What is cirrhosis? What are the symptoms and treatment methods?

The liver is the only organ in the body that can renew itself. Cirrhosis, which is a progressive and irreversible disease in the liver, can lead to inability of this organ to perform its functions and a picture of insufficiency. It is very important that it is treated without wasting time. Specialists of Gastroenterology Department of Memorial Health Group gave information about cirrhosis.

WHAT IS CIRRHOSIS?

Cirrhosis is a dangerous disease that occurs in the liver. Damage can occur in the liver due to various causes. As a result of their continuity, structural changes develop in the liver. Structure of the liver deteriorates and there is an increasing development of scar tissue. As the disease progresses, number of functional liver cells decreases. The liver becomes hard. Resistance to the blood that must pass through it increases. When the blood cannot flow out of here, intravascular pressure increases on the areas where the blood comes from (intestines, spleen), and the blood tries to find other ways for itself. As a result of all this, liver function gradually deteriorates, and signs of liver failure appear.

WHAT ARE THE SYMPTOMS OF CIRRHOSIS OF THE LIVER?

Cirrhosis is a long-term disease and has progressive character. In early stages, the signs may be very mild. As the damage in the liver increases, the symptoms become more severe. The most common symptoms at early stage are loss of appetite, weight loss, nausea, weakness, and rapid fatigue. In later periods, these findings become more severe. During this process, water accumulation in the body, edema in the legs, swelling in the abdomen, muscle atrophy, rapid bruising on the skin, tendency to bleeding, excessive itching, jaundice, and temporary changes in consciousness are observed.

WHAT CAUSES CIRRHOSIS OF THE LIVER?

The liver is, in a sense, the body's factory. All the foods taken are used in the liver to make useful and necessary products for the body. One of the tasks of albumin, which is one of them, is to retain liquids inside of vascular bed. When liver function is impaired, albumin synthesis (production) is also affected. When albumin level reduces, fluids cannot be retained inside of vascular bed and leak between the tissues. This occurs in the form of swelling (edema) of the legs at the earliest. By the same mechanism, fluid also accumulates in abdominal cavity (ascites). Abdomen swells. With the slightest impact in these patients, bruises may form on the skin or tendency to bleeding increases. This is due to the fact that the substances necessary for coagulation (coagulation factors) cannot be produced due to damage to the liver. Again, as a result of inability of the liver to function, some substances accumulate in the blood, and severe itching and changes in consciousness (encephalopathy) may occur. Certain behaviors and situations that occur intentionally or unconsciously can cause serious liver damage. These behaviors can be listed as follows:

• Using medication without a physician's recommendation: Many medications and herbal products can potentially lead to destructive effect. Use of unprescribed analgesics, antirheumatic medications, antibiotics, and vitamin preparations enriched with herbal products without a physician's recommendation can create a picture of toxic hepatitis and severe cases of liver failure that which may sometimes require a liver transplantation. Herbal products sold in seller of medicinal herbs, exposure to certain chemicals used in industry can have toxic effects on the liver that can even lead to death.
• Obesity: Healthy diet, adequate physical activity and weight control are very important for our entire body as well as for the liver. It is necessary to reduce the consumption of fats, sugars and carbohydrates with a regular nutrition plan including regular meal, and to increase consumption of vegetables and fruits rich in vitamins and minerals, and to minimize the consumption of packaged catering foods. Heavy alcohol consumption is the cause of acute or chronic liver disease.
• Hepatitis: Hepatitis A, hepatitis B and C viruses settle in the liver and cause infection. Hepatitis A virus is transmitted from sick people to the environment by fecal route and infect with contaminated water and hands orally. Toilet and hand cleaning are very important for protection. Hepatitis A is an infection that does not become chronic when recovery is achieved, while hepatitis B and hepatitis C infections can become chronic. Chronic infection can range from a quiet and uncomplicated condition to significant liver damage that we call cirrhosis of the liver. This means that there may be people around us who look healthy but carry hepatitis B or C viruses in their blood and have potential to transmit it.

HOW IS CIRRHOSIS OF THE LIVER DIAGNOSED?

Cirrhosis is a disease that is diagnosed by the patient at a late stage. Water accumulation in the abdomen, jaundice, atrophy in the muscles of the hands begins. This is how the patient can understand that he/she has cirrhosis. Diagnosis can be made by the physician with various blood tests. It should be questioned whether the patient drinks alcohol and had viral hepatitis. In addition, physical examination is important in the diagnosis of cirrhosis. In patients with cirrhosis, liver stiffness, enlargement, accumulation of fluid in the abdomen can be diagnosed manually. On physical examination, jaundice, edema, and bruising also draw attention. Laboratory analyzes, ultrasonography and other methods of imaging are also used for diagnosis. Cirrhosis is also diagnosed with these tests. In some patients, liver biopsy may also be required.

HOW IS CIRRHOSIS OF THE LIVER TREATED?

After cirrhosis has developed, it is not possible to reverse it with classical treatments. Although its duration cannot be estimated, the situation ends with liver failure. The only known treatment of the disease at this stage is liver transplantation. Liver transplantation is performed by taking liver part (liver transplantation form living donor) that will not endanger the life of the donor and will be sufficient size for the recipient to live or from the person who had donated an organ previously or whose cerebral death occurred (cadaveric transplant). When a liver transplantation is to be performed from a living person, detailed examinations are performed before liver transplantation surgery by prioritizing health of both the recipient and the donor. After it is decided that he/she is suitable for transplantation, the day of surgery is decided. Living donor and recipient undergo surgery at the same time in separate operating rooms; operation is carried out by taking a piece from healthy liver in other room while diseased liver is removed in one room. Duration of liver transplantation surgery is long and can last 8-18 hours. Therefore, it is extremely important that it is performed by an experienced team. After liver transplantation, patients are taken to intensive care in separate rooms. Donor patient can be discharged after several days of treatment after surgery. Recipient patient is treated in intensive care until he/she fulfills his/her vital functions. All patients who have undergone organ transplantation are prescribed immunosuppressive medications as well as general treatment (medications that suppress the immune system should be used during whole life). After the patient adapts to new lifestyle, he/she is discharged.

FREQUENTLY ASKED QUESTIONS ABOUT CIRRHOSIS 

Can children also have cirrhosis?

Due to certain anomalies from birth and some hereditary diseases, cirrhosis of the liver can develop from the age of several months. One of the most common causes of this is biliary atresia that is a congenital insufficiency or absence of bile ducts.

What is the most common cause of cirrhosis?
The events that cause cirrhosis are very diverse. The most common causes include chronic liver diseases associated with hepatitis B and C, alcohol abuse, and fatty liver disease.

Does the infection cause cirrhosis?
Hepatitis A and B viruses have vaccines, but there is no vaccine for hepatitis C. Cirrhosis is not expected to develop in hepatitis A. People especially who have family members with Hepatitis B virus must be tested, and it is recommended to vaccinate those, who do not have immunity, with hepatitis B vaccine. Infection occurs by contact with blood and blood products or sexually. Properly disinfected disposable medical supplies and medical devices prevents the risk of medically transmission of diseases. Jointly use of the tools such as razor blade and nail trimmer contacting the blood with those carrying disease within the house, or processes such as manicure, pedicure and skin care that are carried out with tools which are used in many people and are not properly disinfected. It is even better to carefully select the places where these services are provided, and it is most correct to take necessary service by taking your own care materials.

What happens in later stages of cirrhosis?
Increasingly deteriorating metabolism in the liver affects bile production. Jaundice is added to the table. Due to the substances accumulated in the blood (especially protein substances), the brain is affected. Tendency to sleep, forgetfulness, concentration disorders develop. If these patients do not restrict protein substances such as meat and milk, severe tables leading to loss of consciousness may develop. As a result of inability of blood to pass comfortably through the liver, the pressure increases in the veins that bring blood here (portal hypertension). Therefore, pressure also increases in the spleen, and the spleen grows (splenomegaly). Growing spleen degrades shaped elements of the blood. Result of this, anemia (anemia) develops due to excessive degradation of red blood cells, and leukopenia develops due to excessive degradation of white blood cells (leukocytes), thrombopenia develops due to excessive degradation of platelets (cells involved in clotting). Due to this, bleeding disorders occur. The blood finds new ways to return to the heart and join circulation again. The most clinically significant of those are capillaries located in inner wall of the esophagus (esophagus). These veins, under pressure, expand excessively, swell and form bubbles. We call this formation of varicosis. Thy are important because they are ruptured by various mechanisms and cause serious fatal bleeding into digestive system (esophagus and stomach) due to their high pressure. Another increased risk in the patients with cirrhosis is development of liver cancer. In addition to cancer-causing effect of cirrhosis alone, liver cancer can also develop with the direct effect of diseases that cause cirrhosis.

Can cirrhosis be prevented?

It is unlikely to reverse structural changes that have occurred in the liver. However, it may be possible to stop or delay the progression of cirrhosis via various treatments. Main point is to identify and struggle the events that can lead to cirrhosis (such as alcohol consumption, hepatitis, some hereditary diseases, obesity) at an early stage. For example, if the cause of cirrhosis is excessive consumption of alcohol, the progression of the disease may stop with discontinuation of alcohol. Hepatitis can be tackled with medications.

Can swelling of the legs (edema) and abdominal fluid (ascites) be reduced?
Swelling of the legs (edema), abdominal fluid collection (ascites) can be tackled with the help of a special diet prescribed by your physician and some diuretics (diuretics). But these medications must necessarily be taken under the supervision of a physician. Some imbalances that may develop due to them can lead to an ingravescence of the disease. Again, special diets and certain medications that will clean the intestines should be used for changes of consciousness that develop due to substances accumulating in the blood due to the loss of liver function.

Is there a treatment for bleeding into the digestive system (varicose bleeding)?
Severe digestive system bleeding (varicose veins) can be stopped with special techniques that can be applied with a special tube (endoscope) that is swallowed orally. By injecting special drugs into these varicose veins, they can be dried (sclerotherapy) or rubber bands can be placed on them (band ligation). Despite these, surgical intervention may be required for bleeding that do not stop or recur. These operations must necessarily be performed by a surgeon who is experienced in these matters. Purpose of surgery is to reduce the pressure, that rises in these veins as a result of inability of blood to flow from the liver due to cirrhosis, with new vascular pathways that will be opened (shunt). Thus, bleeding stops, or its recurrence is prevented.

How should a cirrhosis patient be fed?

Energy requirement of cirrhosis patients is 50% higher than healthy people. While healthy adult should receive 1500-2000 calories per day, adults with cirrhosis should receive 2300-3000 calories. Half of liver patient's daily energy should be calculated from simple and compound glucose called carbohydrates, one third from fats, and the rest from proteins. Water and salt should be applied in cases of abdominal fluid accumulation, diffuse swelling, and a decrease in the amount of salt in the blood. These patients should take regular diuretics and have outpatient checkups. Salt consumption should not exceed 1-2 grams. Following list of nutrients is important for cirrhosis of the liver, as well as for all liver diseases.

• Artichoke:It is rich in vitamins A and B. Artichoke, which has a diuretic and antioxidant feature, can slow the progression of liver disease.
• Multivitamin support:Antioxidant and multivitamin preparations can be given to chronic liver patients.
• Bulgur and legumes:Simple sugary foods such as tea sugar, chocolate, honey, jam, acidic drinks should be consumed . Simple sugars cause blood glucose to rise and fall quickly. Instead of them, compound sugary foods, that moderately increase blood sugar and ensure that blood sugar remains at the desired level for a long time, are recommended. In liver patients, foods containing compound sugars such as pasta, bulgur, vegetables, legumes, milk desserts, bulgur pilaf are recommended.
• Packaged foods:Consumption of fast food, packaged store products, sausage, sujuk, salami are among the foods that chronic liver patients should avoid.
• Meat and egg:Meat with the size of an egg is equivalent to one egg and 4 tablespoons of legumes. Nutrition should also be carried out considering these rates of change.
• Dairy products:A cup of milk, a bowl of yogurt, a matchbox of cheese and 2/3 matchbox of kashar cheese are equivalent. On the day when yogurt is consumed, corresponding amount of milk or cheese should be reduced.
• Cereals:Two slices of bread are equivalent to 4 tablespoons of pasta, rice pilaf and bulgur pilaf. Daily balance should be adjusted according to these proportions.

Special nutrition program should be organized for chronic liver patients and especially for cirrhosis patients. Unnecessary restriction of protein and diet of liver patients who have one and a half times the energy and protein requirements compared to healthy individuals can lead to nutritional deficiencies and progression of the disease.

Is cirrhosis of liver a problem that can be solved with herbal treatment?
There is no herbal method of treatment of cirrhosis. Only treatment for cirrhosis is a liver transplantation.

Does alcohol immediately cause cirrhosis?
Alcohol-related cirrhosis occurs over the years. Cirrhosis disease requires permanent damage to liver cells. "Fatty liver" is the earliest stage that occurs in alcoholic liver disease. If the patient stops drinking alcohol at this stage, the liver will heal itself. According to an epidemiological study, every 1 liter increase in alcohol use per population in society can augments prevalence of cirrhosis by 14% in men and 8% in women, regardless of the type of alcohol.

Will all alcoholics also have alcoholic hepatitis and eventually cirrhosis?
No. Although some alcoholics show most of physical and psychological signs of alcoholism and are severely affected, progressive liver damage does not occur. In 10-25% of alcoholics, alcoholic cirrhosis develops over time.

Does alcoholic hepatitis always cause cirrhosis?
No. In general, alcoholic hepatitis takes years to cause cirrhosis by causing developing liver damage. If alcoholic hepatitis is recognized and treated early, cirrhosis is prevented.

Is cirrhosis different from alcoholic hepatitis?
Yes Hepatitis is an inflammation of liver tissue. In cirrhosis, normal liver cells are damaged and replaced by scar tissue. This development hampers many vital important functions of the liver.

What causes cirrhosis?
There are many causes of cirrhosis. Alcohol intake for a long time is one of them. Chronic hepatitis and liver fattening are other important causes. The most common causes in children are biliary atresia occurring as a result of damage of bile ducts, and neonatal hepatitis. In children with these diseases, liver transplantation is usually performed. A number of adult patients who need liver transplantation have primary biliary cholangitis. Although we do not yet know what causes this disease, it is not associated with alcohol consumption in any way. Cirrhosis can also occur due to hereditary disorders of iron and copper metabolism and prolonged exposure to toxins.

What is decompensated liver cirrhosis?
If the patient has abdominal fluid accumulation, loss of consciousness, prominent edema and jaundice, this situation is called decompensated cirrhosis.

What is compensated liver cirrhosis?
If the patient does not have abdominal fluid accumulation, loss of consciousness, prominent edema and jaundice, this situation is defined as compensated liver cirrhosis.

What is life expectancy of cirrhosis of the liver?
Although it varies from patient to patient, cirrhosis of liver is ranked at the 10th among cause of death in the world.

What should cirrhosis patients pay attention to?
In this matter, physicians of Gastroenterology and Hepatology will help patients. Assessment should be performed every 1-3 months in early stage of cirrhosis; assessment should be performed every 1-4 weeks in advanced stage cirrhosis. Liver function should be followed regularly. According to the degree, severity and symptoms of the disease, follow-up periods are also determined by the physician. It is very important to strictly follow all the recommendations of the physician. It is also necessary to eat healthy, avoid excessive physical activity. Exercise should be done as prescribed by the physician. In addition, cirrhosis patient should not randomly take any medication or herbal cure without consulting the physician.

Prepared by the Medical Editorial Board. Our health library contents have been prepared for informational purposes only and with the scientific content on the registration date. For all your questions, concerns, diagnosis or treatment about your health, please consult your doctor or health institution.