Cirrhosis: What It Is, Symptoms, Causes, Stages, and Treatment

Cirrhosis is a general term used to describe the final stage of liver diseases and their complications. In the early stages of cirrhosis, the patient may show no symptoms and may not have any complaints.

Cirrhosis is a general term used to describe the final stage of liver diseases and their complications. In the early stages of cirrhosis, the patient may show no symptoms and may not have any complaints. The most common causes of cirrhosis include alcohol consumption, hepatitis, and non-alcoholic fatty liver disease. The treatment for cirrhosis varies depending on its cause and the extent of the disease. Despite treatment, if liver failure progresses and the liver is unable to perform its functions, a liver transplant may be required.

What is Cirrhosis?

Cirrhosis is a disease seen in the final stage of liver diseases, where healthy liver tissue is replaced by scar tissue and irreversible damage occurs. Since scar tissue replaces healthy liver tissue, liver functions decrease. It can no longer perform its functions properly. Many types of liver diseases damage healthy liver cells, causing inflammation in the cells and leading to cell death. The remaining liver tissue attempts to repair itself. During the repair process, the liver tries to heal with scar tissue and fibrous structures. However, scar tissue restricts the blood flow to the liver. As the stages of cirrhosis progress, the proportion of scar tissue in the liver increases. The liver loses its abilities to process nutrients, produce hormones, and eliminate drugs and toxins from the body. Additionally, the production of proteins and enzymes secreted by the liver decreases. Cirrhosis is irreversible, and scar tissue cannot be healed. If cirrhosis is diagnosed early, the damage to the liver can be limited. End-stage cirrhosis is a life-threatening condition and requires a liver transplant.

Common Causes of Cirrhosis

Cirrhosis is not a disease with a single cause and pathology. It is considered the final stage of any disease that damages liver cells. The most common causes of cirrhosis are as follows:

• Alcohol use: Chronic excessive alcohol consumption has been reported to be associated with cirrhosis.
• Chronic viral infections of the liver (hepatitis): Hepatitis B and hepatitis C infections are types of hepatitis that lead to chronic viral hepatitis.
• Fatty liver disease: This condition, seen in obesity and diabetes, is one of the major causes of cirrhosis. It is also referred to as non-alcoholic steatohepatitis.

Less common causes of cirrhosis include:

• Hereditary Diseases:
  • Alpha-1-antitrypsin deficiency: Causes abnormal protein accumulation in the liver.
  • Hemochromatosis: A disease that involves excessive iron accumulation in the liver.
  • Wilson’s disease: A condition characterized by excessive copper accumulation in the liver.
  • Cystic fibrosis: The accumulation of sticky and thick mucus in the liver.
  • Glycogen storage diseases: Conditions where the liver cannot break down or store glycogen, the carbohydrate storage form.
  • Alagille Syndrome: A condition where fewer bile ducts are present than normal. There is a problem with bile flow, leading to jaundice.
• Autoimmune hepatitis: Occurs when the body's immune system attacks and damages healthy liver tissue.
• Liver diseases affecting bile flow: Diseases like primary biliary cholangitis, primary sclerosing cholangitis, and biliary atresia block bile flow and cause liver damage.
• Chronic heart failure: Leads to fluid buildup in the liver and insufficient blood circulation.
• Amyloidosis: A rare disease where abnormal protein called amyloid accumulates, reducing normal liver function.

The progression from liver diseases to cirrhosis occurs gradually. If liver damage continues, cells begin to die. In rare cases, cirrhosis can progress very rapidly in some severe cases.

How is Cirrhosis Diagnosed?

Unless there is significant liver damage, a person with cirrhosis may not be aware of their condition and may not show any symptoms. However, if the liver damage is too severe for the body to compensate, symptoms and signs will appear. These symptoms include:

• Fatigue
• Easy bruising and bleeding
• Loss of appetite
• Nausea
• Swelling in the legs, ankles, and feet (edema)
• Weight loss
• Itching
• Jaundice
• Fluid accumulation in the abdomen (ascites)
• Spider-like veins on the skin
• Redness in the palms
• Breast enlargement in men (gynecomastia)
• Altered consciousness in cases of hepatic encephalopathy

When a patient presents with the above symptoms, a medical history is taken, focusing on the cause of cirrhosis, and a physical examination is completed. The patient's history, especially regarding alcohol use, illicit drug use, hepatitis, and jaundice, is inquired. Blood tests related to the medical history are requested. Liver enzyme levels, hepatitis markers, bilirubin levels, autoantibodies, and alpha-fetoprotein hormone levels are measured.

Imaging techniques are used to examine the size, shape, and texture of the liver. Computerized tomography (CT), magnetic resonance imaging (MRI), and ultrasound may be used to visualize the liver. If biliary pathology is suspected, an endoscopic retrograde cholangiopancreatography (ERCP) may be performed to examine the bile ducts in more detail. A special ultrasound technique called transient elastography can provide information on the amount of scar tissue in the liver.

A liver biopsy (tissue sample) is taken to confirm the diagnosis of cirrhosis. The biopsy may also help identify the cause of cirrhosis and determine if it has progressed to cancer.

Stages of Cirrhosis

Cirrhosis is categorized into two stages based on the presence of symptoms: compensated and decompensated cirrhosis. If diagnosed early, decompensated cirrhosis can be reversed to compensated cirrhosis. These two stages are as follows:

• Compensated Cirrhosis Stage: This stage is characterized by the absence of symptoms, and the patient does not complain. There is scar tissue in the liver, but it has not progressed to the point of causing symptoms.
• Decompensated Cirrhosis Stage: Symptoms such as jaundice and fluid accumulation in the abdomen (ascites) appear in this stage. It is a very serious stage. If diagnosed early, it can be reversed, but if left too late, the only option is a liver transplant. It poses a serious threat to life.

Cirrhosis Treatment Methods

There is no definitive treatment that completely reverses cirrhosis. Treatments may be given to reduce the permanent damage to the liver, prevent the progression of cirrhosis, and provide relief to the patient. Treatment is determined by the doctor based on the cause and stage of cirrhosis.

Lifestyle Changes

In cirrhosis caused by alcohol consumption, the first step is to stop drinking alcohol. In cases of obesity and diabetes, the doctor may recommend weight loss. When fluid accumulates in the abdomen and edema occurs due to cirrhosis, a low-sodium diet should be followed.

Medication Treatment

In cases of increased pressure in the portal vein (portal hypertension), which plays a significant role in liver blood flow, beta-blockers and nitrate group drugs are used to reduce pressure. In cases of infections like hepatitis, antiviral treatments are preferred.

Liver Transplant

When lifestyle changes and medication treatment are not effective, the only treatment option for the patient is a liver transplant. The transplant can be performed using a living donor or a cadaveric donor.

Frequently Asked Questions About Cirrhosis

What amount of alcohol consumption is a risk factor for cirrhosis?
A meta-analysis study conducted in 2019 found that alcohol use increases the risk of cirrhosis for women regardless of the amount consumed, while for men, drinking more than one drink per day increases the risk compared to the general population. This is because the male body metabolizes alcohol more effectively than the female body. There is no safe dose of alcohol.

What is Hepatitis and What Causes It?
Hepatitis refers to the damage and inflammation of liver cells. Hepatitis means the inflammation of liver cells, and anything that triggers inflammation in the liver cells can cause hepatitis. This damage can be caused by medications, toxins, alcohol, hereditary diseases, metabolic diseases, and viral infections. There are many microorganisms that cause hepatitis, but the main culprits are the hepatitis A, B, C, D, and E viruses. Only hepatitis B and C viruses cause chronic hepatitis.

What Are the Complications of Cirrhosis?
The most serious complication of cirrhosis is portal hypertension. This is the increase in pressure in the portal vein, which plays a crucial role in liver blood flow. When blood circulation is blocked, varices form in the esophagus, stomach, and intestines. The risk of bleeding from esophageal varices is particularly high, and the patient can be lost. Other complications of cirrhosis include malnutrition, liver cancer, liver failure, and hypersplenism.

Is Cirrhosis a Type of Cancer?
Cirrhosis is not a type of cancer, but most patients with liver cancer also have cirrhosis. Cirrhosis increases the risk of liver cancer by 20 times.