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Liver Cirrhosis

By Prof (Dr.) Subhash Gupta in Liver Transplant and Biliary Sciences

Jul 20 , 2021 | 5 min read

The liver is a vital and the most complex organ in the human body. The importance of the liver can be gauged from the fact that the liver is responsible for performing more than 500 essential functions, which include digestion of food, production of proteins which are the building blocks of the human body, maintaining the immunity of the body, removal of harmful substances from the body and many more. Therefore, it is obvious that the body’s normal functioning is dependent on a healthy liver.

The liver, unlike other organs in the body, has a huge reserve and physical signs and symptoms of liver disease arise only when most of the liver gets damaged. The earliest symptoms may only be fatigue, hyperpigmentation and changes in Liver function tests such as elevated liver enzymes. The two most common causes of liver diseases are alcohol and fatty liver disease. As awareness is increasing, one can check for early liver disease by a simple liver function blood test.

The common symptoms of advanced liver disease are jaundice (yellow colour of eyes), loss of appetite/aversion to food, feeling of weakness and lethargy, abnormal bleeding occurring after minor trauma and swelling in the legs. At very advanced stages of liver disease, ascites (accumulation of water in the abdomen), bleeding from intestine and altered mental status will occur.  

Some of the common causes of cirrhosis have gradually disappeared such as chronic viral hepatitis B and C. Hepatitis B can be prevented by vaccination and if the person has already been infected, effective drug is available for preventing progression of liver disease. The good news is that if an adult acquires the infection, over 95% chances are that the body will eventually get rid of the infection in 6 months’ time. Only in a very small number of cases, acute infection from hepatitis B can result in fulminant liver failure for which an urgent liver transplant will be needed.

Hepatitis C has also been controlled by the emergence of very effective antiviral medicines which can eliminate the virus from the body forever. However, even in those who have been treated successfully with antiviral therapy, they should continue to be under surveillance for the development of liver cancer. Early detection of liver cancer will go a long way in its successful treatment.

Excessive alcohol consumption can become a modern day scrouge with many young people developing liver disease. Combined with diabetes, excessive weight and lack of physical activity, it results in rapid progression of liver disease and subsequently liver cancer. Sensible drinking is important, and one must restrict the total amount of alcohol consumed in a week. Women are more susceptible to damage from alcohol and the general recommendation is that they should not take more than 140 grams of alcohol in a week. It does not matter what type of alcoholic drink one consumes as some of the safest ones, such as beer, may actually end up with more intake of alcohol. Beer has a lower percentage of alcohol, but the absolute amount increases markedly as one drinks by the bottle.

Fatty liver disease is a precursor of cirrhosis and seems more common in overweight persons , who have diabetes and lack physical activity. An ultrasound report of fatty liver is very common and assumes sinister proportions if the liver enzymes are also elevated. Dietary carbohydrate restrictions and weight loss may help in correcting fatty liver disease.

Significant liver disease will often result in persistently low platelet counts and if the cause for this is not clear, a detailed evaluation of the liver must be done. Often, liver Fibroscan score will be elevated, and one must see a specialist in case chronic liver disease is suspected.

An uncommon liver disease leading to cirrhosis is autoimmune hepatitis and typically affects middle aged females who may or may not have other features of autoimmune disorders. Autoimmune disorders are conditions where the body starts attacking its own organs and causes chronic damage. These autoantibodies can be measured and if they are elevated, a liver biopsy will confirm the disorder. Steroids will help in reversing the damage and recovery of liver functions.

Another uncommon liver condition is from damage to the biliary tree (the biliary tree collects bile made by the liver and carries it to the intestine to aid in the digestive process) of the liver which in childhood presents as biliary atresia and in adults the entire biliary tree has areas of narrowing and dilatation resulting in development of jaundice and eventually cancer. Sometimes, this condition may also be associated with ulcerative colitis which is a condition of chronic damage to the colon resulting in ulceration and bleeding in the stool.

Primary biliary cholangitis (previously called primary biliary cirrhosis) is also a disease affecting  bile duct lining and if diagnosed use of ursodeoxycholic acid may help in controlling disease progression. Diagnosis can be made by a blood test.

The aims of treating a patient with liver disease are a) Knowing the cause of liver disease b) Knowing the extent of damage to the liver c) Knowing if the damage can be controlled/reversed with medication or is the damage beyond repair. A large majority of liver problems can be managed with medicines and lifestyle modifications, but this is only when the illness is detected early. Once the disease is advanced and has caused irreversible damage to the liver, the only option is liver transplantation.

Liver transplantation has now become a well-accepted modality for the management of end stage liver disease, acute liver failure and liver cancer. Liver transplantation involves removing the diseased liver from the patient and replacing it with a healthy liver either from a brain dead donor or more commonly with partial liver from a healthy donor. Owing to the scarcity of brain dead or “cadaveric” organs, the available resource is that for a healthy individual to donate a part of his liver for the patient. Owing to the huge functional reserve of a healthy liver, the part of the liver remaining with the donor is sufficient to maintain normal functioning and the remaining liver grows back to its normal size soon after donation.

Liver transplantation has been a major advance in the management of liver diseases. However, as the procedure is highly skilled, requires a fully trained medical team and infrastructure, the procedure has not yet become popular in many parts of the world. Ongoing research might yield better medicines for the treatment of hepatitis in the future and also advances in medical research might provide alternatives to liver transplantation such as medication for reversal of fibrosis, animal source for donor livers and stem cell regenerative therapy.