Cirrhosis is severe scarring of liver tissue that impairs its many functions. While excessive alcohol intake is a known cause, various other conditions can lead to this irreversible damage. This progression often occurs silently over many years, frequently without noticeable symptoms in its early stages.
What Cirrhosis Is
Cirrhosis is a late stage of liver disease where healthy liver tissue is progressively replaced by permanent scar tissue. This scarring disrupts the liver’s normal structure and function. As scar tissue accumulates, it impedes blood flow, hindering the liver’s ability to filter toxins, produce proteins, and process nutrients. This can lead to liver failure, which worsens over time if the underlying cause is not addressed.
Leading Non-Alcoholic Causes
Non-alcoholic fatty liver disease (NAFLD) and chronic viral hepatitis are two prevalent non-alcoholic causes of cirrhosis. NAFLD begins with fat accumulation in liver cells, often associated with metabolic risk factors like obesity, type 2 diabetes, insulin resistance, and high cholesterol. When NAFLD progresses to non-alcoholic steatohepatitis (NASH), inflammation and liver cell damage occur, potentially advancing to cirrhosis.
Chronic viral hepatitis, specifically Hepatitis B (HBV) and Hepatitis C (HCV), also causes persistent liver cell inflammation and damage. Hepatitis B spreads through infected blood or bodily fluids, while Hepatitis C is primarily blood-to-blood. Both infections can remain asymptomatic for decades, causing liver damage and scarring if untreated. Early detection and management prevent progression to advanced liver disease.
Other Important Non-Alcoholic Causes
Several other conditions can lead to non-alcoholic cirrhosis. Autoimmune liver diseases occur when the immune system attacks liver cells or bile ducts. Examples include Autoimmune Hepatitis (AIH), Primary Biliary Cholangitis (PBC), and Primary Sclerosing Cholangitis (PSC). These conditions cause chronic inflammation, resulting in scarring.
Genetic and metabolic disorders also contribute by causing harmful substances to accumulate in the liver. Hemochromatosis is an inherited condition leading to excessive iron deposition. Wilson’s Disease involves copper accumulation, and Alpha-1 Antitrypsin Deficiency results from insufficient protective protein.
Certain medications or toxins can also induce liver injury (DILI). Chronic exposure to specific drugs or environmental toxins can cause liver inflammation and damage, potentially leading to cirrhosis.
Recognizing Signs
Recognizing cirrhosis signs is important for early intervention, though symptoms often appear only in advanced stages. Common symptoms include persistent fatigue, weakness, nausea, loss of appetite, and unexplained weight loss.
Fluid retention is frequent, appearing as swelling (edema) in legs and ankles, and fluid accumulation in the abdomen (ascites). Jaundice, a yellowing of the skin and eyes, occurs when the liver cannot process bilirubin. Itching (pruritus) can result from bile product accumulation. Easy bruising or bleeding may also occur due to reduced clotting factors. The lack of early symptoms underscores the need for regular medical check-ups, especially for those with risk factors.
Diagnosis and Management
Diagnosing cirrhosis involves medical tests. Blood tests, including liver function tests, measure enzymes and proteins. Imaging studies like ultrasound, CT scans, or MRI visualize the liver’s condition and scarring. A liver biopsy may confirm diagnosis and assess damage severity.
While cirrhosis scarring is irreversible, management focuses on slowing progression and addressing complications. This includes treating the underlying cause, such as antiviral medications for hepatitis or lifestyle changes for non-alcoholic fatty liver disease. Managing complications like fluid retention or bleeding may involve medications or procedures. For severe, end-stage cirrhosis, a liver transplant is an option.
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Citations:
Chronic Hepatitis B: Clinical Presentation. StatPearls. [https://www.ncbi.nlm.nih.gov/books/NBK560616/]