Cirrhosis Symptoms - Identifying Liver Damage and Disease

Signs of Cirrhosis: How to Detect and Treat Liver Scarring

Cirrhosis of the liver is characterised by permanent scarring of the liver, leading to extensive liver damage and impairment of its functioning. Cirrhosis is a result of long-term chronic inflammation and is a major cause of liver failure. Alcoholism, viruses, and unhealthy lifestyle habits are some of the many causes of cirrhosis.

Detection of cirrhosis symptoms at an early stage is extremely crucial for a healthy prognosis. Hence, it becomes essential to be aware of the symptoms of liver cirrhosis, its causes, the diagnostic approach, treatment modalities, and other relevant information.

Keep reading to get a detailed overview!

What is Meant by Liver Cirrhosis?

Liver cirrhosis is a late-stage liver disease that is characterised by extensive tissue damage and impairment of liver function. The healthy tissues in the liver get damaged due to extensive scarring. Scar tissue formation occurs as a result of long-term chronic inflammation, which is known as hepatitis.

The liver can regenerate itself in the event of inflammation by forming scar tissue. However, extensive scarring can lead to loss of the regeneration ability of the liver, eventually ending with liver failure.

What are the Different Stages of Liver Cirrhosis?

Liver cirrhosis is categorized into two main stages. These stages are:

1. Compensated Liver Cirrhosis: It is the initial stage of liver cirrhosis and rarely presents with any symptoms. As the name suggests, at this stage, the liver is attempting to compensate for the reduced functioning resulting from scarring. In most people, this stage goes unnoticed.
2. Decompensated Liver Cirrhosis It is the later stage in which the symptoms start to appear. The liver is no longer able to compensate for the tissue damage and reduced functioning.

The identification of these stages is crucial, as it can help improve the prognosis of the condition.

Acute-on-Chronic Liver Failure(ACLF) is a specific, severe syndrome that can occur in patients with decompensated cirrhosis.

What are the liver cirrhosis symptoms?

Symptoms of cirrhosis usually manifest gradually, and in the early stages (compensated cirrhosis), the majority of individuals have no apparent symptoms. Once the condition advances (decompensated cirrhosis), the signs become apparent. These signs and symptoms include:

Early Symptoms 

• Fatigue and weakness: These are effects of the liver's reduced ability to metabolise toxins and gain energy.
• Loss of appetite and weight loss: The impaired liver metabolism affects digestion.
• Abdominal Pain: Abdominal pain or nausea is usually caused by the buildup of toxins.
• Spider Angiomas: Spider angiomas, characterised by small, spider-shaped blood vessels on the skin, are often associated with hormonal imbalances.
• Red palms: Indication of changed blood flow as a result of liver disease.

Late-Stage Symptoms

• Jaundice: Because the liver is unable to metabolise bilirubin.
• Oedema and ascites: Resulting from fluid buildup due to reduced protein synthesis.
• Easy bruising and bleeding: The liver cannot make sufficient clotting factors.
• Confusion and disorientation: Confusion or disorientation, also known as hepatic encephalopathy, occurs when toxins interfere with brain function.
• Pale stools and dark urine: Indicate bile flow obstruction.
• Pruritus (itchy skin):Caused by the accumulation of bile salts under the skin.

What are the Main Causes of Cirrhosis?

Cirrhosis is a result of chronic liver damage. The most critical aetiologies include:

1. Chronic Alcohol Abuse : Heavy drinking over several years is the most common cause of cirrhosis. Alcohol destroys liver cells, causing inflammation and scarring.
2. Viral Hepatitis (B, C, and D) : Chronic hepatitis B and C infection leads to ongoing liver inflammation and ultimately to cirrhosis. Hepatitis D (which is only seen in combination with hepatitis B) also hastens liver injury.
3. Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH) : NAFLD, most commonly associated with obesity and diabetes, leads to excess fat in the liver. At times, it advances to NASH, leading to cirrhosis and inflammation.
4. Autoimmune Liver Diseases : Diseases like autoimmune hepatitis, primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) lead the immune system to attack liver cells, which then become scarred.
5. Genetic Disorders : Genetic disorders like haemochromatosis, Wilson’s disease, and deficiency of alpha-1 antitrypsin can also lead to liver cirrhosis.
6. Biliary Obstruction : Obstructed bile ducts (from gallstones, tumours, or infection) may lead to bile backup, which injures liver tissue.
7. Medications and Toxins : Chronic use of drugs (e.g., acetaminophen toxicity) or toxin exposure may cause liver damage.

What is the diagnostic approach for liver cirrhosis?

Early diagnosis is crucial to slow the progression of the disease. Doctors use several methods, such as:

Physical Examination and Medical History

A detailed medical history, along with a physical examination, is the first step in initiating the diagnosis.

1.  Haematological Tests

• Complete Blood Picture : Helps to diagnose anaemia, leucopenia, and thrombocytopenia due to bone marrow suppression by alcohol and hypersplenism (enlargement of the spleen). Acanthocytosis is also observed on the peripheral blood smear.
• Liver Function Tests (LFTs) : The LFTs help to detect hyperbilirubinemia of both the conjugated and unconjugated types. The LFT results might also show a reversal of the albumin-globulin ratio and raised levels of liver enzymes like ALT, AST, and ALP.
• Prothrombin Time (PT) : PT is prolonged due to reduced synthesis of the vitamin K-dependent clotting factors.
• Hepatitis Markers : Markers for hepatitis B and C, such as the HBsAg, are usually raised in case of hepatitis-related cirrhosis.
• Blood Ammonia : It is raised in case of cirrhosis due to diminished hepatic clearance and portosystemic shunting of blood.

2.  Imaging Tests

• Ultrasonography, CT, or MRI Scan: Helps to identify liver scarring, nodules, or fluid accumulation.
• Fibroscan : It helps to assess the extent of fibrosis.

3.  Liver Biopsy

A tiny sample of liver tissue is studied under a microscope to confirm cirrhosis.

What is the treatment modality for cirrhosis?

While cirrhosis cannot be reversed, treatment is generally focused on controlling symptoms, retarding progression, and avoiding complications.

1.  Lifestyle Changes

• Alcohol cessation : It is required to avoid further harm.
• Balanced diet : A low-sodium diet is essential. A balanced diet with adequate calories and tailored protein intake is crucial to prevent malnutrition. Vitamin supplementation is often needed.
• Weight control : It is critical in NAFLD-related cirrhosis.

2.  Medications

• Diuretics : Decrease fluid buildup (ascites, oedema)
• Beta-blockers : Reduce the risk of portal hypertension.
• Antiviral drugs : Used in case of hepatitis B- or C-related cirrhosis.

3.  Complication Management

• Ascites drainage : In case of excess fluid collection.
• Band ligation : Treats oesophageal varices (dilated veins).
• Lactulose/rifaximin : Decreases hepatic encephalopathy symptoms.

4.  Liver Transplantation

In end-stage cirrhosis, a liver transplant may be the only option.

Cirrhosis is a life-threatening condition that warrants immediate medical attention and care. When identified in the compensated stage, progression can often be slowed or halted by treating the underlying cause, significantly improving the long-term prognosis. However, the scarring itself is permanent.  Hence, being aware of the signs and symptoms of liver cirrhosis is the first step in avoiding its effects.