Liver Cirrhosis Treatment in Delhi, India

Cirrhosis of the liver is a progressive disease in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properly. The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins. It also slows the production of proteins and other substances made by the liver. It can cause complications such as gastrointestinal bleeding, altered mental health state and fluid in the abdomen.

Usually, there are no symptoms of liver cirrhosis. However, in some cases, individuals may experience the following symptoms:

• Confusion or problems thinking.
• Impotence, loss of interest in sex, and breast development (gynecomastia) in men.
• Loss of appetite.
• Nausea and vomiting.
• Nosebleeds or bleeding gums.
• Pale or clay-colored stools.
• Small, red spider-like blood vessels on the skin.
• Swelling or fluid buildup of the legs  and in the abdomen.
• Vomiting blood or blood in stools.
• Weakness
• Weight loss
• Yellow color in the skin, mucus membranes, or eyes.

Cirrhosis can develop as a consequence of liver damage caused by numerous diseases and health conditions. Some of those causes include:

• Hepatitis B (long-term infection).
• Hepatitis C infection (long-term infection).
• Long-term alcohol abuse.
• Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH).
• Autoimmune inflammation of the liver.
• Disorders of the drainage system of the liver (the biliary system), such as primary biliary cirrhosis and primary sclerosing cholangitis.
• Medications
• Metabolic disorders of iron and copper (hemochromatosis and Wilson's disease).
• Hemochromatosis, a condition that leads to excess iron buildup.
• Wilson’s disease, a condition that leads to accumulation of copper in the liver.
• Cystic Fibrosis

Here are the key risk factors that can increase the likelihood of developing liver cirrhosis:

• Excessive alcohol consumption: Heavy drinking poses a risk factor for the development of cirrhosis.
• Obesity: Being overweight or obese heightens the likelihood of conditions like nonalcoholic fatty liver disease and nonalcoholic steatohepatitis, which can progress to cirrhosis.
• Viral hepatitis: While not everyone with chronic hepatitis will develop cirrhosis, it remains a prominent global contributor to liver disease.

Cirrhosis can lead to a number of complications, some of which can be life-threatening. Here are some common complications of liver cirrhosis:

• Portal Hypertension: Cirrhosis increases blood pressure in the veins that supply the liver, leading to portal hypertension.
• Swelling (Edema and Ascites): Portal hypertension can cause fluid buildup in the legs (oedema) and abdomen (ascites) due to impaired blood flow and reduced protein production by the liver.
• Enlarged Spleen (Splenomegaly): Portal hypertension leads to spleen enlargement, which can reduce blood cell counts and may be an early sign of cirrhosis.
• Bleeding (Varices): Portal hypertension can cause vein enlargement (varices) in the oesophagus or stomach, leading to potentially life-threatening bleeding. Impaired clotting factors can contribute to continued bleeding.
• Infections: Cirrhosis weakens the immune system, making patients more susceptible to infections like bacterial peritonitis, often associated with ascites.
• Malnutrition: Cirrhosis can hinder nutrient processing, resulting in weakness and weight loss.
• Toxin Buildup in the Brain (Hepatic Encephalopathy): A damaged liver struggles to remove toxins from the blood, leading to cognitive issues such as confusion and difficulty concentrating, known as hepatic encephalopathy.
• Jaundice: The liver's reduced ability to clear bilirubin from the blood causes yellowing of the skin, eyes, and dark urine.
• Bone Disease: Cirrhosis can lead to bone loss and an increased risk of fractures.
• Increased Risk of Liver Cancer: Many cirrhosis patients are at a higher risk of developing liver cancer.
• Acute-on-Chronic Liver Failure: In some cases, cirrhosis can progress to acute-on-chronic liver failure, a complex condition that greatly increases the risk of death.

Most individuals in the early stages of liver cirrhosis don't experience noticeable symptoms. Instead, it's commonly identified during routine blood tests or checkup appointments. Usually, liver cirrhosis is diagnosed through a combination of tests that include.

• Laboratory Tests: Blood tests are an important part of diagnosing and assessing the severity of cirrhosis. They can help your doctor check for signs of liver damage and dysfunction, as well as kidney function and hepatitis viruses. Your doctor may also order blood tests to measure your international normalised ratio (INR), which is a measure of how well your blood clots. The results of your blood tests can help your doctor determine the underlying cause of your cirrhosis and develop a treatment plan.
• Imaging Tests: Noninvasive tests like transient elastography or magnetic resonance elastography (MRE) look for liver stiffness. Additional imaging methods like MRI, CT, and ultrasound may also be employed.
• Biopsy (if needed): While not always necessary, a biopsy may provide insight into liver damage severity and its root causes.

Treating the Underlying Causes

Treating the underlying causes can help minimise damage to the liver in the early cirrhosis stage. Here are some of the treatment options a liver specialist may suggest.

• Alcohol Dependency Treatment: Those with alcohol-related cirrhosis should cease drinking, and if needed, seek alcohol addiction treatment due to the liver's sensitivity to any alcohol.
• Weight Management: Addressing nonalcoholic fatty liver disease-related cirrhosis may involve weight loss and blood sugar control for improved health.
• Hepatitis Medications: Specific antiviral drugs can be used to manage hepatitis B or C infections, reducing liver cell damage.
• Medications for Cirrhosis Management: Certain medications may slow the progression of various liver cirrhosis types, such as primary biliary cholangitis, when detected early.

Treating the Complications of Liver Cirrhosis

Cirrhosis is a serious condition that can lead to a number of complications. Healthcare providers will work with patients to treat any complications that develop.

One of the most common complications of cirrhosis is ascites, which is a buildup of fluid in the body. This can be controlled with a low-sodium diet and medication. In more severe cases, endoscopic procedures to drain the fluid or surgery may be necessary.

Another common complication of cirrhosis is portal hypertension, which is high blood pressure in the veins that supply the liver. This can be treated with medication to control blood pressure and prevent bleeding. Healthcare providers will also regularly check for varices, which are enlarged veins in the oesophagus or stomach that can bleed. If varices develop, medication or procedures may be necessary to prevent or stop bleeding.

Cirrhosis can also increase the risk of infections. Healthcare providers may recommend antibiotics or other treatments for infections, as well as vaccinations to prevent certain infections.

Finally, cirrhosis can increase the risk of liver cancer. Healthcare providers will likely recommend regular blood tests and ultrasound exams to look for signs of liver cancer.

Healthcare providers will work with patients to develop a treatment plan that is right for them. With proper treatment, many people with cirrhosis can live long and healthy lives.

Liver Transplant Surgery

A liver transplant is a surgery to replace a diseased liver with a healthy liver from a deceased donor or from a living donor. It is usually the only definitive treatment option available In advanced cases of liver cirrhosis.

Historically, liver transplants were rarely offered to individuals with alcoholic cirrhosis due to concerns about relapse. Recent studies, however, show that carefully selected severe alcoholic cirrhosis patients can achieve post-transplant survival rates similar to those with other chronic liver diseases.

To qualify for a liver transplant, individuals with alcoholic cirrhosis must be willing to commit to lifelong alcohol abstinence as a requirement. This shift in approach highlights the importance of patient selection and sobriety commitment for successful outcomes.

1. Can liver cirrhosis be reversed or cured?

Cirrhosis is not typically reversible, but it can sometimes be managed or slowed down if the underlying cause is addressed early. For example, if cirrhosis is caused by excessive alcohol consumption, cessation of alcohol and supportive care can help prevent further damage.

2. Is hepatic failure the same as cirrhosis?

No, hepatic failure (liver failure) is not the same as cirrhosis. Cirrhosis is a condition characterised by scarring of the liver tissue, while hepatic failure refers to a severe impairment of liver function. Cirrhosis can lead to hepatic failure, but not all cases of cirrhosis result in liver failure.

3. Does the Hepatitis C Virus (HCV) cause cirrhosis?

Yes, chronic infection with the Hepatitis C Virus (HCV) can lead to cirrhosis over time if left untreated.

4. Can Hepatitis B be prevented?

Yes, Hepatitis B can be prevented through vaccination.

5. Can Hep C be cured if an individual has cirrhosis?

Yes, Hepatitis C can be cured in individuals with cirrhosis. Treatment with antiviral medications can lead to a sustained virologic response (SVR), which is essentially a cure for HCV. However, the extent of liver damage already present due to cirrhosis may not be reversible.

6. How does smoking affect cirrhosis?

Smoking can exacerbate the complications of cirrhosis and increase the risk of liver cancer. It can also reduce the effectiveness of certain medications used to manage cirrhosis.

7. Is cirrhosis the first stage of liver cancer?

No, cirrhosis is not the first stage of liver cancer, but it is a significant risk factor for the development of liver cancer (hepatocellular carcinoma or HCC). Cirrhosis is considered a precancerous condition because the damaged liver tissue has an increased likelihood of developing cancerous cells.

8. What is the life expectancy of cirrhosis of the liver?

Life expectancy with cirrhosis varies depending on its cause, severity, and the effectiveness of treatment. Early diagnosis and management can improve life expectancy. In advanced cases, a liver transplant may be necessary for survival.

9. What can I do to help keep my cirrhosis from getting worse?

You can help manage cirrhosis by following your healthcare provider's recommendations, including lifestyle changes (such as alcohol abstinence and a low-sodium diet), taking prescribed medications, managing underlying conditions, and attending regular check-ups.

10. When do doctors consider a liver transplant for cirrhosis?

Doctors consider a liver transplant when cirrhosis progresses to a point where the liver is severely damaged and is no longer able to function adequately. Specific criteria and assessments are used to determine transplant eligibility.

11. How common is cirrhosis?

Cirrhosis is a relatively common condition worldwide, with its prevalence varying by region and underlying causes. Common causes include chronic alcohol abuse, viral hepatitis (such as Hepatitis B and C), and non-alcoholic fatty liver disease (NAFLD). It is a prominent cause of liver-related morbidity and mortality globally.

12. What are Non-cancerous Liver Tumours?

Non-cancerous (benign) tumours are quite common and usually do not produce symptoms. Often, they are not diagnosed until an ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI) scan is performed. There are several types of benign liver tumours, including the following:

• Hepatocellular adenoma: This benign tumour occurs most often in women of childbearing age. Most of these tumours remain undetected. Sometimes, an adenoma will rupture and bleed into the abdominal cavity, requiring surgery. Adenomas rarely become cancerous.
• Hemangioma: This type of benign tumour is a mass of abnormal blood vessels. Up to five percent of adults have small liver hemangiomas that cause no symptoms. Treatment is usually not required. Sometimes, infants with large liver hemangiomas require surgery to prevent clotting and heart failure.

13. What are Cancerous Liver Tumours?

Cancerous (malignant) tumours in the liver have either originated in the liver (primary liver cancer) or spread from cancer sites elsewhere in the body (metastatic liver cancer). Most cancerous tumours in the liver are metastatic.

14. What is Hepatocellular carcinoma(Primary Liver Cancer)?

Also called hepatocellular carcinoma, this is the most common form of primary liver cancer. Chronic infection with hepatitis B and C increases the risk of developing this type of cancer. Other causes include cancer-causing substances, alcoholic liver cirrhosis, and chronic liver cirrhosis.

15. What are the Symptoms of Hepatocellular carcinoma?

The following are the most common symptoms of Hepatocellular carcinoma. However, each individual may experience symptoms differently. Symptoms may include:

• Abdominal pain
• Weight loss
• Nausea
• Vomiting
• Large mass can be felt in the upper, right part of the abdomen.
• Fever
• Jaundice – yellowing of the skin and eyes.

The symptoms of Hepatocellular carcinoma may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

16. How is Hepatocellular carcinoma Diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for a Hepatocellular carcinoma may include the following:

• Liver Function Tests: A series of special blood tests that can determine if the liver is functioning properly.
• Abdominal Ultrasound (Sonography): a diagnostic imaging technique that uses high-frequency sound waves to create an image of the internal organs. Ultrasounds are used to view internal organs of the abdomen such as the liver, spleen, and kidneys and to assess blood flow through various vessels.
• Computed tomography scan (CT or CAT scan): a diagnostic imaging procedure using a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
• Hepatic Arteriography: X-rays taken after a substance is injected into the hepatic artery.
• Liver biopsy: A procedure in which tissue samples from the liver are removed (with a needle or during surgery) from the body for examination under a microscope.

17. What are the Factors Doctors Consider When Determining the Treatment of Hepatocellular carcinoma?

Physicians will be able to determine the right treatment for patients suffering from Hepatocellular carcinoma based on:

• Age, overall health, and medical history.
• Extent of the disease.
• Tolerance of specific medicines, procedures, or therapies.
• Expectations for the course of the disease.
• Your opinion or preference.

Reviewed by Dr. Rajesh Upadhyay - Senior Director & Head, Gastroenterology, Hepatology & Endoscopy on 13-Dec-2023.

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