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July 31, 2024

Liver Cirrhosis: Understanding the Stages and Symptoms

Liver cirrhosis is a term that often carries with it a weight of concern and uncertainty. Liver cirrhosis progressively develops as scar tissue replaces healthy liver tissue, potentially leading to liver failure or impaired liver function. This condition doesn’t happen overnight; it’s the culmination of years of liver being under siege by factors like chronic alcohol abuse, viral hepatitis, or fatty liver disease.

Understanding the stages of cirrhosis and its symptoms is vital for early intervention, slowing the progression of the disease, and enhancing life quality. Patients with knowledge can better control their health and treatment needs.


What is Liver Cirrhosis?

Liver cirrhosis is a medical condition that represents the final stage of chronic liver disease. It is characterised by replacing healthy liver tissue with non-functional scar tissue, a process known as fibrosis.

This scarring disrupts the liver’s ability to perform its critical functions and can lead to serious health complications.


Why does it happen?

The most common causes of liver cirrhosis include:

  • Chronic Alcohol Abuse: Excessive and prolonged alcohol intake is a significant contributing factor to the development of liver disease, including cirrhosis. Although the liver processes alcohol, too much can overwhelm its ability to regenerate, leading to scarring.
  • Viral Hepatitis: Viral diseases such as hepatitis B and C can result in persistent inflammation and damage to the liver cells, eventually resulting in cirrhosis.
  • Non-Alcoholic Fatty Liver Disease (NAFLD): This condition, often associated with obesity and diabetes, involves the accumulation of fat within liver cells, potentially leading to inflammation and scarring. You can read our guide on fatty liver disease to understand more about NAFLD.
  • Autoimmune Hepatitis: A condition where the body’s immune system attacks liver cells, causing ongoing inflammation and damage.
  • Genetic Disorders: Diseases such as Wilson’s disease and hemochromatosis, where the body accumulates excess copper or iron, respectively, can also lead to liver cirrhosis.

The Stages of Liver Cirrhosis

Primarily, there are three stages to liver cirrhosis:

  1. Early Stage (Compensated Cirrhosis): Despite some damage and scarring, the liver can perform its functions at this initial stage. Symptoms may be minimal or non-existent, as the liver still manages to compensate for its impaired condition.
  2. Middle Stage: (Progressive Symptoms): As cirrhosis progresses, symptoms become more severe and noticeable. The liver’s ability to function declines, and signs of liver insufficiency may appear.
  3. Late Stage: (Decompensated Cirrhosis) Decompensated cirrhosis is the most advanced stage of liver disease, where serious complications arise. Symptoms are more severe.

Specific Symptoms Related to Each Stage

As liver cirrhosis progresses, the symptoms become more specific and severe:

Early Stage: Symptoms in the early stages of cirrhosis may be minimal or not apparent. When symptoms do appear, they may consist of exhaustion, minor muscle cramps, and decreased appetite. Although these signs, such as fatigue, weakness, and modest weight loss, can be present, they are often subtle and can go unnoticed.

Middle Stage: As cirrhosis progresses, symptoms like leg swelling (oedema), jaundice (yellowing of the skin and eyes), and abdominal bloating (ascites) become more pronounced. Patients may also experience increased abdominal discomfort, ongoing nausea, and significant weight loss.

Late Stage: In advanced stages of cirrhosis, severe symptoms can manifest, including confusion, drowsiness, and slurred speech due to hepatic encephalopathy, as well as bleeding from enlarged veins in the stomach or oesophagus, known as variceal bleeding. Additionally, ascites causes noticeable abdominal swelling from fluid buildup, and hepatic encephalopathy leads to cognitive impairments resulting from liver damage.


When to Get Medical Help

It’s essential to get medical help if you encounter any of the following:

  • New or worsening symptoms, such as abdominal swelling or jaundice. They may be signs of advancing liver damage.
  • Signs of serious complications, such as blood in vomit or stool, could signal variceal bleeding.
  • Alterations in cognitive abilities, such as confusion or difficulty staying focused, may indicate hepatic encephalopathy.

Diagnosis and Monitoring

Diagnosing cirrhosis often begins with a routine blood test or checkup, especially since early-stage cirrhosis might not present any symptoms. To establish a diagnosis, typically, a series of lab and imaging tests are performed:

  • Laboratory Tests: Blood tests check for signs of liver malfunction, such as elevated bilirubin levels or specific enzymes. They also evaluate kidney function, blood count, and the blood’s clotting ability through the international normalized ratio (INR). These examinations can assist in determining the root cause of cirrhosis and its severity.
  • Imaging Tests: Non-invasive tests like transient elastography or magnetic resonance elastography (MRE) assess the liver’s hardness or stiffness. Other imaging tests can also be done including MRI, CT scans, and ultrasounds.
  • Biopsy: While not always necessary for diagnosis, a liver biopsy can provide detailed information about the extent of liver damage and the specific cause.

Regular Monitoring and its Importance

Once cirrhosis is diagnosed, regular monitoring is crucial. It helps in:

  • Tracking the progression of the disease.
  • Detecting signs of complications early, such as oesophageal varices and liver cancer.
  • Adjusting treatment plans as needed to manage symptoms and prevent further damage.
  • Non-invasive tests are becoming more widely available and used for ongoing liver disease monitoring.

Treatment and Management of Liver Cirrhosis

Managing liver cirrhosis involves a multifaceted approach that includes lifestyle modifications, medications, therapies, and, in advanced cases, liver transplantation.

Lifestyle Changes and Their Impact

Lifestyle changes are the cornerstone of managing liver cirrhosis, especially in its early stages. These modifications may significantly affect delaying the course of the illness and enhancing life quality: 

  • Low-Sodium Diet: Reducing salt intake helps prevent fluid buildup, which may result in oedema and ascites.
  • Healthy Diet: A balanced diet high in lean proteins is considered healthy. Whole grains, fruits, and vegetables support liver health and overall well-being.
  • Abstaining from Alcohol: In cases of cirrhosis due to alcohol abuse, ceasing alcohol consumption is critical since any level of alcohol can be harmful to the liver. Research has indicated that total abstinence from alcohol can significantly improve outcomes and extend survival for individuals with alcohol-related liver cirrhosis, even in advanced stages.
  • Exercise: Maintaining a regular physical activity schedule will help you keep a healthy weight, especially for people suffering from non-alcoholic fatty liver disease.

 Medications and Therapies

Treatment options, including medications and therapies, may vary based on the underlying cause of cirrhosis.

  • Antiviral Medications: In treating cirrhosis that results from hepatitis, drugs such as Tenofovir, which is preferred over Adefovir due to its effectiveness and safety profile, can be beneficial.
  • Antibiotics: Antibiotics are used to treat illnesses that can complicate cirrhosis.
  • Chelating Agents: Due to copper buildup from Wilson’s disease, agents like D-penicillamine are recommended.
  • Deaddiction Initiatives: When cirrhosis stems from alcohol misuse, essential treatments include programs aimed at overcoming alcohol dependency.
  • Advanced Options Like Liver Transplantation: When cirrhosis reaches a stage where the liver ceases to function adequately, a liver transplant may be the only curative option. This process includes swapping out the damaged liver for a healthy one from a donor. It’s a complex and significant surgery that requires careful consideration and management before and after the procedure.

A Final Word

Liver cirrhosis, characterised by advancing scar tissue and deteriorating function, highlights the critical need for prompt diagnosis and treatment. Prompt recognition of symptoms can mitigate adverse effects and enhance life quality.

Education and support enable patients to make informed decisions and manage their condition effectively. Ultimately, awareness and proactive care are essential for better outcomes in liver cirrhosis.



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