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CIRRHOSIS

Cirrhosis is an abnormal liver condition which involves loss of the liver cells and scarring of the liver. It occurs when healthy liver tissue is destroyed and replaced by the scar tissue which blocks the flow of blood through the liver. Cirrhosis is a progressive disease which develops slowly and ultimately leads to liver failure, however, it usually takes years to reach this condition.

If cirrhosis is mild, the liver can regenerate on its own and continue to function normally and if cirrhosis is advanced, more and more scar tissues are formed and completely damage the liver. If liver cirrhosis is diagnosed and treated in early stages, further damage can be reversed.

Causes

Various diseases and conditions can damage the liver and lead to cirrhosis. Long-term alcohol abuse, hepatitis B and C infection, and fatty liver disease are the common causes of liver disease. Other causes include:

  • Cystic fibrosis
  • Destruction of bile ducts
  • Medications such as methotrexate
  • Excess iron in the body
  • Wilson’s disease (accumulation of copper in the liver)
  • Poorly formed bile ducts

Symptoms

Fewer symptoms are seen in the early stages of cirrhosis, however, as the functioning of the liver drops down, the patient experiences loss of appetite, nausea, and itchy skin. The advanced stage symptoms include:

  • Pain and tenderness in the area where liver is located
  • Jaundice- yellow discoloration of the skin
  • Blood capillaries become visible on abdominal skin
  • Insomnia
  • Loss of body weight
  • Bleeding and bruising
  • Fluid accumulation in the abdomen
  • Swelling in the legs

Complications

If liver cirrhosis is not diagnosed in early stages or if left untreated, the patient may develop complications like:

  • Portal hypertension- high blood pressure in the veins that supply blood to the liver
  • Bleeding- due to portal hypertension, blood redirects to the smaller vein causing them to increase in size. These smaller veins burst and cause bleeding due to extra load on these vein.
  • Edema or swelling in the legs or abdomen
  • Spleen enlargement
  • Bone disease
  • Increased risk of liver cancer
  • Acute or chronic liver failure

Diagnosis

The diagnosis begins with detailed medical history and physical examination of the patient. Various tests which reveal damage to the liver are performed.

  • Liver function tests- to check for excess bilirubin and other enzymes that indicate liver damage. High levels of alanine transaminase indicate hepatitis.
  • Kidney function tests-blood tests are performed to check for creatinine as the kidney function damages in severe stages of cirrhosis
  • Imaging tests-MRI, CT scan, and ultrasound are performed to get clear and detailed images of the liver to check for the increased size of the liver and scarring.
  • Biopsy- It is the definitive test for cirrhosis. Using an endoscope (a thin, long tube), a sample if liver tissue is taken and sent to laboratory to check the severity, extent, and cause of liver damage. The biopsy not only rules out cirrhosis, but also determines the cause.
  • Endoscopy- An endoscope is sent into the patient’s esophagus and stomach through mouth to check inside of the stomach for swollen blood vessels and hallmark signs of cirrhosis.

Treatment

If cirrhosis is diagnosed in early stages, the damage can be minimized by treating its underlying cause. The treatment depends on the cause and extent of liver damage. The various treatment options include:

  • Treatment program to stop alcohol addiction
  • Maintaining adequate protein intake to reduce weight if cirrhosis is caused by nonalcoholic fatty liver disease
  • Medications to limit further liver damage caused by hepatitis B and C and other causes
  • Medications to relieve pain, fatigue, and itching
  • Nutritional supplements to prevent osteoporosis

Treating cirrhosis complications

  • Excess fluid in the body—Low-sodium diet and pills are given to treat ascites or edema; in severe cases, fluids are drained or removed with surgery
  • Portal hypertension—The doctor performs upper endoscopy regularly to check for the presence of enlarged veins in the esophagus. Blood pressure medications are given to control the increased pressure and to prevent bleeding
  • Infections—Antibiotics and vaccinations for influenza, pneumonia, and hepatitis are recommended to prevent infections
  • Hepatic encephalopathy—Medications are given to prevent toxins formed due to poor liver function
  • Liver transplantation—This is the only treatment option for severe stages of the liver such as hepatic encephalopathy, jaundice, or liver cancer.

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