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Cirrhosis

What is Cirrhosis?

Cirrhosis of the liver is the end point of long term inflammation of the liver which heals with scar tissue. The scar tissue replaces the normal functioning liver tissue which can result in reduced capacity of the liver to perform its usual function.

What conditions can cause Cirrhosis?

The main two causes of liver cirrhosis in Australia are:

  • Excessive & regular alcohol
  • Viral hepatitis- hepatitis B, hepatitis C

There are other less common causes which include:

  • Fatty liver disease
  • Autoimmune hepatitis
  • Drugs
  • Diseases that damage the bile ducts-primary biliary cirrhosis, primary sclerosing cholangitis
  • Inherited diseases- e.g. Wilson’s disease (copper overload), haemochromatosis (iron overload), alpha 1 antitrypsin deficiency, cystic fibrosis
  • Cryptogenic- in a minority of cases the cause of cirrhosis is unknown

What are the symptoms of Cirrhosis?

The symptoms of cirrhosis relate to the severity of liver impairment. In early cirrhosis people tend to have lethargy, fatigue and loss of appetite. As cirrhosis progresses other symptoms can occur such as itching, jaundice (yellow discolouration of the skin) and swelling with fluid of the abdomen/legs.

How is Cirrhosis diagnosed?

The diagnosis of cirrhosis is made based on a combination of medical history, physical examination, blood tests and imaging findings. A liver biopsy can definitively diagnose cirrhosis, however as this is an invasive test it is only performed in few people. Recently, a test called Fibroscan has become available at some centres, and allows for a non-invasive assessment of liver scarring. However, Fibroscan does not provide any information on the cause of cirrhosis.

What are the complications of Cirrhosis?

A number of complications can occur as the degree of cirrhosis and liver function worsens

  • Ascites and Oedema- build up of fluid with swelling of the abdomen and legs
  • Jaundice and itching- due to the inability of the liver to metabolise a substance called bilirubin, which in turn can deposit in the skin and whites of the eyes
  • Oesophageal varices- this refers to the development of enlarged veins in the lower portion of the food pipe or oesophagus. Bleeding of these varices is a medical emergency
  • Encephalopathy- mental disturbances and confusion which occur due to the inability of the liver to filter toxins.
  • Bruising and bleeding- due to the inability of the liver to make sufficient proteins involved in blood clotting.
  • Liver cancer- cancer that originates in the liver is known as hepatocellular carcinoma
  • Bone disease- increased susceptibility to bone fractures
  • Infection- cirrhosis can also impair the immune system, and increase the likelihood of infections.

What is the treatment for Cirrhosis?

The aim of treating cirrhosis is to prevent it from getting worse. It was previously believed that cirrhosis was irreversible, although research has now indicated that a degree of improvement in liver scarring is possible. The strategies of treating cirrhosis include:

  • Treating the cause: e.g. abstinence from alcohol, treatment of viral hepatitis etc
  • Screening and treatment of the complications
  • A liver transplant may be necessary in some cases.