Liver Cirrhosis: Symptoms, Stages, Diagnosis, and Treatment

1. Dr. Punit Singla Liver Transplant and GI SurgeonMBBS, MS, DNB (Surgical gastroenterology)

3. About Liver Cirrhosis

4. What is Liver Cirrhosis? Liver cirrhosis is a chronic liver disease, in which scar tissues develop on the liver surface and prevent normal functioning. It disrupts blood flow and slows the ability of the liver to process nutrients, hormones, and toxins. Cirrhosis can be life-threatening because of irreversible scarring. The symptoms can be none to very mild in an early stage. But as the disease progresses over time, there is an accumulation of fibrous scar tissue that replaces the healthy liver tissue. Regenerative nodules may also form as the liver tries to heal itself. Cirrhosis can be seen in the advanced stages of Non- alcoholic fatty liver disease and various other conditions which lead to liver damage. Mostly the scarring caused by Cirrhosis cannot be reversed, but proper treatment can help keep it under check. Hepatitis B & C, long-term alcohol abuse, excess of toxic substances like copper or iron in the liver, etc. can be other causes apart from NAFLD.

5. Symptoms & Signs of Liver Cirrhosis • Itchy skin • Abdominal swelling • Swelling in legs • Fatigue • Weight loss • Nausea, vomiting • Enlarged or swollen veins • Jaundice (yellowing of the eyes and skin) • Ascites (an abnormal collection of fluid in the tummy)

6. Stages of Cirrhosis of the Liver • Depending on how well the liver is functioning, there are two stages the symptoms of Cirrhosis fall into: compensated and decompensated cirrhosis. The course of treatment depends on the stage a person is in. • Compensated Cirrhosis: there are no noticeable signs of liver disease and no major abnormality in the blood tests. There can be a few features of chronic liver disease in radiological investigations and liver Biopsies. • Decompensated Cirrhosis: The symptoms and signs of chronic liver disease are very noticeable, with worsening of blood investigations with obvious features of CLD and worsening in radiological tests and biopsy (not routinely recommended). The chances of at least one life-threatening complication are higher in decompensated patients and need immediate medical attention. Survival in such patients with decompensated cirrhosis is approximately 6-12 months.

7. Diagnosis:- • Your doctor will ask you to undergo various tests and physical examinations looking at your past medical history. You may have tests such as: • Blood tests: These include tests to check if your blood is able to clot and liver function tests to determine the proper functioning of the liver. • Liver Biopsy: To find out the type of liver disease, small samples are taken from your liver with a needle and accessed under amicroscope. • Complete blood count for anemia • You might have to undergo various imaging tests as advised by your doctor. Namely: • Abdominal computed tomography (CT) scan • Abdominal ultrasound • Elastography • Magnetic resonance imaging (MRI) • If the diagnostic tests suggest that you have been suffering from Liver Cirrhosis your doctor may suggest a treatment planwith various options to slow down the progression of scar tissue buildupand prevention/treatmentof any other health issue. Cirrhosis is a progressive disease, so the liver damage can sometimes reverse or improve if whatever is trigging it is gone.

8. Treatment Lifestyle modifications:Changingyour lifestyle can not cure cirrhosis completely, but can definitely stop it from getting worse. Dietary changes must be made, including cutting back on calories and avoiding fast food, soda, and big meals. You may detox your body by drinking lots of fluids, enjoying healthy snacks, including enough fruits and vegetables in your diet, avoiding drinking too much alcohol, and engaging in daily exercise. Following the doctor’s recommendations for eating wholesome foods and boosting physical activity is crucial. Diuretics: It boosts urine production, which further aids in eliminating any excess water and salt content. Ammonia Reducer: It aids in lowering the body’s ammonia levels and stabilizes its effects. Beta Blocker: Beta blockers can help reduce the pressure on the eyes when used as eye drops. It even helps in bringing down the patient’s heart rate and blood pressure. Antibiotics and Antiviral Drugs: By destroying the bacteria and blocking their replication and multiplication, they aid in stopping their growth. But if Cirrhosis has reached a point where treatment is not enough, the patient has to go through a transplant.

9. Prevention • Do not abuse alcohol. Limit drinking to 2 drinks for men or 1 drink for women. No drinking of alcoholin presence of any liver disease. • Eating a well-balanced, healthy, low-fat diet • Maintain body weight • Regular exercise • Avoid high-risk behaviors(IV drug abuse and multiple sex partners), that can lead toinfectionwith hepatitis • Get vaccinations for HepatitisB & C

10. Thank You