5 Things Doctors Want You To Know About Liver Cirrhosis

Ever felt lost in a maze, with its twists and turns offering no apparent way out? That's like trying to understand liver cirrhosis. With a wealth of information and numerous causes, it is often detected once it's quite advanced. Even though cirrhosis comes with its set of challenges, understanding it shouldn't be one of them. So, whether you're looking to bolster your knowledge for yourself or someone close to you, let's dive into the essentials that doctors wish everyone knew about this liver condition.

Dr Helen S Te, MD (University of Chicago) says that cirrhosis is, simply put, severe scarring of the liver that is caused by various ‘injuries’ over time.” Over the course of time, healthy liver cells are gradually replaced with scar tissue, interfering with the liver’s ability to perform its functions. The liver may also develop regenerative nodules, which form lumps in the tissue as it attempts to repair the damage.

Understanding the critical aspects of cirrhosis—from its causes and symptoms to its stages, treatment, and prevention—is essential for managing and potentially mitigating its impact. 

Alcohol is responsible for nearly half of all cirrhosis-related hospital stays and about a quarter of deaths linked to cirrhosis. Over 40% of liver transplants are due to Alcohol-Related Liver Disease (ALD).

Studies show that heavy drinking can damage nearly every organ in the body over time. However, the liver takes the hardest hit early on because it’s the organ responsible for detoxification, breaking down alcohol into acetate.

The main risk for ALD is linked to how much and how long alcohol is consumed. Risky drinking is defined as more than two daily drinks or over seven weekly for women and more than three daily drinks or over 14 weekly for men. A standard drink is 30 ml whiskey = 100 ml wine = 285 ml full-strength beer = 1 standard drink.

“The liver is remarkably resilient and capable of regenerating itself to a certain extent. However, chronic alcohol consumption can overwhelm its regenerative capacity, leading to a spectrum of liver diseases ranging from fatty liver to cirrhosis,” says Dr Anukalp Prakash, Lead Consultant, Gastroenterology, CK Birla Hospital, Gurugram.

Aside from alcohol-related liver disease, viral hepatitis (infections with Hepatitis B and C), metabolic and genetic conditions, and autoimmune diseases also play a role. As more research has been conducted on the association between liver disease and metabolic conditions like diabetes or heart disease, the term ‘Nonalcoholic Fatty Liver Disease’ (NAFLD) has been changed to ‘Metabolic Dysfunction-Associated Fatty Liver Disease’ (MAFLD). This new name reflects a shift in understanding. Even if you do not consume alcohol,  you may have metabolic risk factors that lead to an excess of fat deposition in the liver (hepatic steatosis),  which could also lead to cirrhosis.

Dr Mary E Rinella, MD, from the University of Chicago Medicine, points out that people with type 2 diabetes have a high risk of getting liver disease, including cirrhosis. She suggests they should get checked for liver disease even if they don't show symptoms.

The variety of causes highlights the need for a broad prevention strategy that combines lifestyle changes with medical care based on personal risks.

“Most of the patients that have liver disease, even advanced cases, are not diagnosed,” says Dr Rinella. “By the time you have symptoms, things are often too advanced to reverse.”

While early cirrhosis may not present noticeable symptoms, recognising signs as they appear can be crucial for early intervention.

Cirrhosis symptoms usually start with tiredness, queasiness, a decreased appetite, and noticeable muscle loss. The skin may also show signs, with tiny red blood vessels emerging on the chest and palms.

As the situation worsens, some might see swelling in their legs (oedema) and belly (ascites) from fluid accumulation, alongside increased spleen size (splenomegaly). Infections, gastrointestinal bleeding, kidney dysfunction and mental confusion can occur. The liver's struggle is visible through jaundice, indicated by a yellowish tint in the eyes and darker urine Other signs include itching, internal bleeding, and reduced libido.

Cirrhosis progresses through stages, from compensated, where the liver still functions, to decompensated, where liver failure becomes apparent. If cirrhosis is suspected, doctors may suggest various tests to assess risk.  

Yale Medicine hepatologist Dr David N. Assis, MD, emphasises the importance of pinpointing the cause of liver disease to begin treatment to prevent cirrhosis development or its progression in cases where it is already present.

For many, cirrhosis treatment means abstaining from alcohol, making dietary changes, and managing weight. Sarah Vilt, MS, RD, LDN, a registered dietitian at UChicago Medicine, advises that seven to ten per cent of the total body weight loss must be achieved to curb the progression of liver disease in patients with MASLD. Cirrhosis treatments vary from medications to surgical interventions that are tailored to each individual’s condition.

Preventing cirrhosis involves a few key lifestyle choices: Scale down alcohol consumption to reduce the risk of ALD, maintain a healthy weight through diet and exercise to avoid fatty liver diseases, and protect against hepatitis infections by getting vaccinated and practising safe sex.

The outlook for someone with cirrhosis largely hinges on their overall health. Those with stable cirrhosis can often live for over ten years. However, those experiencing severe complications from more advanced or decompensated cirrhosis might have a life expectancy of only a few months to a couple of years.

Liver cirrhosis is a severe condition with far-reaching implications for patients and their families. Understanding its signs, causes, and treatment options is the first step toward effective management.

By recognising the importance of lifestyle changes, medical treatment, and regular monitoring, people can take proactive steps to manage liver cirrhosis and improve their overall prognosis.

Medically reviewed by:

Dr Amey Sonavane, Gastroenterologist and Hepatologist (Clinical and Transplant)