Cirrhosis is a disease in which healthy liver tissue is replaced by non-living scar tissue. Over time, scar tissue impedes blood flow to the liver and impairs the liver’s ability to process nutrients, hormones, and medications. Cirrhosis is always linked to other liver diseases and often develops from chronic hepatitis, alcohol-related liver disease, or non-alcoholic fatty liver disease. If cirrhosis is left untreated, the liver will not be able to function properly and liver failure may result.
Scarring, or fibrosis, of the liver occurs when it is exposed to toxic substances, such as alcohol or other drugs, or inflammation, which can be caused by any liver disease.
There are actually four different stages of scarring: F1 (minimal scarring), F2 (significant scarring), F3 (severe fibrosis) and F4 (advanced scarring). Cirrhosis is stage 4, or the last stage of liver scarring.
Signs and Symptoms of Liver Cirrhosis
If scarring is at an early stage, there may be no symptoms of cirrhosis. Many people learn that they have cirrhosis because of a CT scan done for another pathology.
Over time, cirrhosis can begin to cause symptoms, including the following:
Loss of appetite
Fatigue
Weight loss or sudden weight gain
itchy skin
A brownish or orange color in the urine
Light colored stools
blood in the stool
Fever
Causes and risk factors of cirrhosis
Among the many possible causes of cirrhosis are the following:
Chronic viral hepatitis B, C or D
Chronic hepatitis C is the main cause of cirrhosis. It causes swelling of the liver, which can eventually lead to cirrhosis. About one in four people with hepatitis C develop cirrhosis. Although less common, hepatitis B and D can also cause cirrhosis.
Excessive consumption of alcohol
Alcohol is toxic to the liver, and excessive consumption can lead to inflammation of the liver and changes in the liver cells themselves. This causes swelling and ultimately cirrhosis.
Non-alcoholic steatohepatitis
Fat buildup in the liver that is not alcohol-related is called non-alcoholic fatty liver disease (NAFLD). If NAFLD gets worse, it can lead to NASH, which is the development of inflammation in the liver along with fat.
Bile duct diseases
These diseases limit or even prevent the flow of bile to the small intestine, which can cause liver swelling and lead to cirrhosis.
Family history
Certain genetic conditions can increase the risk of developing cirrhosis. Wilson’s disease, hemochromatosis, glycogen storage diseases, alpha-1-antitrypsin deficiency, and autoimmune hepatitis are all genetic conditions that can cause cirrhosis.
How is cirrhosis diagnosed?
Preliminary tests for cirrhosis include a complete medical examination and discussion of symptoms, a review of the person’s medical history and lifestyle, and blood tests. Liver function tests measure the levels of certain enzymes and proteins in the blood. If the levels are not within the normal range, it may indicate that the liver is not working properly.
The gold standard for diagnosing cirrhosis is biopsy, which can determine the extent of scarring. A biopsy involves removing a small piece of tissue from the liver to examine under a microscope.
But a biopsy is quite invasive and carries its own risk of potential adverse effects, which is why there are a number of non-invasive methods to assess the amount of scarring.
Among the non-invasive imaging tests available for the diagnosis and monitoring of liver disease, two of them, shear wave elastography and transient elastography, are based on ultrasound imaging technology. A third, magnetic resonance elastography, is based on MRI technology. All of these tests measure the stiffness of liver tissue, which indicates the severity of fibrosis, notes an article published September 13, 2020 in the journal Life.
An MRI or CT scan can also provide detailed images of the liver to help diagnose cirrhosis.
People with suspected cirrhosis may also have an upper endoscopy, in which a thin tube with a camera attached is inserted through the mouth into the esophagus and stomach to look for enlarged veins, called varices in the esophagus and gastropathy in the stomach, indicating portal hypertension, or high blood pressure in the vein that brings blood to the liver.
