Cirrhosis: What is it, Symptoms, Causes, Stages and Treatment
Cirrhosis is a general term that refers to the end stage of liver diseases and their complications. In the early stages of cirrhosis, the patient may not show any symptoms or complaints.
Cirrhosis is a general term that refers to the end stage of liver diseases and their complications. In the early stages of cirrhosis, the patient may not show any symptoms or complaints. The most common causes of cirrhosis include alcohol use, hepatitis and non-alcoholic fatty liver disease. Cirrhosis treatment varies depending on the cause of cirrhosis and how advanced the disease is. If liver failure progresses and cannot function despite treatment, liver transplantation may be required.
What is Cirrhosis?
Cirrhosis is a disease seen in the last stage of liver diseases, where the healthy tissue of the liver is replaced by scar tissue and becomes irreversibly damaged. Liver functions decrease as scar tissue replaces healthy liver tissue. He cannot perform his duties appropriately. Many types of liver disease; They damage healthy liver cells, causing inflammation and cell death. The remaining liver tissue attempts cell repair. During the repair process, the liver tries to heal with scar tissue and fibrous structures. However, scar tissue restricts blood flow to the liver. As the stages of cirrhosis progress, the rate of scar tissue in the liver increases. Liver; It loses its ability to process nutrients, produce hormones, and remove drugs and toxins from the body. In addition, the production of proteins and enzymes secreted by the liver decreases. Cirrhosis is irreversible, scar tissues cannot be healed. If cirrhosis is diagnosed early, damage to the liver can be limited. End-stage cirrhosis is a life-threatening condition. Requires liver transplant.
Common Causes of Cirrhosis
Cirrhosis is not a disease with a single cause and pathophysiology. It is considered the final stage of any disease that damages liver cells. The most common causes of cirrhosis are:
- Alcohol use: Long-term excessive use of alcohol has been reported to be associated with cirrhosis.
- Chronic viral infections of the liver (hepatitis): Hepatitis B and hepatitis C infections are hepatitis that lead to chronic viral hepatitis.
- Fatty liver disease: This condition, seen in obesity and diabetes, is one of the most important causes of cirrhosis. It is also called non-alcoholic steatohepatitis.
Less common causes of cirrhosis are:
- Hereditary Diseases:
– Alpha-1-antitrypsin deficiency: Causes the accumulation of abnormal proteins in the liver.
– Hemochromatosis: It is a disease that means excessive iron accumulation in the liver.
– Wilson’s disease: It is a disease that manifests itself with excessive copper accumulation in the liver.
– Cystic Fibrosis: It is the accumulation of sticky and viscous mucus in the liver.
– Glycogen storage diseases: These are diseases in which the liver cannot break down or store glycogen, which is the storage form of carbohydrates.
– Alagille Syndrome: It is the presence of fewer bile ducts than normal. There is a problem in the flow of bile. It causes jaundice.
- Autoimmune hepatitis: It occurs when a person’s own immune system attacks and damages healthy liver tissue.
- Diseases that affect bile flow in the liver: Diseases such as primary biliary cholangitis, primary sclerosing cholangitis and biliary atresia block bile flow and damage the liver.
- Chronic heart failure: It causes the liver to be loaded with fluid and inadequate blood circulation.
- Amyloidosis: It is a rare disease. It is a disease caused by the accumulation of amyloid, an abnormal protein that reduces normal liver function.
The progression from liver diseases to cirrhosis occurs gradually. If liver damage continues, cells begin to die. Very rarely, in some severe cases, there may be a very rapid progression to cirrhosis.
How Is Cirrhosis Diagnosed?
Unless there is widespread liver damage, a cirrhosis patient may not be aware of his disease and may not have any complaints. However, if the liver damage is large enough to not be compensated by the body, signs and symptoms are observed. These symptoms are as follows:
– Don’t get tired easily
– Easy bruising and bleeding
– Loss of appetite
– Swelling (edema) in the legs, ankles and feet
– Weight loss
– Accumulation of fluid in the abdomen (ascites)
– Spider-like vascular structures in the skin
– Redness on the palms
– Breast enlargement in men (gynecomastia)
– Impairment of consciousness when hepatic encephalopathy develops
When the patient consults the doctor with the complaints listed above, a medical history is taken from the patient regarding the cause of cirrhosis and a physical examination is completed. The patient’s history is specifically questioned about alcohol use, illegal drug use, hepatitis and jaundice. Blood tests are requested based on medical history. Liver enzyme levels, hepatitis markers, bilirubin level, presence of autoantibodies and alpha fetoprotein hormone are checked.
The size, shape and texture of the liver are examined with imaging methods. Computed tomography, magnetic resonance imaging and ultrasonography may be requested to image the liver, and if biliary pathologies are suspected, endoscopic retrograde cholangiopancreatography may be requested to view the bile ducts in more detail. Information can be obtained about the scar rate in the liver tissue with a special ultrasonography method called transient elastography.
The diagnosis of cirrhosis is confirmed by taking a biopsy (sample piece) from the liver. Additionally, a biopsy can reveal the cause of cirrhosis and indicate whether it has progressed to cancer.
What are the Stages of Cirrhosis?
Cirrhosis is examined in two stages: compensated and decompensated cirrhosis, depending on the presence of symptoms. If diagnosed early enough, it is possible for decompensated cirrhosis to turn into compensated cirrhosis. These two phases are as follows:
- Compensated cirrhosis stage: It is the stage when symptoms of cirrhosis are not observed and the patient has no complaints. There is scar tissue in the liver, but it is not advanced enough to cause symptoms.
- Decompensated cirrhosis stage: Symptoms such as jaundice and accumulation of fluid in the abdomen (ascites) appear at this stage. It is a very serious phase. Reversal is possible with early diagnosis and diagnosis, but if it is late, the only option is liver transplantation. It seriously threatens life.
Cirrhosis Treatment Methods
There is no definitive treatment that completely reverses cirrhosis. Some treatments may be given to reduce permanent damage to the liver, prevent the progression of cirrhosis, and relieve the patient. Treatment is determined by the doctor according to the cause and stage of cirrhosis.
The first thing to do in cirrhosis due to alcohol consumption is to stop using alcohol. In cases of obesity and diabetes, weight loss may be recommended by the doctor. A low sodium diet should be followed when fluid accumulates in the abdomen and edema occurs due to cirrhosis.
In case of increased pressure in the portal vein (portal hypertension), which has an important role in liver blood supply, beta blockers and nitrate group drugs that reduce the pressure are preferred, while antiviral treatments are preferred in cases of infection such as hepatitis.
At the point where lifestyle changes and medication do not work, the only treatment for the patient is liver transplantation. Transplantation can be performed from a living donor or cadaver.
Frequently Asked Questions About Cirrhosis
What amount of alcohol is a risk factor for cirrhosis?
A meta-analysis study conducted in 2019; It states that women’s alcohol use, regardless of the amount, increases the risk of cirrhosis, while men’s drinking more than one drink a day increases the risk of cirrhosis compared to the general population. This is because the male body metabolizes alcohol better than the female body. There is no safe dose for alcohol.
What is Hepatitis, What Causes Hepatitis?
Damage and inflammation of liver cells is called hepatitis. Hepatitis means inflammation of the liver cell, and anything that initiates inflammation in the liver cell can cause hepatitis. This damage; It can be caused by drugs, toxins, alcohol, hereditary diseases, metabolic diseases and viral infections. There are many microorganisms that cause hepatitis, but the main ones responsible are hepatitis A, B, C, D and E viruses. Of these, only hepatitis B and C viruses cause chronic hepatitis.
What are the Complications of Cirrhosis?
The most serious complication of cirrhosis is portal hypertension. It is the increase in the pressure of the portal vein, which plays a very important role in liver blood supply. Since blood circulation is blocked, varicose veins form in the esophagus, stomach and intestines. Especially esophageal varices have a very high risk of bleeding. The patient may be lost. Other complications of cirrhosis; malnutrition, liver cancer, liver failure and hypersplenism.
Is Cirrhosis a Type of Cancer?
Cirrhosis is not a type of cancer, but most patients with liver cancer also have cirrhosis. Cirrhosis increases the risk of liver cancer by 20 times.