Liver Cirrhosis refers to the "fibrotic scarring of the liver".
When the liver is repeatedly injured by agents such as alcohol or Hepatitis B, it tries to repair itself by growing new liver cells. However the repair is often incomplete and the liver forms fibrotic scars and becomes shrunken.
Early Liver Cirrhosis does not cause problems as the liver has enough reserve capacity to cater to the needs of the body even though it is scarred.
As scarring progresses, liver insufficiency develops and the patient is prone to developing the following complications:
In Singapore, the most common cause of Liver Cirrhosis is chronic Hepatitis B. While not every Hepatitis B carrier will become cirrhotic, approximately 20-40% may end up with Cirrhosis if their condition is not monitored. Other causes include alcohol, hepatitis C, fatty liver with inflammation, and rarer causes such as Autoimmune Liver Disease, Primary Biliary Cirrhosis, Wilson’s disease and primary sclerosing cholangitis.
In early or compensated Cirrhosis, patients will not have symptoms and they will feel normal. They may not even know that they have Liver Cirrhosis. It is important that patients at risk of chronic liver injury be monitored by doctors even if they feel well. Ultrasound scan of the liver is probably the easiest way to diagnose Cirrhosis.
In advanced Cirrhosis, symptoms of significant liver damage may include:
If you experience symptoms, is important that you consult a hepatologist who will help you confirm the diagnosis and pinpoint the cause of the Cirrhosis. Many of the causes can be treated, thus preventing further injury and deterioration.
The doctor will prescribe medication (spironolactone and/or furosemide) to try to clear the fluid retention by increasing your urine output. It is important that you do not take excessive water and salt. Patients with ascites and leg swelling on average should restrict their intake to 1 to 1.2L of fluid a day and avoid table salt and soy sauce. If the abdomen swelling is massive and causes breathlessness, a drain can be inserted to drain out the fluid in the hospital.
Avoid taking unnecessary drugs which may stress the liver further. Constipation is a common cause of brain confusion and the doctor may prescribe laxatives to help you clear your bowels regularly to reduce the toxic load on the liver. Any signs of infection or deterioration of mental state should prompt for early consultation with the doctor. Dietary protein should be adequate but not excessive for those sensitive to brain confusion.
An endoscopic examination can be carried out to determine if the veins in the esophagus (food pipe) are swollen due to liver disease. If so, you may need a medication called propranolol to reduce the risks of bleeding. Large swollen veins can also be tied with special bands during endoscopy to reduce the chances of bleeding. Vomiting of fresh blood or passing of black, tarry and foul smelly stools should prompt that an urgent consultation at the hospital needed.
The risks of liver cancer is increased in Liver Cirrhosis. Six monthly ultrasound and alphafetoprotein blood test are recommended for the surveillance of liver cancer. If detected by screening, they are usually early and can be definitively treated.
Cirrhosis can improve and even reverse in some situations. The main aim is to remove the cause of the injury and to allow the liver to repair itself. With treatment, early cirrhosis can be detected, thus preventing further deterioration. Even when complications develop, many of these complications can be controlled and patients can be maintained at compensated stage (with relatively normal functions). For end-stage liver cirrhosis, liver transplantation provides a cure for Cirrhosis patients.
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