Cirrhosis is a complication of liver disease that involves loss of liver cells and irreversible liver scarring.
Alcohol and viral hepatitis B and C are common causes of cirrhosis, although there are many other causes.
Cirrhosis can cause weakness, loss of appetite, easy bruising, yellowing of the skin (jaundice), itching, and fatigue.
Cirrhosis can be diagnosed through history, physical examination, and blood tests, and this can be confirmed with a liver biopsy.
Complications of cirrhosis of the liver include edema, spontaneous bacterial peritonitis, bleeding from esophageal varices, hepatic encephalopathy, hepatorenal syndrome, overactive spleen, and liver cancer .
Cirrhosis is treated to prevent further damage to the liver, treat complications of cirrhosis, and prevent or detect liver cancer early.
Liver transplantation is an important treatment option for patients with advanced cirrhosis.
Symptoms of cirrhosis
Individuals with cirrhosis may have few or no symptoms of liver disease. Some symptoms may be nonspecific, that is, they do not indicate that the liver is the cause of them. Some of the more common symptoms and signs of cirrhosis include:
- Yellowing of the skin (jaundice) due to a build-up of bilirubin in the blood.
- Easy bruising from reduced production of blood clotting factors in the patient’s liver.
What is cirrhosis?
Cirrhosis is a complication of many liver diseases characterized by an abnormal structure of the liver. The diseases that lead to cirrhosis do this because they infect and kill liver cells, and then the inflammation and repair associated with the dead hepatocytes causes scar tissue to form. Liver cells that do not die proliferate in an effort to replace those that have died. This leads to clusters of newly formed liver cells (regenerative nodules) within the scar tissue. There are many causes of cirrhosis including chemicals (such as alcohol, fats, and some medications), viruses, toxic metals (such as iron and copper accumulated in the liver as a result of genetic diseases) and autoimmune liver diseases that result from the body’s immune system attacking the liver.
Why does cirrhosis cause serious problems?
The liver is an important organ in the body. It performs many critical functions, two of which are the production of substances that the body needs, for example, the coagulation of proteins necessary for blood clotting, and the removal of toxic substances that can be harmful to the body, for example drugs. The liver also has an important role in regulating the supply of glucose and fats that the body uses as fuel.
In order to perform these vital functions, the liver cells must function normally, and it must be in contact with blood because substances that are added or removed from the liver are transported to and from the liver by blood.
The relationship between the liver and blood is unique. Unlike most organs in the body, only a small amount of blood is introduced into the liver by the arteries. Most of the blood supply in the liver comes from the intestinal veins while the blood returns to the heart. The main vein that returns blood from the intestine is called the portal vein. When the portal vein passes through the liver, it splits into smaller and smaller veins. Smaller veins (called sinuses due to their unique composition) are in close contact with liver cells. In fact, liver cells line up along the sinuses. This close relationship between liver cells and blood in the portal vein allows liver cells to remove and add substances to the blood. Once the blood travels through the sinuses, it collects in larger and larger growing veins that eventually form a single vein, the hepatic vein, which returns blood to the heart.
In cirrhosis, the relationship between blood cells and the liver is destroyed. Although the surviving or newly formed liver cells may be able to produce and remove substances from the blood, they do not have a normal and friendly relationship with the blood, and this interferes with the ability of the liver cells to add or remove substances from the blood. Additionally, scarring within the cirrhotic liver impedes the transfer of blood from the liver to the liver cells. As a result of blocked blood flow through the liver, pressure in the portal vein increases, a condition called portal hypertension. Due to the obstruction of flow and high pressure in the portal vein, the blood in the portal vein is directed to other veins to return to the heart, and the low-pressure veins bypass the liver. Unfortunately, the liver is unable to add or remove substances from the blood that it bypasses.
The second cause of problems with cirrhosis is the troubled relationship between liver cells and the channels through which bile flows. It is a fluid produced by liver cells and has two important functions: to aid digestion and eliminate toxic substances from the body. The bile produced by the liver cells is excreted in very small channels that run between the liver cells that line the sinuses. In the case of cirrhosis, the liver becomes unable to eliminate the normally toxic substances, and these toxins can accumulate in the body. To some extent, the digestive process in the intestine is also impaired.
What are the complications of cirrhosis?
When cirrhosis becomes severe, signals are sent to the kidneys to retain salt and water in the body. Excess salt and water first build up in the tissue under the skin of the ankles and legs due to the effect of gravity when standing or sitting. Fluid accumulation is called peripheral edema or pitting edema. As cirrhosis progresses and more salt and water increases, fluid may accumulate in the abdominal cavity between the abdominal wall and the abdominal organs. This fluid buildup causes abdominal swelling, discomfort, and weight gain.
Spontaneous bacterial peritonitis (SBP)
The fluid accumulated in the abdominal cavity turns into an ideal location for bacterial growth. Usually, the abdominal cavity contains very little fluid that is able to fight infection well, and it kills bacteria that enter the abdomen (usually from the intestine) or find their way into the portal vein and liver where they are killed. In cirrhosis, the fluid that collects in the abdomen cannot naturally fight infection. Additionally, more bacteria find their way from the intestine into the abdominal cavity. Therefore, an intra-abdominal infection referred to as spontaneous bacterial peritonitis or SBP, is more likely to occur. SBP is a life-threatening complication. Some patients with SBP have no symptoms, while others have fever, chills, abdominal pain, and diarrhea.
Bleeding from esophageal varices
In a cirrhotic liver, the scar tissue blocks the blood flow returning to the heart from the intestine and raises the pressure in the hyperal pressure portal vein. When the pressure in the portal vein becomes high enough, it causes blood to flow around the liver through the lower pressure veins to reach the heart. The most common veins through which blood bypasses the liver are the veins that line the lower part of the esophagus and the upper part of the stomach.
As a result of the increased blood flow and the resulting increase in pressure, the veins in the lower esophagus and upper stomach expand and are then referred to as esophageal and stomach varicose veins. And the higher the pressure, the more varicose veins.
Bleeding from varicose veins is usually severe and can be fatal without prompt treatment. Symptoms of bleeding from varicose veins include vomiting of blood (in the vomit there may be red blood mixed with clots, black stool passing due to changes in the blood as it passes through the intestine, and lightheadedness or fainting (caused by low blood pressure).
Bleeding may also occur from varicose veins located elsewhere in the intestine, for example, the colon, but this is rare.
Cirrhosis is a very serious problem and it may progress to very advanced stages without the patient showing any symptoms, and this further complicates the situation, as most patients are diagnosed with cirrhosis after they have severe symptoms, and in most cases the liver cannot be restored to its normal state and be The treatment is focused on ensuring that the damage to the liver does not continue, and here the treatment must be adhered to and the underlying cause of cirrhosis should be determined to treat it, otherwise this fibrosis will continue to cause damage to the liver and cause serious complications that may develop into more serious problems such as liver cancer and may cause cirrhosis in the liver. Its advanced stages with the death of the injured.
The life span of a patient with cirrhosis
Cirrhosis is a serious liver disorder and is often associated with a number of life-threatening complications such as bloody cough, kidney failure, fluid buildup in the abdomen, infections, easy bleeding, and altered mental status. The development of cirrhosis depends on many factors and it is impossible to determine what the average life expectancy of each person will be.
In most patients with cirrhosis, the general course is characterized by a progressive deterioration of overall health. Ultimately, most patients develop a buildup of fluid in the abdomen (abdominal ascites). And once patients develop complications, life expectancy drops sharply.
In general, other than saying that patients with cirrhosis have a short life span, the course of the disorder is highly variable from patient to patient. The reasons for this variation are the reason that cirrhosis may be different between people (some causes are treatable and others not), the availability of means to prevent the progression of liver damage, and most importantly the development of liver cancer. Other factors that need to be taken into account when predicting life expectancy include the patient’s ability to undergo a specific treatment intervention or whether there is any treatment option that can improve liver function.
It is difficult to predict the life expectancy of a person with cirrhosis, as the condition depends on a combination of factors that can negatively affect the length of stay. Several tools have been developed that enable clinicians to predict the severity of cirrhosis and life expectancy.
There are three main types of cirrhosis, and ABC is commonly used in medicine to assess the severity of cirrhosis.
The result a person gets determines the type of cirrhosis:
- Class A cirrhosis: average life expectancy from 15 to 20 years.
- Category B cirrhosis: average life expectancy 6 to 10 years.
- Category C cirrhosis: average life expectancy only 1 to 3 years.
These tools are not just set to provide a rough estimate of how long a patient can survive. Most of the tools use a scoring system that measures the severity of complications, the patient’s age, liver function, nutritional status, and other comorbidities such as diabetes, alcohol drinking, lung and kidney disease. Generally speaking, the higher the score on any of these tools means the lower the life expectancy.
Over the past two decades, the availability of liver transplantation has helped improve the survival and life expectancy of people with cirrhosis. However, the problem with a liver transplant is that there are simply not enough organs, and this is a huge stumbling block. It is also important to understand that just because a person has a liver transplant, it does not automatically mean that they will live longer. Liver transplantation is a very complex procedure with many life-threatening complications. More importantly, patients with cirrhosis are vulnerable and not always in the best health to undergo major surgery. This procedure carries a risk of death and the patient must always take effective drugs that suppress the immune system. This also leads to many side effects and the development of opportunistic infections.
There has also been progress in treating hepatitis B with antiviral drugs. These drugs have been shown to reduce the progression of liver damage and improve quality of life. Unfortunately, there are no effective medications to manage hepatitis C.
A rough guide to life expectancy
Patients with low markers and without complications may live for 12-20 years after diagnosis provided they do not drink alcohol and take precautions to protect the liver.
Patients who score high and who develop complications can survive for 3 months to 3 years.
Those who undergo successful liver transplant, at least 80% expect to live to 5 years. Unfortunately, even when a liver donor is available, many patients are simply not physically ready to undergo this procedure.
Ways to improve life expectancy
Some ways to improve your life expectancy after a diagnosis of cirrhosis is:
- Do not take medications (either prescription or over-the-counter) because the drugs can harm the liver.
- Avoid drinking alcohol as much as possible.
- Make sure to eat a balanced diet and reduce your sodium intake.
- Get vaccinated against influenza and hepatitis A and B.
- Wash your hands frequently to reduce the risk of infection.