The significant scarring and irreparable harm to the liver tissue characterizes the chronic, progressive liver disease known as cirrhosis. It is a significant global health issue and the main global cause of illness and mortality. Chronic alcohol misuse, viral hepatitis, fatty liver disease, autoimmune illnesses, and specific genetic problems are just a few of the causes that contribute to the development of the ailment.
During cirrhosis, the liver, a crucial organ in charge of detoxification, metabolism, and the production of necessary proteins, goes through a number of intricate alterations. The liver’s normal shape and function are hampered as healthy liver cells are gradually replaced by scar tissue. Serious side effects such as portal hypertension, liver failure, and a higher chance of developing liver cancer might result from this impairment.
People who have cirrhosis frequently have no symptoms until the condition has evolved to a severe degree. Fatigue, jaundice, abdominal pain, swelling of the legs, and bleeding or bruising easily are just a few of the symptoms that may appear once they do. To stop the progression of the disease and enhance patient outcomes, prompt diagnosis, and adequate care are essential.
The causes, risk factors, and underlying mechanisms of cirrhosis will all be covered in this article. We shall examine the several types of cirrhosis, such as cirrhosis brought on by alcohol, cirrhosis brought on by viral hepatitis, and cirrhosis brought on by non-alcoholic fatty liver disease. In addition, we’ll go over the various diagnostic methods, accessible therapies, and possible preventative measures that can be used to lessen the effects of cirrhosis.
Causes of Cirrhosis:
- Chronic Alcohol Abuse: Heavy and persistent alcohol usage is a major contributor to cirrhosis. Alcohol causes liver damage when it cannot be effectively metabolized by the liver, causing inflammation, fatty liver, and finally scarring.
- Viral hepatitis: Cirrhosis can develop as a result of chronic viral infections, particularly hepatitis B and C. When these viruses target liver cells, it results in swelling and gradual liver damage over time.
- Non-Alcoholic Fatty Liver Disease (NAFLD): The accumulation of fat in the liver in people who do not drink too much alcohol is referred to as NAFLD. NAFLD can eventually lead to cirrhosis, inflammation, and non-alcoholic steatohepatitis (NASH).
- Autoimmune Liver Diseases: A number of liver diseases, including autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis, are caused by the body’s immune system wrongly attacking the liver, which results in cirrhosis and chronic inflammation.
- Genetic and metabolic disorders: A number of hereditary conditions, including hemochromatosis (excessive iron buildup), Wilson’s disease (copper buildup), alpha-1 antitrypsin deficiency, and diseases of the glycogen storage system, can result in cirrhosis.
- Chronic Bile Duct Obstruction: Long-term obstruction of the bile ducts, whether from tumors, gallstones, or other disorders, can result in cirrhosis and liver damage.
- Long-term use of several medications, including some antibiotics, antivirals, nonsteroidal anti-inflammatory drugs (NSAIDs), and some herbal supplements, can damage the liver and, in some cases, proceed to cirrhosis.
- Other Causes: Other conditions including alpha-1 antitrypsin deficiency and rare disorders like severe heart failure and congestive hepatopathy, as well as prolonged exposure to environmental pollutants like specific chemicals or heavy metals, may cause cirrhosis.
Effects of Cirrhosis
- Cirrhosis interferes with the liver’s capacity to carry out its fundamental tasks. The production of bile for digestion, food metabolism, protein synthesis, and detoxification are all vital functions of the liver. These activities are hampered by cirrhosis, which causes an accumulation of toxins in the body and disruptions to a number of metabolic processes.
- The primary blood channel that carries blood from the intestines to the liver, the portal vein, experiences an increase in blood pressure due to cirrhosis. This condition is known as portal hypertension. Portal hypertension is a disorder that causes the development of collateral blood vessels and can have dangerous side effects like ascites (an accumulation of fluid in the abdomen) and variceal hemorrhage (rupture of dilated veins in the esophagus or stomach).
- Ascites: As cirrhosis worsens, fluid may collect in the abdominal cavity, resulting in abdominal discomfort and edema. Increased strain on other organs, weight gain, and shortness of breath are all symptoms of ascites that can cause further issues.
- Toxins, including ammonia, can build up in the bloodstream and make their way to the brain in cases of hepatic encephalopathy, where the liver is unable to effectively metabolize chemicals. Hepatic encephalopathy, which can cause cognitive decline, confusion, personality changes, and in severe cases, coma, is a disorder that can result from this.
- Various clotting factors required for blood coagulation are produced by the liver, which causes coagulation disorders. The liver’s capacity to make these substances is impaired in cirrhosis, which causes irregularities in blood clotting. External and internal bleeding as well as easy bruising may arise from this.
- Increased Susceptibility to Infections: People with cirrhosis have immune systems that are less healthy, which increases their susceptibility to infections. In advanced cirrhosis, bacterial infections are frequent and can cause life-threatening consequences, including spontaneous bacterial peritonitis (infection of the ascitic fluid).
- Liver cancer, also known as hepatocellular carcinoma, is a serious health concern that is significantly increased by cirrhosis. The chance of malignant cell transformation and tumor formation is increased by persistent liver inflammation and injury.
- Nutritional deficits: Cirrhosis patients who have poor food absorption, low appetite, and altered metabolism may experience nutritional deficits. This may lead to a loss of weight, muscle atrophy, weariness, and weakness.
- Impact on Other Organs: Beyond just the liver, advanced cirrhosis can have a systemic impact on a number of other organs. It may have an impact on the kidneys, resulting in fluid imbalances and decreased renal function. Cirrhosis can also lead to hormonal abnormalities, which can result in issues including gynecomastia (enlarged breast tissue in men) and feminization in men as well as irregular menstruation in women.
Symptoms of Cirrhosis
- Fatigue and Weakness: Cirrhosis is frequently accompanied by fatigue and a general sense of weakness. The metabolism of energy is impacted by the liver’s dysfunction, which can cause fatigue to linger over time.
- Jaundice: When a person gets jaundice, their eyes and skin turn yellow. The yellow pigment created when red blood cells are broken down, bilirubin, cannot be effectively processed by the liver, which causes it to happen.
- Appetite Loss and Weight Loss: As cirrhosis worsens, some people may lose their appetite and unintentionally lose weight. Inadequate nutritional absorption and excessive hepatic energy consumption can lead to malnutrition.
- Cirrhosis can result in fluid buildup in the abdominal cavity, which can induce ascites and cause discomfort and abdominal enlargement. The ascites condition is brought on by an increase in portal vein pressure.
- Edema, or fluid retention in the lower extremities, is a common cirrhosis symptom that causes swelling in the legs and ankles. Leg, ankle, and foot swelling is how it often shows up.
- Easy Bleeding and Bruising: Cirrhosis can interfere with the generation of clotting factors, which impairs blood clotting. As a result, there may be frequent bruising, extensive bleeding, and the emergence of spider angiomas, which are tiny, red patches on the skin.
- Itchy Skin: Toxins may accumulate in the bloodstream due to the reduced liver function associated with cirrhosis. As a result, there may be severe and prolonged itching or pruritus.
- Hepatic encephalopathy, a disorder marked by cognitive impairment, confusion, personality changes, and in severe cases, coma, is a side effect of advanced cirrhosis that can cause these symptoms. Toxins like ammonia that build up in the brain are to blame for this.
- Blood Vessels that Look Like Spiders: Spider angiomas are tiny, dilated blood vessels that appear close to the skin’s surface. They can be a visible symptom of liver illness and have a central red spot with radiating spider-like branches.
Natural remedies for Cirrhosis
- Milk Thistle: Milk thistle, also known as Silybum marianum, is a common herb used to assist the liver. It contains a substance called silymarin, which has anti-inflammatory and antioxidant qualities. In certain liver illnesses, such as cirrhosis, milk thistle may help improve liver function and reduce inflammation, according to some research. To prove its usefulness, more research is necessary.
- Dandelion Root: Dandelion root, or Taraxacum officinale, has a long history of use in liver health support. It might possess diuretic qualities that can aid in lowering fluid retention brought on by cirrhosis. Dandelion root is offered as a tea, dietary supplement, or as a component of a salad or herbal concoction.
- Curcumin, a substance found in turmeric (Curcuma longa), is recognized for its anti-inflammatory and antioxidant properties. Curcumin may help lessen liver fibrosis and inflammation, according to several research. It may be advantageous to consume curcumin supplements or add turmeric to your diet, but it’s critical to ensure good absorption by mixing it with black pepper or using liposomal formulations.
- Ginger: Since ancient times, ginger (Zingiber officinale) has been used for its therapeutic benefits. It has antioxidant and anti-inflammatory effects that might aid in liver protection. Ginger can be used in a variety of foods and recipes or drunk as tea.
- Green Tea: Green tea contains several antioxidants and may protect the liver. It has been investigated for its capacity to lessen liver inflammation and fat buildup in specific liver disorders. Two to three cups of green tea a day may be useful, but if you are sensitive to caffeine or take blood thinners, you should limit your intake.
- Mediterranean Diet: Adopting a nutritious and well-balanced diet, like the Mediterranean diet, can help to maintain liver health in general. Fruits, vegetables, whole grains, lean proteins, and heart-healthy fats like olive oil are prioritized in this diet. It encourages a diet high in nutrients while avoiding overindulging in processed foods, alcohol, and saturated fats.
- frequent Physical Activity: People with cirrhosis can benefit in a variety of ways from regular physical activity. Maintaining a healthy weight, boosting energy levels, and improving general well-being can all be facilitated by exercise. But it’s important to speak with a medical expert before beginning an exercise program so they can advise you depending on your unique health situation and any restrictions.
Treatment options for Cirrhosis
- Modifications to the way you live: Changing certain aspects of your way of life can help you manage cirrhosis and stop the disease’s progression. To lower the risk of infections, these include abstaining from alcohol, eating healthily, exercising frequently, and keeping proper cleanliness.
- The management of particular cirrhosis symptoms and complications may involve the use of a number of drugs. These might include diuretics to treat fluid retention (ascites) and drugs to lower blood pressure (ACE inhibitors or beta-blockers). Antiviral drugs may be used to treat viral hepatitis in order to stop the underlying infection.
- Nutritional Support: Proper nutrition and a balanced diet are essential for managing cirrhosis. A healthcare provider or nutritionist may advise dietary changes, oral supplements, or, in extreme circumstances, enteral or parenteral nutrition to ensure appropriate nutritional intake in cases of advanced malnutrition.
- Complications caused by cirrhosis may result in a number of different issues that call for unique care. For instance, in cases of severe ascites, treatments like paracentesis may be carried out to drain extra fluid from the belly. To treat and stop bleeding from esophageal varices, band ligation or sclerotherapy may be utilized. In addition, hepatic encephalopathy can be treated with medicine, and infections can be treated with antibiotics.
- Liver Transplantation: When cirrhosis or liver failure is advanced, liver transplantation may be an option. This entails swapping out the sick liver for a donor’s healthy liver. A thorough evaluation is necessary to establish eligibility and fitness for a liver transplant because it is a significant surgical procedure.
- Supportive care is essential to address the psychological, emotional, and social effects of the disease because cirrhosis can have a major impact on quality of life. Comfort levels and general well-being can be raised with the use of palliative care and symptom control techniques.
*Disclaimer: This article is for informational purposes only and should not substitute professional medical advice. Please consult a healthcare professional for a thorough evaluation of your symptoms and appropriate treatment.
Author Contribution: Reviewed by Dr. Ram Reddy, MD – General Physician, and Rajeshwar Rao, Pharm D.