Liver Cirrhosis

Cirrhosis is permanent damage and progression of healthy liver cells into scar tissue or fibrosis. Numerous medical conditions and diseases, such as hepatitis and alcohol addiction etc. can cause scar tissue formation and liver cirrhosis. Treatment of cirrhosis depends on its cause. However, liver transplantation is the only treatment option to recover patients with liver failure.

Highlights

• Cirrhosis is permanent damage and progression of healthy liver cells into scar tissue or fibrosis.
• Numerous medical conditions and diseases, such as hepatitis and alcohol addiction etc. can cause scar tissue formation and liver cirrhosis.
• Treatment of cirrhosis depends on its cause. However, liver transplantation is the only treatment option to recover patients with liver failure.

What is cirrhosis?

Liver cirrhosis is a slowly progressing damage to healthy liver cells and scar tissue formation that disturbs liver’s normal function. Numerous medical conditions and liver diseases cause inflammation of the liver cells, tissue necrosis, and permanent liver failure. However, it usually goes asymptomatic because the liver continuously repairs damaged cells. Thus results in scar formation that affects the blood flow to the liver. The problem is usually of no concern until inflammation spreads to other parts of the liver. Thereafter, scar tissue formation in multiple sites. As a result, the blood supply to liver cells is excessively disrupted, damaging the liver cells. This affects the liver’s ability to process nutrients and hormones and detoxify chemical wastes.

Cirrhosis occurs at this stage when liver function is significantly affected. So, it leads to scar formation, liver dysfunction, and, ultimately, liver failure (Figure 1). This is called a late-stage liver disease or late-stage cirrhosis.

Causes of cirrhosis

Anything or condition that can damage the liver can cause liver cirrhosis. Common causes of cirrhosis include:

1. Alcohol addiction slowly damages the liver cells, leading to alcoholic fatty liver disease resulting from chronic alcohol abuse.
2. Microbial infections of the liver, such as hepatitis B and C virus infections and ascites.
3. Nonalcoholic fatty liver disease usually results from diabetes and obesity. Steatohepatitis is a common example of advanced-stage nonalcoholic fatty liver disease.
4. Other causes of cirrhosis are autoimmune hepatitis, inherited diseases, chronic heart failure, bile duct blockage or damage, and rare diseases like amyloidosis.
5. Autoimmune hepatitis is a liver condition in which the body’s immune system begins to damage healthy liver cells, causing inflammation of hepatocytes known as hepatitis.
6. Inherited diseases come from parents to offspring and can happen anytime from zygote to fetus development or later in an individual’s life. Common examples of inherited disease are:
7. Hemochromatosis is the excessive storage of iron in liver when hemoglobin from dead red blood cells metabolize in the liver. It converts into bilirubin and iron—the latter is stored in the liver. Sometimes, genetic mutations of familial origin inhibit iron utilization in hemoglobin formation. Thus iron accumulates in the liver, causing a condition called hemochromatosis. Other similar inherited conditions are copper accumulation (Wilson disease), mucus build-up (cystic fibrosis), and the liver’s inability to convert stored glycogen into glucose (glycogen storage diseases).
8. Alpha-1 antitrypsin deficiency is when abnormal protein accumulates and builds up in the liver.
9. Alagille syndrome is when you have fewer than a normal number of bile ducts in the liver. It greatly affects bile flow towards the main bile duct and gallbladder and results in jaundice, i.e., yellowing of skin and eyes.
10. Chronic heart failure results in the return of harmful toxic fluids from the blood into the liver and swollen body parts, resulting in liver cirrhosis.
11. Various diseases can block or damage bile ducts that carry bile from the liver to the small intestine for the digestion of fats in the small intestine. Examples include:
12. Primary sclerosing cholangitis is the inflammation of bile ducts, leading to bile duct scarring, narrowing, and accumulation of bile in the liver.
13. Biliary atresia is when infants are born with underdeveloped or blocked bile ducts that cause scarring and narrowing of the bile ducts, resulting in liver cirrhosis.
14. Primary biliary cholangitis is a condition that develops due to progressive injury, inflammation, and permanent damage of the bile ducts.
15. Bacterial infection of the bile duct is another reason for their blockage, leading to the accumulation of bile in the liver and liver cirrhosis.
16. Amyloidosis is a rare liver disease due to the accumulation of abnormal protein amyloid that affects liver function and results in liver cirrhosis.

Symptoms

Common symptoms of the liver include loss of appetite, fever, nausea, easy bruising and bleeding, yellowing of skin and eyes, swelling or edema in lower limbs, parasitic infection ascites, and light-colored stool.

• Symptoms that specifically occur in men include enlarged breasts, loss of sex drive, and shrunken testicles.
• Symptoms that specifically occur in women include premature menopause.

Diagnosis

Blood tests, imaging tests, and liver biopsies diagnose liver cirrhosis. Blood tests to diagnose cirrhosis include albumin, clotting factors, liver enzymes, iron, autoimmune antibodies detection, WBC count, creatinine, sodium, and alpha-fetoprotein test. Imaging tests include abdominal ultrasound, CT (Computed tomography), MRI (Magnetic resonance imaging), endoscopic retrograde cholangiopancreatography, and upper endoscopy. A liver biopsy is also performed in which a liver tissue sample is collected and diagnosed under the microscope.

Treatment

Liver cirrhosis is permanent liver damage, so it does not have any treatment. However, prevention and management may slow down disease progress. Management therapies include stopping drinking alcohol, avoiding the use of medications that stress the liver, treating chronic hepatitis, and eating a healthy, hygienic diet.