Liver cirrhosis is a fibrotic scarring of the liver. When the liver is repeatedly injured by agents such as alcohol or Hepatitis B, the liver tries to repair itself by growing new liver cells. Up to a certain point, the repair is incomplete and the liver forms fibrotic scars that become shrunken.
In early or compensated cirrhosis, patients will not have symptoms and they will feel normal. They may not even know that they have liver cirrhosis. It is important that patients at risk of chronic liver injury be monitored by doctors even if they feel well. Ultrasound scan of the liver is probably the easiest way to diagnose cirrhosis.
In advanced cirrhosis, symptoms of significant liver damage may include:
In Singapore, the most common cause of liver cirrhosis is chronic Hepatitis B. While not every Hepatitis B carrier will become cirrhotic, approximately 20-40% may end up with cirrhosis if their condition is not monitored. Other causes include alcohol, hepatitis C, fatty liver with inflammation, and rarer causes such as Autoimmune Liver Disease, Primary Biliary Cirrhosis, Wilson’s disease and primary sclerosing cholangitis.
Early liver cirrhosis does not cause problems as the liver has enough reserve capacity to cater to the needs of the body even though it is scarred.
As scarring progresses, liver insufficiency develops and the patient is prone to developing the following complications:
It is important that you consult a hepatologist who will help you confirm the diagnosis and pinpoint the cause of the cirrhosis. Many of the causes can be treated, thus preventing further injury and deterioration.
The doctor will prescribe medication (spironolactone and/or furosemide) to try to clear the fluid retention by increasing your urine output.
It is important that you do not take excessive water and salt. Patients with ascites and leg swelling on average should restrict their fluid intake to 1L to 1.2L a day and avoid table salt and soy sauce.
If the abdomen swelling is massive and causes breathlessness, a drain can be inserted to drain out the fluid in the hospital.
Cirrhosis can improve and even reverse in some situations. The main aim is to remove the cause of the injury and to allow the liver to repair itself. With treatment, early cirrhosis can be detected, thus preventing further deterioration. Even when complications develop, many of these complications can be controlled and patients can be maintained at compensated stage (with relatively normal functions). For end-stage liver cirrhosis, liver transplantation provides a cure for cirrhosis patients.
