Liver Cirrhosis Treatment In India

A French Chest specialist by the of Rene Laennec is most famously known for having invented the stethoscope. However, he also had a keen interest in pathology and gave the name ‘ Cirrhosis ‘ to a chronic scarring of the liver due a variety of causes. Hence Liver Cirrhosis is also called Laennec’s Cirrhosis.

Long standing liver damage due to alcohol, viruses like Hepatitis B or C or a variety of reasons may lead to Liver Cirrhosis. This may lead to many problems :

  • Cirrhosis alters the structure of the liver ( small, shrunken, nodular liver ).
  • Liver functions are affected ( less protein synthesis, impaired clotting mechanisms etc ).
  • The smooth flow of blood through the liver is blocked leading to back pressure effects ( portal hypertension, enlaged spleen, large dilated veins or varices in the food pipe which may bleed ).
  • Build of toxins like ammonia in the blood which the liver is unable to filter out. Ammonia causes drowsiness, confusion , disorientation and even coma ( Hepatic encephalopathy ).

However, if it starts causing problems which the patient can feel , it has usually become Decompensated Liver Cirrhosis. With Decompensated disease, patients may be sufferng from one or more of the following :

  • Ascites : Fluid in your tummy or the abdomen.
  • S.B.P : Spontaneous Bacterial Peritonitis , refers to bacterial infection of the fluid in your tummy ( Infected ascites ) causing pain / fever.
  • Jaundice : Eyes and skin become yellow.
  • G.I. Bleed : Red vomit or black stools mean Gastro Intestinal ( G I ) bleed

Hepatic Encephalopathy ( HE ) means the toxins in the blood are not being filtered by the liver and are reaching the brain. One becomes forgetful, sleepy, disoriented or unconscious. This is quite sinister. Hepato Renal Syndrome ( HRS ) implies that long standing liver disease is temporarily affecting the functioning of the kidneys.

The spectrum of problems caused due to Liver Cirrhosis is often referred to as Chronic Liver Disease( CLD ) or End Stage Liver Disease ( ESLD ). The severity of CLD or ESLD may be assessed by the Child Pugh Turcottee ( CTP ) score or simply the Child score. Liver Cirrhosis is a condition where your normal healthy liver tissue is replaced by scar tissue. This process of scarring is slow and usually happens over many years, often decades.

Cirrhosis is the result of a number of possible reasons / diseases :
  • Regular alcohol consumption.
  • Viral infections like Hepatitis B, C ( Sometimes even Hepatitis D can contribute ).
  • Non Alcoholic Fatty Liver Disease ( NAFLD ) or Non Alcoholic Steato Hepatitis ( NASH ) – often associated with Diabetes, Obesity, high Blood Pressure and high Cholesterol levels.
  • Autoimmune Hepatitis.
  • Primary Sclerosing Cholangitis ( PSC ) or other diseases of the bile ducts.
  • Childhood Liver Diseases.

The scar tissue makes the liver nodular ( Lumpy ) and hard; slowly the organ begins to fail. The liver is unable to produce the proteins like albumin . The scar tissue also blocks the smooth flow of blood through the liver. This builds up pressure in the portal vein leading to back pressure effects ( Portal hypertension ) .

There’s no cure for cirrhosis except a liver transplant, but you can often slow down the process by treating whatever is causing it.

Stages of Cirrhosis

There are two main stages —

  • compensated and
  • decompensated.

Compensated Cirrhosis

In compensated cirrhosis, you won’t have any symptoms. There are still enough healthy liver cells to meet your body’s needs. They compensate, or make up for, the damaged cells and scarred tissue. If you don’t get treatment for the cause of your cirrhosis, it’ll get worse and over time, the healthy liver cells won’t be able to keep up. Nor will your liver be able to get rid of toxic substances in your body like ammonia.

Decompensated cirrhosis

Decompensated cirrhosis causes symptoms. It can lead to problems like these:

  • You bleed from large blood vessels in your esophagus (bleeding varices).
  • Fluid builds up in your belly (ascites, pronounced “ah-SIGH-tees”).
  • Toxins build up in your blood that can cause confusion (encephalopathy).
  • Your eyes and skin are yellow (jaundice).
  • You get gallstones.
  • You bruise and bleed easily.

Here are some ways to lower your chances for having these problems

  • Stick to your treatments.
  • Don’t drink alcohol or use street drugs.
  • Don’t smoke.
  • Keep a healthy weight.
  • Eat a low-fat diet.