Definition and Overview

Cirrhosis is a medical term that refers to a scarred liver. It is often seen in people who regularly drink more alcohol than their liver can handle. When the liver is damaged, its healthy tissues are replaced by scar tissues. This prevents the organ from working properly. Scarring of the liver is irreversible.

The disease can also develop in people who drink little to no alcohol. Any scarring of the liver not caused by drinking alcohol is called non-alcoholic cirrhosis (NAC). NAC is often a complication of liver diseases that cause progressive damage to the organ over the span of many years.

Causes of Condition

NAC is often a result of liver diseases that are left untreated or poorly managed for a very long time. These include the following:

  • Autoimmune hepatitis - This condition develops when the immune system attacks liver cells as if they are foreign bodies. It causes the liver to become inflamed. NAC often occurs after many years of chronic inflammation.

  • Fatty liver - As the term suggests, this condition develops when fat accumulates in the liver. It is often associated with diabetes, obesity, and high levels of fat in the blood.

  • Hepatitis B virus - This is the most common cause of NAC in countries where children are not routinely vaccinated against the virus.

  • Hepatitis C virus - Millions of people around the world are infected with hepatitis C virus. But many remain undiagnosed and are not aware of their condition. Untreated HCV infection can also cause irreversible damage to the liver.

  • Cystic fibrosis - This is an inherited condition that affects the liver and other organs. Many patients with this disease also have liver problems. Other inherited conditions linked to cirrhosis include haemochromatosis and Wilson’s disease.

Other possible causes of NAC are multiple episodes of heart failure and blocked bile ducts. It can also be caused by severe reaction to certain medications. In up to 10% of cases, the cause of cirrhosis is unknown. This means that it develops in patients who do not have liver disease or risk factors.

Key Symptoms

Cirrhosis often causes symptoms when it reaches an advanced stage. This means that the liver has already lost its ability to carry out some or all of its function. When this happens, patients will start to feel tired all the time, weak, and nauseated.

The whites of their eyes and their skin will also become yellow in colour. Female patients may stop having their menstruation. Male patients, on the other hand, may suffer from erectile dysfunction and breast enlargement.

The condition can also cause the following:

  • Internal bleeding - This leads to chronic vomiting and fever.

  • Changes in mental function - These occur when the liver fails to remove toxins from the blood. If toxins reach the brain, patients will lose their ability to focus and may trouble speaking or understanding speech.

  • Ascites - This refers to the accumulation of fluid in the abdominal cavity.

Other signs include difficulty fighting infections, malnutrition, and bone disease. The condition also increases the risk of liver cancer and acute liver failure.

Many patients are also forced to stop taking medications because their liver is unable to metabolise them. This is often a big problem for those with other serious disorders or diseases.

Who to See and Types of Treatments Available

Many patients with early-stage NAC do not have symptoms. This prevents them from seeking immediate medical attention. The condition is often diagnosed when they undergo tests meant for unrelated medical problems. If their doctor suspects liver cirrhosis, patients are referred to doctors specialising in liver diseases (gastroenterologists).

The condition is diagnosed by:

  • Assessing kidney and liver function. This is done through urine and blood tests. The same tests are used to determine if the patient has hepatitis B or C.

  • Imaging tests - Magnetic resonance imaging (MRI), CT scan, and ultrasound are used if initial test results suggest an abnormality. These tests produce images of the liver, helping doctors determine any changes in its appearance and size.

  • Biopsy - A small tissue sample is taken from the liver for further study. This test helps determine the extent of liver damage. This information is crucial in choosing the best possible treatment for the patient.

Any damage to the liver is irreversible. Thus, treatment of NAC focuses on:

  • Preventing more damage to the organ - This involves treating underlying medical conditions that cause scarring to the liver. These include hepatitis and fatty liver. Patients are strongly advised not to drink alcohol. They must also lose weight (if they are obese) and make sure that their risk factors are properly managed. These include diabetes and high blood pressure.

  • Treating complications - Medications are prescribed to treat pain and itching. They are also used to prevent bone-related problems. Antibiotics are provided to treat infections.

Patients with NAC are carefully monitored to ensure that their condition does not progress. They are often advised to undergo various tests on a regular basis. This also helps doctors diagnose new complications so they can be treated promptly.

If the patient’s liver is no longer functioning, the only treatment option is a liver transplant. This procedure involves removing and replacing the diseased liver with a healthy donor liver. Although liver transplants have a high success rate, there are not enough organ donors. This leads to a long waiting list. In many cases, patients have to wait for several months or years to get an organ. Also, not all patients are healthy enough to undergo the procedure.

In general, the prognosis for patients with cirrhosis is poor. The overall five-year survival rate for those who have already developed ascites and internal bleeding is only 50%.

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