Cirrhosis is one of the end stage liver diseases in which there is irreversible loss of liver tissue and scarring of the liver resulting into permanent impairment of liver function. The most common causes associated with cirrhosis are prolonged alcoholism and following infection with hepatitis B and hepatitis C virus.
Common presenting symptoms include loss of appetite, weakness, jaundice, increased bleeding tendency, easy bruising of the skin, bone loss leading to fracture, swelling of the abdomen due to collection of fluid (ascites), generalized swelling of the body (oedema), etc. Cirrhosis may lead to several complications like hepatic encephalopathy characterized by mental confusion, clouding of consciousness, coma, liver cancer impaired kidney function (hepatorenal syndrome), impaired lung function (hepatopulmonary syndrome).
Treatment options include treatment of underlying cause, if diagnosed and management of complications to improve quality of life. Liver transplantation is advised in advanced stages of the disease.
The goal of treatment of cirrhosis is to halt or slow the progression of the disease (scar tissue formation), management of complications and treatment of symptoms. Hospitalization may be required in severe cases.
Treatment options to slow progression of the disease include
1. Quitting alcohol, if required professional help should be sought.
2. Maintaining body weight within normal limits along with maintenance of normal blood sugar is important especially in people suffering from nonalcoholic non alcoholic steatohepatitis (NASH).
3. Drugs are available to manage patients suffering from viral hepatitis (hepatitis B and hepatitis C).
4. Patients of primary biliary cirrhosis may not experience symptoms if diagnosed early and treated adequately from early stage.
Treatment options for management of complications include
1. Fluid accumulation in the abdominal cavity (ascites) and in the whole body: can be managed with low sodium diet, restricted water intake and drugs which facilitate fluid removal like diuretics
2. Portal hypertension and subsequent bleeding from the esophageal varices can be managed by regular upper GI endoscopy. Drugs are prescribed to prevent bleeding. certain surgical procedure like band ligation of the varices and placement of transjugular intrahepatic prtosystemic shunt (TIPS)in the portal veins may also help.
3. Extensive treatment with antibiotics help to manage the attacks of infection
4. Hepatic encephalopathy can be prevented by drugs which help to prevent the accumulation of toxic substances in the blood.
5. Regular ultrasound of the abdomen and blood tests helps to detect liver cancer, if any at an early stage when with proper treatment patient have increased chance of cure.
For advanced stage of cirrhosis, liver transplant is the only option. Liver transplant is obtained from either a deceased donor or from a healthy donor (here part of liver is obtained from the healthy donor).
Common preventive measures include
1. Moderate drinking of alcohol. It means one drink a day for women and men above 65 years of age and up to two drinks for men below 65 years.
2. Eating vegetable based diet rich in fruits
3. Maintaining healthy body weight
4. The risk of suffering from hepatitis (both B and C) can be reduced by avoiding needle share, unprotected sex, using proper precautions while using blood and other body fluid especially in health care personnel etc.