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Cirrhosis of the Liver: Symptoms, Causes, and Diagnosis

Cirrhosis of the Liver: Symptoms, Causes, and Diagnosis

General Information

The liver is your body’s largest and most important solid internal organ. It is localized on the right side of the abdomen. In healthy adults, it is completely hidden under the coastal arch. In women, it reaches a weight of 1500 grams, and in men, 1700 grams.

The liver is built up from cells called hepatocytes. It is very well vascularized. The blood comes to it by two vessels: the hepatic artery (oxygenated blood) and portal vein (blood rich in nutrients) and comes out by the hepatic vein.

The liver has excellent regenerative abilities. This is due to the possibility of rapid renewal of its cells after the action of damaging factors, such as alcohol, viruses, and some drugs. If provided that the destruction processes do not exceed the possibility of renewal.

The liver performs over 500 functions in the body. Here are some of them:

  • Production of proteins. The liver produces around 85% of plasma proteins, including albumin and proteins essential for clotting.
  • Detoxification functions. This applies to the neutralization of various toxins, including alcohol, as well as the degradation of hormones, the transformation of drugs, etc.
  • Bile production is vital for the digestion of fats and absorbing some of the vitamins (A, D, E, and K). This complex substance is essential for the digestion process and ensures the body can adequately absorb these crucial vitamins.
  • Cholesterol production.
  • Accumulation of vitamins (e.g., A, D, and B12) and iron.
  • Glucose metabolism. Suppose there is too much glucose in the body. In that case, the liver converts it into glycogen, which acts as a storage of glucose, releasing it into the bloodstream when the body needs it.
  • Immune functions. The liver is also an organ of significant immune value. Its cells absorb and neutralize microorganisms reaching it with blood.
  • Bilirubin metabolism. Bilirubin is a product of the breakdown of red blood cells. When the body has a problem with its removal, bilirubin accumulates, causing the yellow color of the skin and eye whites.

The liver plays a vital and indispensable role in keeping our bodies running smoothly.

What is Cirrhosis of The Liver

Liver cirrhosis is a late stage of the liver damage. The initial stages of liver damage are reversible. Once cirrhosis sets in, the damage becomes irreversible, leaving a liver transplant as the only hope for recovery.

Fibrosis replaces healthy liver cells with scar tissue in cirrhosis. This happens as a result of the long-term action of the liver-damaging factor. Fibrosis reaches such a high intensity in cirrhosis that the typical structure of the organ is destroyed.

Blood flow through the diseased liver is disturbed, and the liver does not perform its functions sufficiently.

In the most advanced cases, cirrhosis leads to liver failure, which is a complete stop of its work.

Stages,Of,Liver,Damage.,Liver,Disease.,Healthy,,Fatty,,Liver,Fibrosis

Frequency of liver cirrhosis

In U.S. alone, 4.5 million adults have cirrhosis. Liver cirrhosis is the 11th most common cause of death in the world. Incidence varies geographically, depending on the amount of alcohol consumed and the presence of hepatitis viruses.

Symptoms of liver cirrhosis

The progression from long-term liver disease to cirrhosis symptoms appearance can take many years. In about 30% of patients, cirrhosis is wholly asymptomatic and is detected during examination for another reason.

The disease follows a progression with two distinct phases: the compensated phase, where the condition stays stable, and the decompensation phase, which is characterized by the sudden onset of severe symptoms and a rapid decline in health.

Because the liver has multiple functions, the symptoms of cirrhosis are broad and involve many organs.

General symptoms

  • weakness and fatigue
  • low-grade fever
  • loss of appetite
  • weight and muscle loss
  • characteristic body shape – slim upper and lower limbs and enlarged belly (caused by the accumulation of water in the stomach)
  • itching of the skin (due to impaired bile production)
  • edema (swelling)
  • muscle cramps
  • bleeding gums and nosebleeds (caused by a defect in the production of proteins needed for blood clotting)
  • dark urine

Skin changes

  • skin and eye whites color change to yellowish (jaundice)
  • hemangiomas, spider veins
  • redness of the palms and soles
  • white discoloration of nails
  • dilated veins on the skin of the abdomen

Disorders in the digestive system

  • bloating, nausea, and vomiting
  • enlargement of the spleen (an organ placed on the left side of the belly, above the stomach)
  • pain under the right ribs

Hormonal disorders

  • menstrual disorders in women
  • hirsutism which is excessive male pattern hair growth in women
  • loss of hair on the chest and armpits in men
  • libido loss
  • potency disorders

Causes

Cirrhosis can happen for multiple reasons. The most common of these are alcoholism and hepatitis viruses.

Silhouette,Of,Anonymous,Alcoholic,Person,Drinking,Behind,Bottles,Of,Alcohol

Less common causes include:

  • Nonalcoholic fatty liver. Disease-associated with obesity and high cholesterol.
  • Autoimmune liver disease is when the immune (defense) system attacks the healthy cells of its own body.
  • Bile duct diseases (e.g., blockage or inflammation)
  • Some medications. Liver-toxic drugs include paracetamol, some antibiotics, and antiviral drugs.
  • Toxic chemicals exposure.
  • Some genetically passed diseases like hemochromatosis or Wilson’s disease. In those diseases, metals accumulate excessively in the body, causing damage to various organs, including the liver. Regarding hemochromatosis, it is iron, and in Wilson’s disease – copper.
  • Some infections (syphilis).
  • Budd-Chiari syndrome is a disease in which blood clots in the liver veins.

Diagnosis

Doctors begin to suspect liver cirrhosis based on the presented symptoms. The additional tests are then ordered. Tests that can be performed include:

Blood tests

Due to the complex functions of the liver, various blood tests may be ordered when cirrhosis is suspected. To assess the functioning of the liver, doctors typically perform a range of tests. These may involve checking liver enzyme activity, protein levels, blood clotting parameters, bilirubin levels, and various other parameters.

Scans

Scans that the doctors could order during the cirrhosis diagnostic process include various types of ultrasound, CT, and MRI.

Abnormalities found in an ultrasound examination include an enlarged spleen, the liver has an irregular appearance, it may be enlarged or, on the contrary, too small, shrunken.

In addition to routine ultrasound, the doctors usually order a color Doppler ultrasound that can show characteristic disturbances in blood flow to and from the liver.

Another type of ultrasound is liver elastography which can be used not only in making a diagnosis but also in assessing the prognosis of the disease.

Gastroscopy

Gastroscopy examines the upper gastrointestinal tract (esophagus and stomach). In cirrhosis, it is performed to assess the presence of typical complications: varicose veins of the esophagus, which are dilated, winding veins, and portal gastropathy, which is damage to the stomach mucosa caused by blood stagnation associated with cirrhosis.

Liver biopsy

In a liver biopsy doctor collects a small part of the liver by inserting a thin needle through the skin. Next, the sample is examined under a microscope. This test is performed if the doctor has doubts about the diagnosis.

Treatment

Liver damage in cirrhosis is irreversible. That’s why there is no known cure for cirrhosis. However, treatment of the cause and prevention of the effects of the disease are implemented.

Treatment of the cirrhosis cause

The basis of treatment is the elimination of the factor damaging the liver. The most common one is alcohol. Absolute abstinence can delay the appearance of severe complications by many months or even years.

In the case of hepatitis-induced cirrhosis, antiviral treatment is used. However, it must be remembered that this is to stop the disease’s progression, not cure cirrhosis.

Lifestyle changes

Experts also recommend not smoking and a proper, balanced diet. In most people with chronic liver diseases, dietary restrictions, e.g., limiting coffee, do not apply. The exception is people suffering from Wilson’s disease, for whom a diet low in copper is necessary for treatment, i.e., limiting products such as chocolate, nuts, seafood, and mushrooms.

Medications

Doctors may use several medications to prevent or treat complications and relieve symptoms of cirrhosis:

  • diuretics to treat the accumulation of water in the abdomen and legs
  • high blood pressure medications
  • Beta-blockers are drugs that prevent esophageal varices
  • medicines that improve blood clotting to prevent bleeding

Liver transplantation

If cirrhosis enters the phase of irreversible decompensation, the doctor may decide to do a liver transplant If the organ is destroyed, it is the only chance of getting better. For this step, however, the patient must meet many requirements, including a psychological assessment of alcohol abuse.

Complications

Ascites

Ascites are an accumulation of fluid in the stomach. During cirrhosis, blood pressure in the abdomen’s vessels is too high. This causes blood stagnation in the blood vessels and fluid leakage to the belly. Ascites are the most common and earliest-occurring complication of cirrhosis. If ascites appear, the prognosis of the disease worsens significantly.

Depending on the amount of accumulated fluid, ascites is divided into:

  1. Mild – noticed only with ultrasonography
  2. Moderate – fluid accumulation exceeds 500 milliliters
  3. Advanced – belly is tense, and the navel is smoothed out.

Shortness of breath may occur with this complication. This means more than 15 liters of fluid have accumulated in the abdomen.

Doctors treat mild ascites with water pills (diuretics) and a low-sodium diet. In more severe cases, hospitalization and fluid drainage can be necessary.

Jaundice

Jaundice happens when bilirubin accumulates in the body. Bilirubin is a product of red blood cell breakdown. Usually, it is removed from the body by the liver, but in cirrhosis, the liver doesn’t remove it well enough. The excess of bilirubin deposits in the body cells creates the yellowish color of the skin and eye whites—bilirubin deposits in the skin cause persistent itching.

Jaundice first appears in the whites, then the skin, and resolves reversely.

Esophageal varices

In cirrhosis, the pressure in the portal vein increases. This means that the blood can’t flow in this vein efficiently and must find an alternative way of flow – it goes through the so-called collateral circulation, including the esophageal veins. They are not adapted to transport such large amounts of it – they widen and stretch, creating varicose veins. Such veins become weak, brittle, and break easily. Ruptured esophageal varices may present as vomiting blood or loose black stools. It can be highly dangerous. Emergency medical attention is necessary.

Peritonitis

Peritonitis is the inflammation of the inner lining of your abdomen. Ascites, combined with fever and severe abdominal pain, persisting despite taking home painkillers, may indicate infection of the fluid accumulated in the stomach. Infected fluid, in turn, leads to peritonitis.

Hepatic encephalopathy

Hepatic encephalopathy is a set of psychiatric symptoms. A damaged liver does not remove toxins such as ammonia, phenols, or fatty acids from the body. Toxins entering the brain cause symptoms of encephalopathy.

Hepatic encephalopathy can manifest as:

  • mood changes
  • decreased concentration
  • somnolence
  • confusion
  • personality changes
  • lethargy or apathy
  • behavior inappropriate to the situation
  • hepatic coma

Liver cancer

People with cirrhosis have a higher chance of liver cancer development. This applies mainly to the people with cirrhosis caused by the HCV infection.

Cirrhosis,Of,The,Liver.,Photo,Of,Man,Holding,His,Hand

Prognosis

Liver cirrhosis prognosis differs depending on the severity of the disease. The severity is estimated with the Child-Pugh scale. On this scale, factors such as the presence of encephalopathy, ascites, bilirubin level, protein levels, and blood clotting are assessed.

Based on the severity of the abovementioned factors, you can obtain a score of 5 to 15 points. Based on that, three groups of cirrhosis severity with different 1-year survival rates are distinguished:

  1. Group 1 – least severe, 5-6 points, 100% 1-year survival rate
  2. Group 2 – moderately severe, 7-9 points, 80% 1-year survival rate
  3. Group 3 – most severe, 10-15 points, 45% 1-year survival rate

When should you see a doctor?

Some cirrhosis symptoms can be severe and require emergency medical help.

The symptoms that should alert you:

  • Yellowish color of eye whites and skin combined with unpleasant odor from the mouth
  • bleeding from the digestive tract (especially vomiting fresh blood)
  • sudden worsening of mental state, including unnatural drowsiness
  • the rapid increase in stomachs circumference associated with fluid accumulation
  • ascites combined with fever and abdominal pain (suggestive of peritonitis)

Other less sudden symptoms that should prompt you to see your GP include the following:

  • leg edema
  • skin changes indicating disorders in blood clotting (hemangiomas, nosebleeds, bleeding gums)
  • persistent itching of the skin
  • menstrual disorders in women
  • erectile dysfunction in men
  • jaundice

Prevention

Some of the causes of cirrhosis are related to our lifestyle. You can reduce your chances of liver cirrhosis development by:

  1. Alcohol abstinence – excessive alcohol consumption is the most common factor causing liver cirrhosis.
  2. Healthy diet – maintaining a healthy diet prevents the development of obesity and high cholesterol, which are nonalcoholic fatty liver risk factors.
  3. A safe lifestyle that minimizes the risk of getting hepatitis viruses. This includes using condoms and not using narcotics.
  4. Before getting a piercing or tattoos, make sure that the place in which you’re doing it uses sterile equipment.
  5. By receiving the Hepatitis B vaccination, you can safeguard yourself against infection, which is one of the possible cirrhosis causes.
  6. It’s essential to be careful when taking hepatotoxic medications, including OTC ones.

Sources

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