Protect your liver: Learn about the prevention and treatment of hepatic cirrhosis

What is Hepatic Cirrhosis？

Hepatic cirrhosis is the end stage of various chronic liver diseases. When liver is repeatedly or continuously damaged, the normal liver tissue will replaced by non-functional fibrous scar tissue, leading to the gradual formation of liver fibrosis and cirrhosis, resulting in impaired liver function.

Based on the extent of liver function impairment, it can be classified into two stages: compensated cirrhosis and decompensated cirrhosis.

Patients in the compensated cirrhosis stage may have normal liver function and show no obvious symptoms, but imaging studies reveal the presence of cirrhosis.

If the disease continues to progress and liver function cannot be compensated, it enters the decompensated cirrhosis stage. Patients with decompensated cirrhosis typically exhibit features of portal hypertension and severe liver damage, often accompanied by complications such as ascites, gastrointestinal bleeding, spontaneous bacterial peritonitis, sepsis, hepatic encephalopathy, hepatorenal syndrome, and hepatocellular carcinoma.

Etiology

Common causes include:

? Chronic viral hepatitis (hepatitis B and hepatitis C)

? Alcoholic liver disease

? Non-alcoholic fatty liver disease

? Hemochromatosis

Less common causes include:

? Cholestatic and autoimmune liver diseases: Primary biliary cholangitis, Primary sclerosing cholangitis, Autoimmune hepatitis, Autoimmune cholangiopathy, Immunoglobulin G4 (IgG4) related disease.

? Hepatolenticular degeneration or Wilson's Disease

? Biliary obstruction: Mechanical obstruction, Biliary atresia

? Hepatic vein outflow obstruction: Budd-Chiari syndrome

? Drugs and toxins

Symptoms

In the early and compensated stages, patients may not exhibit significant symptoms or may experience mild fatigue, loss of appetite, weight loss, abdominal discomfort, and mild upper abdominal pain.

In the decompensated stage, common symptoms are related to complications and include:

? Abdominal distension, increased abdominal girth, and ascites.

? Abdominal pain and diarrhea.

? Lower limb edema and pulmonary edema.

? Fragile bones and muscle wasting.

? Yellowing of the sclera and skin (jaundice).

? Itchy skin.

? Skin with small red spots or bruises (petechiae).

? Pale skin and fatigue.

? Vomiting blood, passing black stools (melena), and fresh blood in stools (hematochezia).

? Common symptoms of infections.

? Confusion and drowsiness.

? Coma.

? Breast enlargement in males (gynecomastia).

? Spider angioma (spider-like dilatation of capillaries).

Possible laboratory test results

? Abnormal liver function indicators

? Abnormal coagulation function indicators

? Positive for viral hepatitis

? Decreased red blood cells, white blood cells, and platelets

? Splenomegaly (enlarged spleen)

? Abnormal liver morphology, liver cirrhosis

? Gastric and esophageal varices

When is immediate medical attention needed?

Patients with chronic liver disease require regular follow-up.

Cirrhotic patients should seek immediate medical attention in the following situations:

? Bleeding issues, such as:

?? Rectal bleeding (hematochezia)

?? Vomiting blood (hematemesis)

?? Bleeding or bruising

? Symptoms of infection, such as fever or chills

? Abdominal pain

? Swelling in the legs or ankles

? Jaundice (yellowing of the skin or eyes)

? Difficulty breathing

? Extreme fatigue

? Confusion or altered consciousness

Treatment

The main treatment for liver cirrhosis is focused on managing the underlying chronic liver disease as effectively as possible and preventing additional liver damage. Therefore, identifying the cause of cirrhosis is crucial. Additionally, early detection, control, and treatment of complications are of utmost importance. If you have signs of decompensated cirrhosis along with chronic liver disease, seek immediate medical attention.

When is liver transplantation necessary?

liver transplantation is considered when cirrhotic patients develop liver cell carcinoma or when decompensated symptoms and complications become uncontrollable (e.g., ascites, jaundice, variceal bleeding, hepatic encephalopathy, hepatopulmonary syndrome, or hepatorenal syndrome). In such cases, the patient should be referred to a liver transplant center for evaluation.

Prevention

Primary Prevention:

? Treat various potential chronic liver diseases to prevent progression to cirrhosis.

? Regularly screen patients with risk factors for liver disease using non-invasive markers of liver fibrosis to identify liver diseases before they progress to cirrhosis.

? Reduce alcohol consumption or abstain from alcohol completely to prevent alcoholic liver disease.

? Adopt a balanced diet, control weight, and exercise regularly to prevent non-alcoholic fatty liver disease.

? Get vaccinated, avoid intravenous drug use, and practice safe sex to prevent chronic viral hepatitis.

Preventing further liver damage in cirrhosis patients:

? Treat underlying chronic liver diseases.

? Abstain from alcohol.

? Avoid the use of hepatotoxic drugs.

? Regular health monitor.

Health monitoring for cirrhosis patients

For cirrhosis patients, undergo laboratory tests (renal function/electrolytes, liver function tests, albumin, complete blood cell count, prothrombin time, alpha-fetoprotein) and imaging studies (abdominal ultrasound every 6 months) every 6-12 months to monitor:

? Signs and symptoms of advanced liver disease.

? Disease progression.

? The occurrence of complications of portal hypertension, such as ascites, hepatic encephalopathy, jaundice, and variceal bleeding.

Reference：

1.?????? https://bestpractice.bmj.com/topics/zh-cn/278

2.?????? https://www.msdmanuals.cn/professional/hepatic-and-biliary-disorders/fibrosis-and-cirrhosis/cirrhosis?query=%E8%82%9D%E7%A1%AC%E5%8C%96#v899476_zh

3.?????? 中华医学会肝病学分会. 肝硬化诊治指南[J]. 中华肝脏病杂志,2019,27(11):846-865. DOI:10.3760/cma.j.issn.1007-3418.2019.11.008

4.?????? https://www.uptodate.com/contents/zh-Hans/cirrhosis-in-adults-etiologies-clinical-manifestations-and-diagnosis?search=%E8%82%9D%E7%A1%AC%E5%8C%96&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

5.?????? https://www.uptodate.com/contents/cirrhosis-beyond-the-basics?search=%E8%82%9D%E7%A1%AC%E5%8C%96&source=search_result&selectedTitle=1~20&usage_type=default&display_rank=1