop malnutrition which can further affect their health. This can be prevented by good protein intake. The death in compensated cirrhosis occurs more often due to non-liver conditions such as cardiovascular diseases, stroke, renal disease, or malignancy.
Whereas, cirrhosis with complications (decompensated) has a higher death rate which is attributed to cirrhotic complications.
According to prognosis, the condition has been classified into 4 stages:
Stage 1: Compensated cirrhosis without esophageal varices- mortality rate of 1% per year.
Stage 2: Compensated cirrhosis with esophageal varices- mortality rate of 3.4% per year.
Stage 3: Decompensated cirrhosis with ascites- mortality rate of 20% per year.
Stage 4: Decompensated cirrhosis with GI bleed- mortality rate of 57% per year.
Cirrhosis till now has been considered as an irreversible disease. However, recent findings have suggested that fibrosis could be reversed to some extent in some of the cases which are discussed later in the treatment.
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