The liver performs many vital functions in the body. Its main task is to detoxify the body. For example, it breaks down alcohol, nicotine, and medication residues. It also removes dead cells and pathogens from the bloodstream.
The liver produces:
- Hormones
- Proteins
- bile, and
- Cholesterol
The liver stores:
It also plays a role in fat, sugar, and protein metabolism. In cases of liver cirrhosis, the liver can no longer perform these functions.
If a doctor fails to diagnose liver cirrhosis in time, the patient’s life expectancy decreases drastically. If left untreated, it always leads to death from acute liver failure. Approximately 250 out of every 100,000 people develop cirrhosis of the liver each year. However, health experts estimate that the actual number of cases is significantly higher.
Therefore, every patient should have their liver checked at regular intervals by a gastroenterologist or hepatologist. This also includes a liver function test.
Illustration of a liver with cirrhosis © SciePro | AdobeStock
The main causes of cirrhosis of the liver include:
The following conditions can also lead to liver cirrhosis:
- Fatty liver disease—often accompanied by diabetes
- Wilson’s disease (a copper storage disorder) or
- Autoimmune hepatitis
However, this is much less common.
In cirrhosis, the liver converts functional liver cells into scarred connective tissue that the body cannot use.
This scar tissue significantly impairs the organ’s function. Eventually, the liver can no longer fulfill its role as the body’s central storage organ.
Alcohol-Related Cirrhosis
Long-term alcohol abuse leads to the accumulation of toxins in the liver. The organ becomes fatty as it stores large amounts of fat over the years.
At this stage, the patient (if they stop drinking alcohol) can still be effectively treated. The pathological tissue changes can still be halted. If this does not happen, the fatty liver cells die off and shrink. They form scar tissue, leading to liver fibrosis.
At this stage of ethyl-toxic, alcohol-induced cirrhosis, the disease progresses inexorably. Women generally tolerate less alcohol than men. They have a higher risk of developing cirrhosis than men if they consume the same amount of alcohol daily.
Viral Hepatitis
A liver infected with the hepatitis B, C, or D virus can also lead to liver cirrhosis.
People are generally at higher risk of developing cirrhosis if they:
- who work in the medical field
- who frequently travel abroad, or
- whose partner has hepatitis
Other causes of liver cirrhosis include:
- Autoimmune hepatitis (liver inflammation caused by an excessive immune system response)
- Certain tropical diseases
- Certain metabolic disorders, such as cystic fibrosis
- Heart failure
- Medications
- Toxins
In its early stages, liver cirrhosis presents with nonspecific symptoms. It progresses through several stages (Child 1–3). In the end stage, life expectancy is very low.
Signs of liver cirrhosis include:
- Drowsiness
- Itching (pruritus)
- Loss of appetite
- Nausea
- Confusion
- Weight loss
- Constipation
- Bloating
- Fullness in the upper abdomen
- Yellowing of the skin and the whites of the eyes
- Bad breath
- Tendency to bruise
- Slower blood clotting
- Increased susceptibility to infections
- Opaque fingernails (milky discoloration)
- In women: irregular menstrual periods
- In men: erectile dysfunction
- Ascites: The lower abdomen becomes significantly enlarged as excess fluid leaks from the blood vessels into the abdominal cavity
- Hepatic encephalopathy (a brain disorder resulting from the inadequate breakdown of toxins)
- Esophageal varices (varicose veins in the esophagus that can easily rupture)
- Hepatocellular carcinoma (HCC)
- Hepatic coma
During the physical examination, the examining physician palpates the patient’s spleen and liver to check for possible changes in size. He taps the patient’s abdomen to determine whether fluid has already accumulated in the abdominal cavity.
Then they check the skin for signs of liver disease, such as spider naevi. These are clearly visible, spider-like dilations of capillaries beneath the skin’s surface.
They usually appear on the face or above the chest. In addition, the patient’s skin may appear yellowish, and the palms of the hands and soles of the feet may be reddened.
Location of the liver in the human body © yodiyim | Adobe Stock
A blood test showing the following is also a clear indication of liver cirrhosis:
- Elevated albumin levels
- Elevated cholinesterase levels
- Low levels of coagulation factors II, VII, IX, and X (Quick test)
- Elevated liver enzyme levels
Using imaging techniques such as ultrasound, the doctor determines the size of the liver and its condition. The doctor measures the progression of the disease using an ultrasound Fibroscan, which helps determine the degree of tissue remodeling. Computed tomography (CT) or magnetic resonance imaging (MRI) may be used as supplementary tests in some cases.
However, the patient will not have definitive certainty until the biopsy results are available. This involves the examination of a tissue sample taken from the liver.
Liver cirrhosis can only be halted if the underlying disease is treated optimally.
Treatment is particularly effective when the disease is still in its early stages. However, the damaged organ cannot regenerate liver cells that have already been destroyed.
Treatment for liver cirrhosis is:
- causally (based on the causes) and
- simultaneously symptomatic (based on the symptoms)
The more successful the treatment of the underlying disease is, the higher the life expectancy of patients with liver disease. In addition, the patient’s remaining life expectancy depends on how advanced the underlying disease is.
First and foremost, the patient must avoid all contributing factors. Alcoholics undergo detoxification. Smokers quit smoking to avoid causing further damage to the liver. If necessary, the use of medications that impair liver function must be reduced.
In later stages of cirrhosis, a liver transplant is often the only option. However, this does not apply to patients with alcohol dependence. The symptoms of cirrhosis also require appropriate treatment. Doctors treat ascites with medication and paracentesis.
In cases of viral hepatitis, the patient is given antiviral medications.
If the patient has autoimmune hepatitis, the doctor prescribes medications that suppress the immune system. If the Quick values are too low, doctors reduce the increased risk of bleeding by administering vitamin K.
Patients suffering from a shrunken liver must follow a liver-friendly diet.
This diet contains a large amount of protein and other important nutrients. Patients consume about 1.5 grams of protein per kilogram of body weight daily, unless they have hepatic encephalopathy.
What is the most common cause of liver cirrhosis?
The most common cause of liver cirrhosis is chronic alcohol-related liver damage. Chronic hepatitis B, viral hepatitis, or non-alcoholic fatty liver disease can also lead to liver cirrhosis. Less commonly, autoimmune hepatitis or Wilson’s disease are responsible.
What are the symptoms of liver cirrhosis?
Initial symptoms of liver cirrhosis are nonspecific, such as fatigue. In advanced stages, typical symptoms such as yellowing of the skin, ascites, spider naevi, or hepatic encephalopathy may occur. Hepatic encephalopathy is caused by elevated ammonia levels and can lead to confusion.
What complications can liver cirrhosis cause?
Complications of liver cirrhosis include ascites, portal hypertension, bacterial infections such as peritonitis, or severe bleeding. There is also an increased risk of HCC and liver cancer. Decompensated liver cirrhosis carries a risk of liver failure.
How is the prognosis for liver cirrhosis assessed?
The prognosis is assessed based on disease stages, the Child-Pugh score, and the MELD score. Parameters such as bilirubin, coagulation factors, and ascites are taken into account. Child A describes a liver that is still relatively functional, while higher stages are associated with reduced life expectancy.
When is a liver transplant necessary?
In cases of advanced liver cirrhosis or when complications such as hepatic encephalopathy, ascites, or bleeding cannot be controlled, a liver transplant is considered. It represents the only definitive treatment in the end-stage of liver cirrhosis. However, consistent treatment of the underlying disease can often slow its progression.
