Cirrhosis

Cirrhosis is a chronic liver disease characterised by fibrosis, which impairs liver function and can lead to end-stage liver disease. It develops slowly over months or years as scar tissue replaces normal liver tissue, causing impaired liver function. This disease can result from alcoholic liver disease, hepatitis B and C, non-alcoholic steatohepatitis (NASH), and other conditions.

Signs and Symptoms

Cirrhosis can take a long time to develop, with early symptoms including tiredness, weakness, loss of appetite, weight loss, and nausea. As the disease progresses, symptoms may include itchiness, swelling in the lower legs, fluid build-up in the abdomen (ascites), jaundice, easy bruising, and the development of spider-like blood vessels in the skin. Advanced cirrhosis can lead to complications such as hepatic encephalopathy, gastrointestinal bleeding from dilated veins, and liver cancer.

Diagnosis

Diagnosis of cirrhosis involves a combination of blood tests, medical imaging, and sometimes liver biopsy. Imaging techniques like ultrasound, CT scans, and MRI help assess liver structure and function. Ultrasound may show a small, shrunken liver in advanced disease and can also screen for hepatocellular carcinoma. Elastography techniques measure liver stiffness, which helps determine the extent of fibrosis.

Laboratory findings can include elevated liver enzymes (AST and ALT), low platelet count, increased bilirubin, and prolonged prothrombin time. The Bonacini score helps evaluate cirrhosis severity based on platelet count, ALT/AST ratio, and INR.

Treatment

While liver damage from cirrhosis is often irreversible, treatment aims to stop or delay further progression and manage complications. A healthy diet with high protein and fibre is encouraged, along with frequent follow-ups. Avoiding alcohol is very important, especially in alcoholic cirrhosis. Medications can help manage symptoms and complications such as itching, infections, and fluid build-up. Ursodiol may be useful if the disease is due to bile duct blockage.

For underlying causes like hepatitis B and C, antiviral medications can slow disease progression. In cases of iron overload, chelation therapy or bloodletting is used. For those with Wilson's disease, copper removal through chelation therapy is necessary. In severe cases, liver transplantation may be required.

Preventing Further Liver Damage

Avoiding alcohol and other hepatotoxic substances is essential. Vaccination against hepatitis B and management of conditions like diabetes and hypertension can prevent further liver damage. Certain medications may need dose adjustments to reduce liver stress.

Decompensated Cirrhosis

Patients with decompensated cirrhosis, marked by complications such as gastrointestinal bleeding, hepatic encephalopathy, and ascites, often require hospitalisation. Treatment includes diuretics, antibiotics, laxatives, and sometimes steroids. Liver transplantation may be necessary for those who cannot be stabilised.

Palliative Care

Palliative care aims to improve quality of life by managing symptoms such as abdominal swelling, itching, and pain. Discussions about healthcare power of attorney and life support are also essential, as cirrhosis is incurable without a transplant.

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Self-assessment MCQs (single best answer)

Which of the following is NOT a common cause of cirrhosis?

Which symptom is generally associated with the early stages of cirrhosis?

What diagnostic technique measures liver stiffness to assess the extent of fibrosis?

Which lab finding is NOT commonly associated with cirrhosis?

Which medication may be useful for cirrhosis due to bile duct blockage?

Which of the following is a complication of decompensated cirrhosis?

What is a primary goal of palliative care in cirrhosis patients?

Which treatment is NOT typically used to manage symptoms and complications of cirrhosis?

What is the Bonacini score used for in cirrhosis patients?

Which prevention strategy is NOT recommended for cirrhosis patients to avoid further liver damage?