Cirrhosis

What is cirrhosis? 

Over time, certain factors can lead to a build up of scar tissue in the liver. These factors include alcohol consumption, certain underlying illnesses, metabolic syndrome, viral infection, type 2 diabetes or obesity. Instead of being smooth, the liver becomes hard and bumpy. This liver scarring is known as cirrhosis.

 

It is estimated that cirrhosis affects around 1 in 200 Australians.

However, this may be even higher as cirrhosis is difficult to diagnose in the early stages.

 

Symptoms


In the first stages of cirrhosis, people often don’t notice any symptoms at all. This stage is known as compensated liver cirrhosis. As the scarring of cirrhosis progresses to the point where liver function is affected, symptoms start to become noticeable. This stage is known as decompensated liver cirrhosis.

UPDATE

 

Symptoms of decompensated liver cirrhosis can include:

  • Swelling or discomfort caused by fluid in the abdomen

  • Discoloured skin or eyes

  • Feeling tired or mentally foggy

  • Bruising or bleeding easily

  • Vomiting of blood or black, tarry stools

Causes

Cirrhosis is the result of long-term liver damage. Often people equate cirrhosis with alcohol, but any process causing progressive liver injury may result in cirrhosis including:

UPDATE

Diagnosis


To determine whether you have cirrhosis, your doctor may run some or all of the following tests:

 

Imaging

An ultrasound, contrast CT or MRI may be used to check if your liver is enlarged or has surface nodules. These are signs of cirrhosis. These imaging techniques are not invasive. However, a contrast CT requires an injection of dye to make features of your liver show up more clearly on the image.

 

Blood tests

Liver function blood tests look for abnormal levels of liver enzymes in your blood.7 Routine blood tests are usually normal in compensated cirrhosis, but often show differences in decompensated cirrhosis (the stage when you start noticing symptoms). Your doctor may order specific blood tests for detecting cirrhosis.

 

Transient elastography

Hardening of the liver occurs when scar tissue gradually replaces healthy liver cells (cirrhosis). Transient elastography uses vibrations directed between the ribs to measure how hard the liver is. This test is painless and takes less than 5 minutes.

 

Liver Biopsy

A biopsy is a method of sampling a very small portion of your liver so this can be looked at under the microscope. This is the best way to know for certain whether you have liver cirrhosis. While liver biopsy is invasive, it is a relatively low-risk procedure and may help to identify a specific cause for cirrhosis.

Treatment & management

Treatment of the underlying condition causing cirrhosis may help reverse liver damage and improve liver function. In addition, some healthy lifestyle measures can help prevent further damage to the liver. These include maintaining a healthy weight, controlling metabolic risk factors, such as blood pressure and blood lipids, and reducing further harm to the liver from alcohol.

 

Because there are lots of causes of cirrhosis, your treatment plan will be specific to your individual condition. For example, if your cirrhosis is caused by hepatitis B or C, you may be prescribed an antiviral medication. Treatment of hepatitis B or C can have major benefits in reducing complications of liver disease and improving survival. If your liver cirrhosis is related to obesity, type 2 diabetes and excessive alcohol consumption, weight loss, effective diabetes management and abstinence from alcohol will be recommended.

 

The following are usually recommended for everyone with a diagnosis of cirrhosis:

  • Check-ups every 6 months, including a liver ultrasound and blood tests, to monitor your liver health.

  • Vaccinations against hepatitis A and B.

  • Vaccinations against Covid-19, influenza and pneumococcus.

  • Not drinking alcohol.

  • Quitting smoking.

 

Cirrhosis of the liver is the greatest risk factor for developing liver cancer. Checking the progression of cirrhosis every 6 months with a liver ultrasound is important to detect any changes early on. For people living with cirrhosis, ongoing liver ultrasounds are reimbursed by the Medicare Benefits Scheme.

 

If liver cancer is detected, you will be referred to a liver specialist or multi-disciplinary team for further assessment and management. Many effective treatments are available for liver cancer.11 The earlier the diagnosis, the higher the chances of a cure.4

 

Your doctor may prescribe some medications to manage or prevent complications of cirrhosis. These medications are important to manage fluid overload, confusion (associated with hepatic encephalopathy) or prevent internal bleeding or infection.4 It is important to take your medications as prescribed and attend regular follow-up appointments with your doctor.4

 

Paying attention to nutrition is also very important for people with cirrhosis and you might benefit from referral to an accredited dietitian.4 Reduced salt intake in people with fluid retention, and high protein intake when there is depletion of muscle mass are important considerations.4

 

In late-stage cirrhosis, liver transplantation can be a life-saving procedure.6 You can learn more about liver transplant at the Transplant Australia website. Liver transplantation is not necessary for everyone with cirrhosis, and this procedure may not always be appropriate depending on individual circumstances.4,6 Your doctor can discuss this with you in more detail.

 

 [SIS1]Cancer Council is currently updating its information book on primary liver cancer and will be able to link to that – I just reviewed it and worthwhile. They list Liver Foundation in useful websites.

 [AB2]Dr Strasser to please let us know when this becomes available to the public

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