Cirrhosis Warning Signs

When we talk about cirrhosis, we usually mean cirrhosis of the liver. The liver is a vital organ that processes nutrients, filters the blood, and fights infections. Cirrhosis is an advanced form of scarring (fibrosis) of the liver caused by injuries and insults from a range of causes such as disease or excessive alcohol consumption. Cirrhosed liver tissue appears shrunken and lumpy, has impaired blood flow, and is permanently damaged - it cannot heal like liver tissue damaged in other ways. When a large proportion of the liver becomes cirrhosed (decompensated cirrhosis), it can no longer perform its many vital tasks properly, such as eliminating toxins, making hormones, and storing nutrients. Advanced cirrhosis like this can be very serious and even life-threatening.

What are the Causes and Risk Factors for Cirrhosis?

• Chronic excessive alcohol consumption/misuse. Each time the liver filters alcohol, some of the cells die. Normally the liver can regenerate new cells, but prolonged alcohol exposure prevents this from happening. Alcohol-related liver disease (ARLD) progresses from alcoholic fatty liver disease (AFLD) to alcoholic hepatitis and finally to cirrhosis (NHS).
• Non-alcoholic fatty liver disease (NAFLD).  Progresses from a largely harmless buildup of fat in the liver (steatosis) to non-alcoholic steatohepatitis (NASH). This leads to persistent inflammation, fibrosis and eventually cirrhosis (NHS).
• Chronic viral hepatitis (B, C and D).  A leading cause of liver diseases. If you have it for more than 6 months it is considered chronic and can lead to cirrhosis. (Mayo Clinic, CDC)
• Liver disease caused by your body's immune system (autoimmune hepatitis).
• Bile duct problems.  Including poorly formed bile ducts (biliary atresia), destruction of the bile ducts (primary biliary cirrhosis), or hardening and scarring of the bile ducts (primary sclerosing cholangitis). (Mayo Clinic)
• Certain medications. Including methotrexate for arthritis or isoniazid for tuberculosis. Antibiotics, such as amoxicillin and flucloxacillin (Robles et al. 2010), statins for high cholesterol, and paracetamol may also damage your liver.
• Certain supplements.  Over 6000 herbs, including borage, comfrey, groomwell, and coltsfoot contain any of over 660 pyrrolizidine alkaloids that can cause blockages in the very small blood vessels in your liver (Food Standards Agency). Other examples include Camellia sinensis (tea plant), germander, and pennyroyal oil (used in tea). Over time, this damage can lead to cirrhosis.
• Blood clots.  Clots can obstruct blood vessels which cause scarring of the tissue.
• Genetics. For example, alpha-1 antitrypsin deficiency, inherited disorders of sugar metabolism (galactosemia or glycogen storage disease), and genetic digestive disorder (Alagille syndrome).
• Obesity.  Increases the risk of NAFLD and NASH.
• Diabetes. Increases the risk of NAFLD and NASH.
• Iron build-up in the body (haemochromatosis).
• Cystic fibrosis.
• Copper accumulated in the liver (Wilson's disease).
• Infection, such as syphilis or brucellosis.

What are the Signs and Symptoms of Cirrhosis?

Those with liver cirrhosis often have no signs or symptoms until liver damage is very advanced. When signs and symptoms do occur, they may include:

• Fatigue.
• Fever.
• Loss of appetite.
• Weight loss.
• Nausea.
• Easily bleeding or bruising.
• Itchy skin.
• Yellow discolouration in the skin and eyes (jaundice).  Jaundice occurs when the diseased liver doesn't remove enough bilirubin, a blood waste product, from your blood. 
• Spider-like blood vessels that surround small, red spots on your skin (telangiectasias).
• Redness in the palms of the hands.
• An absence or loss of menstruation not related to menopause.
• For people assigned male at birth, a loss of sex drive, breast enlargement (gynaecomastia) or testicular atrophy.
• Confusion, drowsiness, and slurred speech (hepatic encephalopathy).

The first five signs on the list are early symptoms of liver problems, with the other signs appearing as the liver damage gets progressively worse. Additional complications of cirrhosis include:

• High blood pressure in the veins supplying the liver and spleen (portal hypertension).
• Swelling in the legs and abdomen. Portal hypertension can cause fluid to accumulate in the legs (oedema) and in the abdomen (ascites).
• Enlargement of the spleen (splenomegaly). Portal hypertension can also cause swelling of the spleen.
• Internal bleeding. Portal hypertension can cause blood to reroute through smaller veins. The extra pressure can cause these smaller veins to swell (varices) or burst.
• Infections. Your body may have trouble fighting infections. Also, ascites can lead to bacterial peritonitis.
• Malnutrition. Impaired liver function due to cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss.
• Buildup of toxins in the brain (hepatic encephalopathy).  These toxins can cause mental confusion, slurred speech, difficulty concentrating and eventually coma.
• Bone disease. Cirrhosis can lead to a loss of bone strength and a greater risk of fractures.
• Increased risk of liver cancer. 
• Acute-on-chronic cirrhosis. Some people with cirrhosis end up with multiorgan failure. 

Diagnosis of Cirrhosis

• Laboratory tests. These might include blood tests to check for signs of liver malfunction, such as excess bilirubin or certain enzymes that indicate liver damage. Kidney function is assessed by measuring creatinine.  Screening is done for the hepatitis viruses. Your international normalized ratio (INR) is also checked for your blood's ability to clot effectively.
• Imaging tests. Includes magnetic resonance elastography (MRE), MRI, CT, and ultrasound.
• Biopsy. A tissue sample (biopsy) is not always necessary for diagnosis, but it may be used to assess the severity, extent and cause of liver damage.
• If you have cirrhosis, you will probably undergo regular tests to monitor for signs of disease progression or complications, especially esophageal varices and liver cancer.

Prevention and Treatment of Cirrhosis

According to the Mayo Clinic, cirrhosis cannot be reversed. However, if started early on, several treatments may limit its progression.  These include treatment for alcohol addiction, a weight loss programme, and medication to control hepatitis.  To these can be added treatments for symptoms such as itching, fatigue, pain, oedema, portal hypertension and infections.   If the liver is very cirrhosed, liver transplant surgery can be contemplated.

You can reduce your risk of cirrhosis:

• Avoid alcohol if you have cirrhosis or any liver disease.
• Eat a healthy diet full of fruits and vegetables, whole grains and lean protein. Reduce fatty and fried foods.
• Maintain a healthy weight. 
• Reduce your risk of hepatitis. Sharing needles and having unprotected sex can increase your risk of hepatitis B and C.

Conclusion

Cirrhosis is a serious liver condition with many complications, stemming from numerous causes, including alcohol misuse, obesity and viral hepatitis.  It cannot be reversed but can be managed if detected early enough.  It can be avoided in many cases by avoiding alcohol and eating a healthy diet that is low in fat and processed foods.