Cirrhosis

Cirrhosis occurs when healthy liver tissue gets damaged over a long period of time. Chronic liver disease leads to scarring of liver tissue, which affects the structure and functionality of the liver. Cirrhosis is linked to over 32,000 annual deaths in the United States alone.  

A wide variety of chronic liver conditions could be responsible for cirrhosis. It takes years or even decades to develop the condition. Compared to scars that occur in most of the other parts of the body, liver scarring is reversible – even in patients with cirrhosis. The liver is located on the upper right-hand side of your abdomen and is a vital organ in the body. It converts nutrients from food into vital blood components, metabolizes, detoxifies, and produces many factors that are necessary for blood clotting. The liver also produces bile for the digestion of fats. 

Liver disease can affect all these functions. Liver disease can occur due to a wide variety of causes such as physical injuries, infections, autoimmune conditions, exposure to toxins, and genetic conditions that lead to the build-up of iron and copper. Liver disease can lead to inflammation, clotting abnormalities, obstruction of bile flow, and many other conditions. Persistent or prolonged damage to the liver results in accumulating excess connective tissue or fibrosis of the liver – which can lead to cirrhosis at a later stage.  

When one has cirrhosis, the structure of his/her liver will change – forming nodules of cells that are surrounded by fibrous tissue. Fibrous tissue won’t function like healthy liver tissue. It will interfere with the flow of bile and blood through the liver. Cirrhosis begins to affect many other organs and tissues throughout the body as the condition progresses. Some examples of cirrhosis complications include: 

• Portal Hypertension – The pressure increases in the vein that carries blood to the liver.  
• Swelling and bleeding of veins in the esophagus or stomach – this happens because of the increased pressure due to portal hypertension and the redirection of blood into the smaller veins. 
• Increasing of blood toxins – which can lead to confusion and many other mental changes. 
• Kidney disfunction 
• Fluid build-up in the abdomen – Ascites 
• Easy bleeding and bruising due to the decline in the production of clotting factor. 
• Patients who suffer from cirrhosis are at a higher risk of developing liver cancer over time – about 3-5% of cirrhosis patients are supposed to get multiple cancers, including liver cancer in the long run. 

Causes:

When injury or damage to the liver is limited, it can repair itself. But when injury or damage is repeated over many years, it will result in liver cirrhosis.

There are many causes of liver cirrhosis, but they fall into one of these categories: 

• Excessive use of alcohol over time can lead to alcoholic liver cirrhosis in the long run. 
• Hepatitis conditions such as viral hepatitis, nonalcoholic fatty liver disease (NAFLD), and autoimmune hepatitis 
• Damage to bile ducts or biliary obstruction 
• Congestive heart failure can result in liver damage and cirrhosis in the long run. 
• Drug and toxin-related conditions 
• Metabolic or inherited conditions such as hemochromatosis, cystic fibrosis, and Wilson disease 
• In about 10% of cirrhosis cases, the actual cause is unknown. 

The causes of liver cirrhosis may vary by population or geographic region. Over 50% of the cases in the United States are caused due to alcoholism or chronic hepatitis C infection. Chronic hepatitis B infection coupled with hepatitis D co-infection leads to a significant number of cirrhosis cases in other parts of the world. Nonalcoholic steatohepatitis (NASH) and nonalcoholic fatty liver disease (NAFLD) are two of the most common causes of non-infectious cirrhosis. The frequency of this cause is increasing across the globe. 

Symptoms of Liver Cirrhosis 

Most people who suffer from the condition don’t have or have little clinical evidence of the disease. Symptoms don’t usually occur until significant scarring of the liver has occurred. Some of the symptoms of the condition include: 

• Weakness 
• Fatigue 
• Confusion and difficulty in concentrating 
• Itching 
• Abdominal discomfort 
• Jaundice 
• Abdominal swelling due to ascites or build-up of fluid in the abdomen 
• Leg swelling 
• Easy bruising and bleeding 
• Nausea 
• Loss of appetite and weight loss 

Tests 

Cirrhosis needs to be diagnosed as soon as possible to have a chance of saving the life of the patient. If not, significant liver damage could occur with little or no clinical evidence of the condition. When the cause of the liver disease is controlled or eliminated, the scarring will stop, and some existing scars may resolve. There isn’t a specific test to diagnose liver cirrhosis. But blood tests can help detect liver injury. A liver biopsy is the best test to diagnose cirrhosis. But the procedure is invasive and won’t detect every case. 

Routine laboratory tests can help detect liver damage or scarring. These tests can help evaluate the severity of the condition in case the patient has some risk factors of developing cirrhosis. The patient may need additional tests to diagnose the underlying cause of the condition and monitor his or her health in the long run. It includes monitoring the development of hepatocellular carcinoma. 

Routine Tests 

Liver injury is usually diagnosed by a liver panel or a comprehensive metabolic panel (CMP).

Here are some tests included in these panels: 

• Aspartate aminotransferase (AST) – AST is an enzyme found in the liver and many other organs in the body. AST will be elevated if a person has a liver injury or cirrhosis. 
• Alanine aminotransferase (ALT) – This enzyme is found mainly in the liver. The values will be increased when a person has a liver disease or cirrhosis. 
• Alkaline phosphatase (ALP) – ALP is an enzyme found in the bile ducts. When one has cirrhosis, ALP can be normal or mildly elevated.  
• Total bilirubin – Bilirubin is produced exclusively in the liver. It increases with most liver conditions. Bilirubin is either normal or slightly increased until cirrhosis becomes advanced. 
• Albumin – This is a protein made by the liver and decreases when one has cirrhosis. 

If any of these test results are abnormal, one needs to further investigate the cause of it. The pattern of results will be more informative than any single test. 

Complete Blood Count or CBC – This test is ordered to evaluate the red and white blood cells and platelets. Anemia can occur if bleeding has occurred. Platelets become decreased when one has cirrhosis. 

Prothrombin Time (PT/INR) – Most of the clotting factors are produced in the liver. This test is important to evaluate the clotting function. The results can be prolonged with cirrhosis. 

These tests are used to monitor the progression of cirrhosis. As the condition progresses, the results can become increasingly abnormal.  

Additional Testing 

If a patient has chronic liver disease, the healthcare provider will order hepatitis C and B testing to determine the underlying cause of the condition. If ascites is present, your healthcare provider will order a peritoneal fluid analysis test. A liver biopsy is done to diagnose the cause of the condition. It involves taking a sample of liver tissue to evaluate the structure and cells of the liver. A biopsy will clearly indicate the presence of cirrhosis. But since the sample is tiny, a negative result cannot rule out cirrhosis. Depending on the situation, one or more of these specialized tests may be performed: 

• Iron test – When hemochromatosis is suspected  
• Alpha-1 antitrypsin – Diagnosing the deficiency of this protein 
• Copper test – When Wilson disease is present 
• Antimitochondrial antibody (AMA) – Diagnosing primary biliary cirrhosis 
• Alpha-fetoprotein (AFP) – Mildly elevated with cirrhosis 
• Ammonia – Values will rise in late-stage cirrhosis 
• Hyaluronic acid – This test is associated with liver fibrosis – when low, excessive fibrosis is unlikely.