Cirrhosis is a late-stage liver disease marked by irreversible scarring that replaces healthy liver tissue. This widespread scarring interferes with the liver’s ability to perform its many functions, such as filtering toxins from the blood and producing important proteins.
Understanding the Causes
Cirrhosis develops from chronic liver damage. Common causes include chronic viral hepatitis (Hepatitis B and C), where persistent inflammation forms scar tissue. Long-term alcohol abuse also contributes, as the liver’s breakdown of alcohol leads to inflammation and scarring.
Non-alcoholic fatty liver disease (NAFLD) can progress to non-alcoholic steatohepatitis (NASH), a severe form eventually causing cirrhosis. This condition is often associated with obesity, diabetes, and high cholesterol. Autoimmune hepatitis, where the immune system attacks liver cells, also causes chronic inflammation and scarring. Genetic disorders like hemochromatosis (excessive iron buildup) and Wilson’s disease (copper accumulation) can also damage the liver, leading to cirrhosis.
Stages of Liver Damage
Liver damage progresses gradually to cirrhosis, beginning with inflammation and fibrosis, or initial scarring. If the underlying cause persists, fibrosis becomes more extensive. Over time, scar tissue connects, forming bands called septa, and the liver may shrink, impairing its function and impeding blood flow.
Cirrhosis has two primary clinical stages: compensated and decompensated. In compensated cirrhosis, the liver is significantly scarred but still functions adequately, and individuals may experience no noticeable symptoms. This stage can last for years, with individuals often unaware of their condition.
If damage continues or the underlying cause is not managed, compensated cirrhosis progresses to decompensated cirrhosis. At this point, the liver can no longer perform its essential functions, leading to severe complications and a decline in overall health. This transition often involves increased pressure in the portal vein, which carries blood to the liver.
Recognizing Advanced Symptoms
As cirrhosis progresses to its decompensated stage, the liver’s inability to function properly leads to noticeable symptoms and complications. Jaundice, a yellowish tint to the skin and eyes, occurs because the damaged liver cannot effectively process bilirubin. Fluid retention is also prevalent, manifesting as ascites (fluid accumulation in the abdomen) and peripheral edema (swelling in the legs and ankles).
Hepatic encephalopathy is another complication, involving a decline in brain function due to the liver’s failure to remove toxins like ammonia from the blood. This can lead to confusion, memory problems, personality changes, and sleep disturbances. Variceal bleeding, resulting from enlarged and fragile veins in the esophagus or stomach, can cause severe internal bleeding. Individuals may also experience easy bruising and bleeding due to the liver’s impaired production of clotting factors. Other symptoms include severe fatigue, unexplained weight loss, and muscle wasting.
Managing and Slowing Progression
While cirrhosis scarring is irreversible, treatment focuses on preventing further liver damage, managing symptoms, and preventing complications. Primary management involves strict abstinence from alcohol, as even small amounts accelerate liver damage. Addressing the underlying cause is also important; for instance, antiviral therapy treats chronic hepatitis B and C, and weight management programs benefit individuals with NAFLD.
Dietary modifications are recommended, including a low-sodium diet to help manage fluid retention like ascites and edema. Medications alleviate specific symptoms and complications. Diuretics, for example, reduce fluid buildup, while lactulose manages hepatic encephalopathy by lowering ammonia levels. Beta-blockers may be prescribed to reduce portal vein pressure and prevent variceal bleeding.
Regular monitoring of liver function and screening for complications like liver cancer are important aspects of ongoing care. In end-stage liver disease, where liver function is severely compromised and complications are unmanageable, a liver transplant may be considered. Emerging research also explores antifibrotic agents and cell-based therapies aimed at reducing scarring and promoting liver regeneration.