Cirrhosis

It refers to extensive scarring of the liver and can occur after many years of liver disease. It can cause long-term irreversible damage to the liver. Any form of chronic liver injury can lead to cirrhosis but the most common causes are excess alcohol, chronic viral hepatitis, and non-alcohol fatty liver disease (NAFLD). Other causes include auto-immune diseases of the liver and bile ducts, and inherited metabolic disorders such as haemachromatosis (iron overload). Medications and chemicals may rarely cause an acute liver injury but are very unlikely to cause cirrhosis.

Chronic liver disease typically causes few, if any, symptoms, and indeed patients may even have cirrhosis and be unaware of it. After a patient has developed cirrhosis, they may go onto develop symptoms as part of their disease progression. Symptoms occur due to loss of liver function, but cirrhosis of the liver can be quite advanced before there are any complaints at all. Patients may ultimately develop liver failure, which is a life-threatening condition.

Cirrhosis and Liver Function

The liver is the largest individual organ in the body and is responsible for hundreds of different chemical and physiological functions which, overall, play a central role in keeping conditions constant within the body.

Functions of the Liver

  • Metabolism of fats and carbohydrates
  • Removal and breakdown of toxins
  • Breakdown and disposal of old red blood cells
  • Production of bile, a fluid that helps with digestion
  • Storage of minerals, vitamins and glycogen
  • Production of a majority of blood proteins including those that make a blood clot
  • Regulation of the immune system

The liver has an impressive ability to keep renewing often despite repeated or long- term injury, so a patient’s liver function may be preserved even in the setting of chronic liver disease. There may come a time, however, after the onset of cirrhosis when the capacity for regeneration is exhausted. At this point a patient may start to exhibit the signs and symptoms of liver dysfunction. These can include:

  • Fluid retention in the abdomen (ascites) or legs
  • Recurrent infections
  • Loss of weight and muscle wasting or weakness
  • Internal bleeding in the gut from portal hypertension (see below)
  • Confusion or excessive drowsiness (encephalopathy)

Diagnosing liver cirrhosis.

Your doctor would initially perform blood tests of liver function, an ultrasound scan of the liver anatomy and Fibroscan. A fibroscan is a completely painless test that measures the amount of scarring (fibrosis) and fat (steatosis) in the liver and very reliably determine whether a patient has cirrhosis. (hyperlink to fibro scan) that can be performed in 5-10mins and does not require sedation. If cirrhosis is confirmed, further investigations may be advised to determine the cause and assess for complications.

Looking after a patient with cirrhosis

The mainstay of management is to identify and treat or remove the underlying cause. Part of the care of a patient with cirrhosis will also include screening for potential complications, and the treatment of these as and when they occur.

Screening for complications of cirrhosis

Hepatocellular Carcinoma (HCC)

This is a primary liver cell cancer that usually occurs only in the context of cirrhosis, though not always. Regular screening with blood tests and scans can pick up HCC at an early stage, making it more likely that curative treatment can be given.

Portal Hypertension

Blood flow through a cirrhotic liver is impeded causing backpressure in the veins that drain into it from the gut and spleen. This is termed portal hypertension and can lead to the development of dilated blood vessels in the gut called varices. Varices may burst and cause severe or life-threatening internal bleeding. Treatment can be given to reduce the risk of this occurring. Screening for cirrhosis is safely performed with an endoscopic examination of the oesophagus and stomach.

In end-stage cirrhosis, the only treatment that can relieve symptoms and improve survival is a liver transplant but not everyone will be a suitable transplant candidate. Because of the risks involved with liver transplant surgery and the potentially long wait for a suitable organ, it is better to consider whether someone may need a transplant earlier rather than later.