Cirrhosis is a chronic liver disease that causes scarring and damage to the liver, leading to its inability to function properly. This scarring process, also known as fibrosis, causes the liver to stiffen. Cirrhosis can be caused by a number of factors, including chronic alcohol use, viral hepatitis, nonalcoholic fatty liver disease (NAFLD), and other liver disorders.
Cirrhosis is a leading cause of death worldwide, accounting for an estimated 700,000 deaths each year. Autoimmune liver disease, primary biliary cirrhosis, primary sclerosing cholangitis, and inherited metabolic disorders are some of the other causes.
It is a progressive disease with four stages: compensated, early decompensation, advanced decompensation, and end-stage liver disease. Compensated cirrhosis is distinguished by few or no symptoms, whereas decompensated cirrhosis is distinguished by the development of symptoms and complications. Cirrhosis progression is determined by the underlying cause and the rate of fibrosis.
Cirrhosis can be asymptomatic in the early stages and may not cause symptoms until the disease has progressed. Common symptoms of cirrhosis include fatigue, weakness, weight loss, loss of appetite, and abdominal swelling. Other signs of cirrhosis include jaundice (yellowing of the skin and eyes), spider angiomas (red spots on the skin), and palmar erythema (redness on the palms of the hands).
Imaging tests such as ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) can be used to evaluate liver structure and function, and detect the presence of cirrhosis. Laboratory tests such as blood tests can detect elevation of liver enzymes, decreased albumin, and coagulation disorders, which suggest cirrhosis. A biopsy is the most definitive way to diagnose cirrhosis and evaluate the stage of the disease.
A thorough history and physical examination, together with imaging and laboratory tests are used to identify underlying causes of cirrhosis and to rule out other conditions that may present similarly such as malignant or benign liver tumors or liver injuries due to medications or toxins. Other conditions that may have similar symptoms include chronic viral hepatitis, fatty liver disease, and liver cancer.
Cirrhosis management focuses on controlling the disease’s underlying cause, preventing or managing complications, and improving the patient’s quality of life. This includes the treatment of any underlying medical conditions, infection treatments, and dietary and lifestyle counseling. For example, diuretics and vasodilators can help control the symptoms of portal hypertension and ascites.
The most common surgical procedure for treatment is shunt surgery, which is used to reduce pressure in the portal vein and relieve symptoms of portal hypertension. Other surgical procedures, such as liver transplantation, are reserved for patients with advanced cirrhosis and end-stage liver disease.
It is a chronic disease that necessitates ongoing monitoring and care. Regular examinations, laboratory tests, and imaging studies are required to assess the patient’s condition and adjust the treatment plan. Cirrhotic patients are at a higher risk of developing liver cancer and should be screened for it on a regular basis.
Regular monitoring and follow-up are critical for avoiding complications and detecting decompensation early, which can lead to a better outcome.
Cirrhosis causes an increase in the pressure in the portal vein (which is known as portal hypertension). Portal hypertension can lead to a number of complications such as esophageal varices, which are dilated veins in the esophagus that can bleed, and ascites, which is the accumulation of fluid in the abdominal cavity. Other complications include, hepatic encephalopathy, a condition caused by the accumulation of toxins in the brain that results in changes in mental state, and spontaneous bacterial peritonitis, an infection of the fluid in the abdominal cavity.
Decompensated cirrhosis is defined as the presence of one or more complications of cirrhosis, such as ascites, hepatic encephalopathy, or variceal bleeding. The management of decompensated cirrhosis includes: treating the underlying cause, controlling symptoms, and preventing further complications.
End-stage liver disease is the final stage of cirrhosis and is distinguished by the emergence of irreversible complications that are no longer treatable with medical therapy. When cirrhosis has progressed to the point where the liver can no longer function, liver transplantation may be the only treatment option. Transplantation is a complex procedure that is only considered for patients who meet certain criteria and are good candidates.
Cirrhosis is a chronic and progressive disease that can lead to serious complications if left untreated. Addressing the underlying cause, preventing and managing complications, and improving the patient’s quality of life are all part of disease management.
Despite advances in treatment, cirrhosis continues to be a leading cause of death worldwide. More research is needed to understand the disease’s underlying mechanisms and develop new treatments, but new treatments are being developed to slow or reverse fibrosis progression and improve cirrhotic patients’ survival.
Early diagnosis and management are critical for improving patient outcomes. Regular check-ups, laboratory tests, and imaging studies are critical for disease monitoring and early detection of decompensation. Initiatives to raise awareness and improve access to care are needed to improve outcomes for patients.