Liver Cirrhosis is a condition (not a disease) that results from permanent damage or scarring of the liver. This leads to a blockage of blood flow through the liver and prevents normal metabolic and regulatory processes.
Liver cirrhosis meaning
Liver cirrhosis is where your liver is severely scarred and permanently damaged. While the word cirrhosis is most commonly heard when people discuss the alcohol-induced liver disease, cirrhosis is caused by many forms of liver disease.
Liver cirrhosis cause
The 7 major causes of liver cirrhosis are as follows;
- chronic alcoholism
- viral infections caused by chronic viral hepatitis (types B, C, and D)
- metabolic diseases such as alpha-1-antitrypsin deficiency, galactosemia, and glycogen storage disorders
- inherited diseases such as Wilson’s disease and hemochromatosis
- biliary cirrhosis resulting from diseases such as primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC)
- toxic hepatitis caused by severe reactions to prescribed drugs or prolonged exposure to environmental toxins
- repeated bouts of heart failure with liver congestion
Liver cirrhosis symptoms
People in the early stages of liver cirrhosis have few symptoms. Some symptoms an individual may notice include;
- loss of appetite
- weight loss
When liver function decreases, fewer proteins, such as albumin, are produced, resulting in fluid accumulation in the legs (edema) or abdomen (ascites).
Individuals with liver cirrhosis may bleed and bruise easily because of a decrease in proteins required for blood clotting. Some people may even experience intense itching because of products that are deposited in the skin.
Liver cirrhosis stages
In the later stages of liver cirrhosis, jaundice occurs and gallstones are more common because insufficient levels of bile reach the gallbladder. A cirrhotic liver no longer removes toxins effectively, leading to toxin accumulation in the blood, which can impair mental function and lead to personality changes and possibly coma. Early signs of toxin accumulation in the brain (Hepatic Encephalopathy) may include neglect of personal appearance, unresponsiveness, forgetfulness, concentration problems, or changes in sleeping habits. Because the normal cleansing process is impaired by liver cirrhosis, drugs are not properly filtered, resulting in an increased sensitivity to drugs and their side effects.
Normally, blood from the intestines and spleen are pumped into the liver through the portal vein. However, liver cirrhosis blocks the normal flow of blood through the liver. This can lead to swelling of the liver and potentially the spleen. Blood from the intestines is then forced to find a new way around the liver through new vessels. Some of these new blood vessels, called “varices” which form primarily in the stomach and oesophagus, become quite large. These varices may rupture because of high blood pressure (portal hypertension) and thin vessel walls, causing bleeding in the upper stomach or oesophagus.
Liver cirrhosis blood test
It is important to detect liver cirrhosis as soon as possible, since significant liver damage may occur with few or no symptoms. If the cause of liver damage can be eliminated or controlled, further scarring will stop and some existing scars may resolve. While blood tests can detect liver injury, there is no single test that can diagnose cirrhosis. A liver biopsy is considered the “gold standard” for diagnosing cirrhosis, but the procedure is invasive and will not detect every case.
Routine laboratory tests may be done to detect liver damage and/or scarring and to evaluate its severity, particularly if the individual has some risk factor for developing cirrhosis. Additional tests may be performed to help diagnose the underlying cause and to monitor the affected person’s health. This can include monitoring for the development of hepatocellular carcinoma.
Routine tests for liver cirrhosis
Liver injury may be first detected by a comprehensive metabolic panel (CMP) or a liver function test. Both profiles include the following tests;
- Alanine aminotransferase (ALT): An enzyme found mainly in the liver. Values are increased with many liver injuries, including cirrhosis.
- Aspartate aminotransferase (AST): An enzyme found in the liver and other organs. AST is elevated in people with liver injury, including cirrhosis.
- Alkaline phosphatase (ALP): An enzyme found along bile ducts. ALP is usually normal or mildly elevated in cirrhosis.
- Total bilirubin: A substance produced only in the liver. It is increased with many liver diseases. Bilirubin is usually normal or slightly elevated until cirrhosis becomes far advanced.
- Albumin: A protein made by the liver that is often decreased in cirrhosis.
If any of these tests are abnormal, then they will be further investigated. The pattern of results is more informative than the result of any single test.
Another routine testing addition to the above may include;
- Complete blood count (CBC): Maybe advised evaluating a person’s red and white blood cells and platelets; anaemia may be present if bleeding has occurred, and platelets are often decreased with cirrhosis.
- Prothrombin time (PT/INR): Most clotting factors are produced by the liver. This test evaluates the clotting function and results may be prolonged with cirrhosis.
Many of the tests listed above are used to monitor the progression of liver cirrhosis. As the condition worsens, results may become increasingly abnormal.
Additional testing to diagnose liver cirrhosis
- Hepatitis B and hepatitis C testing may be advised to help diagnose the underlying cause of chronic liver disease.
- If ascites are present, a peritoneal fluid analysis may be performed.
- A liver biopsy involves taking a sample of liver tissue to evaluate the structure and cells of the liver. It can show cirrhosis, but since the sample is tiny, a negative result may not rule cirrhosis out.
Depending on the suspected cause, one or more specialized tests may be performed;
- Iron tests–when hemochromatosis is suspected
- Copper and ceruloplasmin–when Wilson’s disease is suspected
- Anti-mitochondrial antibody (AMA) to help diagnose primary biliary cirrhosis
- Alpha-1 antitrypsin to help diagnose a deficiency of this protein
- Genetic tests for inherited liver diseases (hemochromatosis, Wilson disease)
- Hyaluronic acid test associated with fibrosis if low, then extensive fibrosis is unlikely
Some tests may be ordered to monitor for the development of liver cirrhosis complications;
- Alpha-fetoprotein (AFP): Often mildly elevated with cirrhosis; may be markedly elevated with liver cancer
- Des-gamma-carboxy prothrombin (DCP): Maybe elevated with liver cancer
- Ammonia: Values rise in late-stage liver cirrhosis with liver failure
Liver cirrhosis diagnosis
Non-laboratory tests used for liver cirrhosis diagnosis.
Other procedures and imaging tests may be useful for liver cirrhosis diagnosis;
- Ultrasound–sometimes advised to help diagnose nonalcoholic fatty liver disease (NAFLD). Periodic ultrasounds are done for some patients to monitor for the development of hepatocellular carcinoma.
- Magnetic or transient elastography–to evaluate liver fibrosis by measuring liver stiffness
- CAT scan (computerized axial tomography)
- radioisotope liver/spleen scan
- liver biopsy
Once it is determined that liver disease is present, immediate treatment is recommended.
Liver cirrhosis treatment
For individuals diagnosed with liver cirrhosis, treatment usually includes:
- Addressing and treating the underlying cause of the liver disease, where possible. This may involve, for example, treating chronic hepatitis C with medications.
- Maintaining remaining liver function to help take care of their liver, people with liver cirrhosis should not drink alcohol and should avoid substances that can harm the liver. They may need to change or supplement their diet to ensure adequate nutrition and work with their healthcare provider on medication dosage, since their liver may not process drugs at a normal rate.
- Treating complications, for example, endoscopy is sometimes needed to look for varices (dilated veins) and to address bleeding varices. In advanced cases of liver cirrhosis, liver transplantation may be showed.
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