What is liver cirrhosis and what causes it?
Cirrhosis implies irreversible scarring of the liver which can be potentially life-threatening. In an advanced stage, 80-90% liver may be damaged and replaced with scar (dead) tissue. Cirrhosis is caused by sustained liver damage over several years either by alcohol, viral infection (Hepatitis B, C), a toxic substance (for eg. drugs, excess copper or iron in the liver), or by blockage of the biliary system such that the liver undergoes progressive scarring that slowly replaces all of the normal liver cells.
In most instances, the above causes initially result in Hepatitis which can usually be treated. However, if the offending factor is not removed or treated on time, cirrhosis develops, and then it is usually too late to change the course of the disease.
Symptoms of liver cirrhosis
Initially, there may be general symptoms such as tiredness, lethargy, yellowness of eyes, and urine (mild jaundice), swollen feet, excessive itching, and anemia (low hemoglobin). In more advanced stages, the patient may have several life-threatening complications such as blood vomiting, bloated stomach due to water (ascites) in the abdomen which may develop a serious infection, mental deterioration, and coma, deep jaundice and kidney impairment. In addition, the patient may have a bleeding tendency due to low levels of a liver protein prothrombin, and low platelet count both of which are vital for normal clotting of blood.
Living with cirrhosis (do’s and don’ts)
Although cirrhosis implies irreversible damage to the liver, a person with early cirrhosis (stage Child’s A or early Child’s B) can have several years of fairly active life provided appropriate treatment is given by liver specialists. Advanced or Child’s C Cirrhosis on the other hand, clearly dictates the need for a liver transplant for which expert opinion should be sought.
Some do’s
- Initial detailed evaluation with a liver specialist is essential to grade the disease and chalk out appropriate therapy.
- Regular liver function tests and follows up with your specialist is necessary every 1-3 months in early cirrhosis and 1-4 weeks in advanced cirrhosis. The exact interval between check-ups will be decided by your liver physician depending upon your symptoms and severity of the disease.
- A nutritious diet is essential for optimal liver function in the presence of chronic liver disease. Contrary to popular belief, the digestion remains normal until very late stages of liver disease except in the presence of severe jaundice. Hence, the need for complete avoidance of fatty food and proteins in all forms of liver disease is a myth. This is not only unnecessary in most cases, but also harmful since it results in malnutrition, weight loss and faster deterioration in health.
- In Hepatitis B induced cirrhosis, appropriate antiviral treatment may be considered in consultation with the liver specialist if HBV DNA test is positive
- In early cirrhosis due to Hepatitis C, based on Genotype on evaluation, treatment with directly acting antiviral agents & or combination therapy may be useful in consultation with your liver physician.
Some don’ts
- Alcohol must be avoided at all costs in alcohol-induced cirrhosis and restricted in all other forms of cirrhosis, especially Hepatitis C.
- Excessive physical activity should be avoided especially in virus-related cirrhosis.
- At the same time, forced bed rest should be avoided and a reasonable degree of mobility and activity should be maintained.
- Contact sports should be avoided in advanced stages of cirrhosis due to poor clotting and a bleeding tendency.
- Self-medication is dangerous since the liver is suboptimal and drugs will have much more prolonged effects and may harm the already damaged liver.
All About Liver Transplantation:
A few facts about liver transplantation –
- The only cure for advanced stages of cirrhosis
- Can be done by a donation by a brain dead person or by a close relative with matching blood group
- If done in time, it carries 80% success rate
- Close follow up is essential after transplant
- Life can be completely normal after transplant
Who needs a Liver Transplant?
According to international guidelines, any patient suffering from liver cirrhosis who is assessed to have a life expectancy of less than a year should be considered for a transplant. The severity of the liver disease is graded from A to C. Usually all Grade C and most grade B patients are candidates for transplant. Any patient with any of the liver failure symptoms listed below should seek specialist opinion so that liver experts can assess whether a transplant or drug treatment is more suitable for them. In any case, the better the condition of the patient at the time of transplant, the better are the results of surgery. In patients who are critically ill in ICU, malnourished, have an active infection, or other organ damage such as kidney impairment at the time of the operation, the results of transplantation are dismal. Therefore, a timely transplant is of the essence in obtaining good results. A timely transplant done on a patient who is in a reasonable condition, with a good donor liver has around 80% chance of success.
In most instances, the above causes initially result in Hepatitis which can usually be treated. However, if the offending factor is not removed or treated on time, cirrhosis develops subsequently, and then it is usually too late to change the course of the disease.
Symptoms of liver failure due to cirrhosis
- Black stool
- Blood vomiting
- Water in the abdomen (ascites)
- Drowsiness and mental confusion
- Excessive bleeding from minor wounds
- Jaundice
- Kidney dysfunction
- Excessive tiredness
- Low hemoglobin and other blood counts
Assessment for Liver Transplantation:
The liver specialist usually suggests this evaluation once he has diagnosed end-stage liver disease. Recipient (Patient) evaluation is done in three phases and normally takes 5-7 days in the hospital.
- To establish a definite diagnosis, determine the severity of liver disease and the urgency of the transplant.
- To determine the fitness of the patient for a transplant. The other systems such as heart, lungs, kidneys, blood counts are tested and the presence of any infection is ruled out. The liver specialist then decides how successful the surgery is likely to be depending on the status of the patient and the cause and severity of the liver disease.
- The final phase entails the psychological and mental preparation of the patient. The patient and the family are counseled about the procedure, hospital stay, the likely course after surgery, follow up, and aftercare.
After evaluation, the patient is either placed on the waiting list for cadaveric donation or, if there is a willing and blood group matched family donor available, he/she is evaluated for donation and a transplant is scheduled.
While on the cadaver waiting list, the patient follows up with the Transplant Team until a suitable liver becomes available. If the patient’s condition shows signs of deteriorating, we normally suggest the family to consider living liver donation.
Dr. Varun Mahabaleshwar, Consultant Liver Transplant & HPB Surgery, Narayana Superspeciality Hospital, Gurugram