Liver Cirrhosis? Find Clarity, Courage, and Expert Insights Here

Cirrhosis, a late stage of liver fibrosis, is brought on by a variety of liver disorders, including prolonged drinking, hepatitis, etc. Fibrosis is a sluggish, years-long scarring process that causes the liver to shrink and stiffen.
The smooth liver surface becomes lumpy due to scar tissue, which obstructs blood flow and causes portal hypertension.

A wide range of conditions can damage the liver and result in cirrhosis. Common causes highlighted across the sources include:

• Chronic hepatitis B or C infections
• Alcoholic liver disease
• Non-alcoholic fatty liver disease (NAFLD)
• Autoimmune hepatitis
• Genetic disorders (e.g., Wilson’s disease, hemochromatosis)
• Prolonged exposure to toxins or certain drugs
• Cryptogenic (Cause Unknown)

1. Stage 1 (Compensated Cirrhosis): Mild scarring with few or no symptoms.
2. Stage 2: Portal hypertension begins, with possible swelling or varices.
3. Stage 3 (Decompensated): Ascites, hepatic encephalopathy, bleeding.
4. Stage 4: End-stage liver disease – life-threatening complications.

Technically no

Once a liver is diagnosed with cirrhosis, it means the damage has progressed, typically stage 3 or 4 on a FibroScan. At this stage, the liver has developed permanent scarring, and unfortunately, the condition is not reversible.

Here’s what you need to understand:

• Cirrhosis is progressive, not reversible. You cannot reverse the damage, but you can slow down further progression by managing the root cause.
• For example:
  • Alcohol-related liver disease: Stopping alcohol can significantly slow down the disease.
  • Fatty liver (MASLD): Managing diabetes, obesity, and cholesterol can prevent worsening.

What doctors can do:

We treat the symptoms and complications, not the underlying damage.

Common complications include:

In reality, most patients with cirrhosis will eventually require a liver transplant. It may not be urgent today, but it’s wise to:

• Understand your stage
• Discuss transplant planning early
• Prepare financially and emotionally
• Keep regular follow-ups with your hepatologist

While some online claims say “I cured cirrhosis,” be cautious. Early-stage liver damage may improve, but true cirrhosis (Stage 3 or 4) is often irreversible. Focus on managing the cause, symptoms, and complications and preventing further damage.

No, cirrhosis is not cancer. However, cirrhosis increases your risk of developing liver cancer (Hepatocellular carcinoma).

Warning signs of end-stage cirrhosis include:

• Severe confusion (hepatic encephalopathy)
• Bleeding varices (vomiting blood)
• Ascites (fluid in the belly)
• Jaundice
• Kidney dysfunction
• Frequent infections

These require immediate medical attention.

There is no one-size-fits-all answer. It depends on:

• The stage of liver damage
• The presence of complications
• The underlying cause
• The response to medical management

This varies. If untreated, especially after complications arise, cirrhosis can shorten lifespan to months or a few years. The onset of complications like hepatic encephalopathy, ascites, and hepatorenal syndrome (Kidney involvement) is associated with reduced survival times.

Survival is significantly reduced for patients with organ failures and infections. So, consult your doctor and do the needful.

Treat the Underlying Cause: Stop alcohol use immediately. Treat hepatitis with antivirals. Manage metabolic risk factors like diabetes and obesity. Address autoimmune, genetic, or biliary diseases specifically.

Diet and Lifestyle:

To control ascites, follow a low-sodium diet (less than 2 grams per day).

Steer clear of canned, processed, and salty meals.

Sufficient consumption of protein unless otherwise advised (e.g., HE).

For MASLD/ Fatty liver disease, weight loss and consistent exercise are recommended.

Medication:

Diuretics for ascites.

Rifaximin with lactulose for encephalopathy.

Beta-blockers to stop variceal haemorrhage and lower portal pressure.

Steroids or antivirals, based on the underlying reason.

Monitoring and Assistance: Frequent Endoscopy (EGD) for the screening of varices.

Every six months, AFP and imaging tests are performed for HCC surveillance.

Early management of problems such as Hepatorenal syndrome/HRS and Spontaneous bacterial peritonitis/ SBP.

TIPS: May be used to stop repeated variceal rebleeds, but because of the possibility of consequences such as hepatic encephalopathy, it is important to choose patients carefully.

Liver transplantation: Taken into consideration for patients who meet transplant criteria for HCC, recurrent problems, or decompensated cirrhosis. Prioritising candidates is aided by the MELD (Model for End-Stage Liver Disease) score.

Yes. In a living donor liver transplant (LDLT), a healthy person donates a portion of their liver to someone with end-stage cirrhosis. The liver regenerates in both the donor and the recipient. It’s life-saving when done at the right time.

On average, people may live months to a few years, depending on:

• The cause
• Response to treatment
• Availability of transplant

But every case is unique — hope and help both exist.

The patient’s medical history, a physical examination, and several tests are usually used to diagnose cirrhosis.

• By assessing levels of liver enzymes, proteins, and bilirubin, blood tests are used to evaluate liver function. They can also reveal decreased blood coagulation.
• The size, shape, and texture of the liver are examined using imaging procedures such as abdominal ultrasounds, CT scans and MRIs.
  • Liver stiffness is measured by elastography, a unique imaging modality that uses ultrasound or MRI and corresponds with the degree of fibrosis; cirrhosis is usually confirmed if the liver stiffness is 15 kPa or more.
• A liver biopsy, which entails removing a small sample of liver tissue for laboratory analysis, is still the gold standard for identifying the origin of cirrhosis and verifying its existence, even if it is not always required.

Cirrhosis can result in several complications.

• Ascites, or fluid accumulation in the abdomen;
• Hepatic encephalopathy, or brain dysfunction brought on by the liver’s incapacity to eliminate toxins.
• Variceal haemorrhage, or bleeding from enlarged blood vessels in the stomach or oesophagus as a result of portal hypertension;
• Spontaneous bacterial peritonitis, or infection of the ascites fluid.
• Hepatorenal syndrome, or kidney dysfunction, and
• Hepatocellular carcinoma, or liver cancer, is one of these conditions.
• Sexual dysfunction, pruritus, cramping in the muscles, and poor sleep are additional possible complications.

A common complication of cirrhosis is ascites, or the buildup of fluid in the abdomen. Because too much salt exacerbates fluid accumulation, management usually starts with –

• Dietary salt restriction, usually less than 2 grams daily. Diuretics, especially loop diuretics and aldosterone antagonists, are frequently used to promote the excretion of water and salt.
• In cases of refractory ascites (ascites that don’t respond to diuretics and sodium restriction), procedures like large-volume paracentesis (removing the fluid with a needle) or the insertion of a transjugular intrahepatic portosystemic shunt (TIPS) may be necessary.
• TIPS poses the risk of complications, including hepatic encephalopathy, but it can also help decompress the portal system, enhance renal function, and lessen ascites.

Toxin buildup, especially ammonia, in the brain causes cirrhosis-related neuropsychiatric complications called hepatic encephalopathy (HE). The symptoms can include mild cognitive impairments (minimal HE), disorientation, confusion, motor dysfunction, and even coma (overt HE).

• Reducing the body’s toxin levels is the main goal of treatment for HE. One typical treatment is lactulose, a form of sugar that helps to reduce ammonia levels. Because it can lessen the amount of bacteria in the gut that produce ammonia, the antibiotic Rifaximin is also utilised.
• In certain situations, dietary protein changes might be taken into consideration, and therapies for certain symptoms, like cramping in the muscles or poor sleep, might also be used. The best course of treatment in severe or recurring cases might be liver transplantation.

Although there is no way to reverse established cirrhosis, addressing the underlying reasons and maintaining liver health can decrease its progression.

• Avoiding alcohol intake is part of this, particularly if you have liver problems.
• Steatotic liver disease/ fatty liver disease linked to metabolic dysfunction can be avoided by eating a healthy liver diet high in fruits, vegetables, and whole grains and low in fatty and fried foods.
• Maintaining metabolic parameters like cholesterol, blood pressure, and blood sugar at the optimum level.
• Because too much body fat might harm the liver, it’s also very important to maintain a healthy weight.
• Cirrhosis can also be avoided by lowering the risk of viral hepatitis B and C through safe practices (avoid sharing needles and unprotected sex) and taking into account hepatitis immunisations.

To explore the medications commonly used in treating hepatic encephalopathy and ascites in liver disease patients, please refer to our detailed guide in the blog post Know Your Medicine.