Understanding Liver Cirrhosis

Liver cirrhosis is late stage scarring of the liver caused by chronic alcoholism, hepatitis, cystic fibrosis, fatty liver disease and many more diseases and conditions. Although it's not very well researched, chronic alcohol use is one of the number one causes of liver disease. "Among individuals who consume more than 70 drinks per week for over 20 years, 19% developed alcoholic liver disease and 7% developed cirrhosis" (Huang). This is because the liver is the organ to break down alcohol. When more alcohol is consumed than can be broken down, the functional cells of the liver (hepatocytes) are destroyed and scarring takes place. Over time, this scarring becomes cirrhosis. In non-alcohol related cirrhosis cases, cirrhosis occurs because of diseases and conditions. With these diseases the hepatocytes are also destroyed and scarring takes place. For example with viral hepatitis C the hepatocytes are destroyed. Either by the virus itself or the body's immune response. The death of these cells activates the body's inflammation process. This triggers cytokines, which triggers leukocytes, which triggers stellate cells to begin to "heal" the liver by creating collagen. Normally this collagen works to heal the injured portion of the body and prevent the spread of infection and then dissolves. But in patients with Hepatitis C, the collagen spreads rapidly and doesn't dissolve like it should. Resulting in scarring.

2) Cirrhosis of the liver impairs it's function. It's functional cells are scarred over and the cells cannot filter like they should be able to. The resulting symptoms include; fatigue, loss of appetite, nausea, edema of the extremities, weight loss, and jaundice.

3) Unfortunately Cirrhosis cannot be reversed. If caused by alcoholism, quitting alcohol can stop or slow the progression of the disease. For other diseases, medications to treat that  disease can help treat cirrhosis. A patient with hepatitis can take medications to limit the damage done to the liver. For other conditions, a healthier lifestyle may be used to treat cirrhosis. For example if a patient suffers from fatty liver disease, weight loss can help relieve the stress placed on the liver. There is such a wide range of diseases that can cause cirrhosis so each individuals treatment will be different.

4) Implications are complicated for the individual, family, and community. For alcoholics, it's not as simple as "quitting drinking". Alcoholism is an addiction that has to be battled before treatment can begin. This is the individuals choice to battle. It can be hard for a family or community to watch and it's important that the individual to have the support of their family and their community. For patients suffering from other diseases, the diseases are often chronic and can lead to many different complications with cirrhosis being just one of them. For the individual it's hard to live with, and can be difficult to bear the weight of. Again, support goes a long way for the individual.

Symptoms of Liver Cirrhosis

Bonus: I have actually seen a cirrhosis of the liver. Just by looking at a liver, you can tell it does not look right. It was all splotchy and larger than normal. Supa cool to see not so cool for the patient.

Liver cirrhosis occurs as a result of extensive and long-term damage to the liver and it will be diagnosed when a large amount of scar tissue in the liver inhibits its ability to function properly. There are many ways that cirrhosis can happen, though viral diseases such as hepatitis B, hepatitis C, and hepatitis D, as well as chronic alcoholism are the most common causes of cirrhosis (American Liver Foundation, 2016). Patients can also be susceptible to cirrhosis based on a genetic predisposition, conditions like cystic fibrosis or Wilson’s disease, or “…infections, such as syphilis or brucellosis,” (Mayo Clinic, 2021).

Excessive and repeated alcohol consumption can lead to numerous health problems, with alcohol-related liver disease being one of the most common. On a cellular level, alcohol-induced cirrhosis destroys hepatocytes, or liver cells, and eventually replaces “…the normal hepatic parenchyma with extensive thick bands of fibrous tissue…which results in liver failure,” (Cleveland Clinic, 2021). The resulting scar tissue in the liver hinders the liver’s ability to metabolize alcohol in the future. The levels of hepatocytes like alcohol dehydrogenase, cytochrome P450 2E1, and acetaldehyde dehydrogenase are also impacted by excessive alcohol consumption, and the resulting reactive oxygen species can further inhibit the liver’s ability to function properly (American Liver Foundation, 2016).

Hepatitis C-induced liver cirrhosis differs from alcohol-induced cirrhosis, though it does still impact the body, and specifically the liver’s function, in similar ways. Hosts with hepatitis C experience damage to their liver for many years, often without seeing any symptoms that point to hepatitis C or liver damage. This disease leads to symptoms that are similar to those with alcohol-induced cirrhosis – abdominal pain, edemas, the inability to fight infections, and an increased risk of liver cancer are some of the most common symptoms (Mayo Clinic, 2021). Risk factors for hepatitis C include those who have a history of intravenous drug use, “baby-boomers” born between 1945-1965, and children born to parents who have hepatitis C (American Liver Foundation, 2016). Unfortunately, patients who have hepatitis C often do not know they have this disease until they reach end-stage hepatitis C, at which point few treatment options are available.

Symptoms of unhealthy liver function rarely occur until the damage has reached a dangerous level. These symptoms include fatigue, weight loss, nausea, ascites, jaundice, itchy skin, and redness in the palms of the hands (Mayo Clinic, 2021).

Treatment Options for Liver Cirrhosis

 Liver cirrhosis may result in additional complications like portal hypertension, which can lead to serious complications like internal bleeding, an enlarged spleen, edemas, and encephalopathy, or an increased risk of developing liver cancer (Hopkins Medicine, 2021),

Cirrhosis and the damage to the liver are not curable or reversible, thus doctors will attempt to treat the underlying cause of cirrhosis. For alcohol-induced cirrhosis, patients are urged to stop drinking entirely to allow their liver to avoid furthering the damage to the liver. The Mayo Clinic clearly and directly states, “If you have cirrhosis, it is critical to stop drinking since any amount of alcohol is toxic to the liver,” (Mayo Clinic, 2021). Lifestyle changes like adjusting one’s diet to include healthier foods and managing one’s weight to control blood sugar levels are also recommended to minimize potential complications.  

Though hepatitis C is treatable, the resulting damage to the host’s liver is not reversible, making it crucial to catch this disease in its early stages. There are oral medications that patients with hepatitis B and C can take to cure them of the disease and prevent any further damage to the liver (American Liver Foundation, 2016).

If the liver is damaged to a point at which it can no longer function, the patient may be a candidate for a liver transplant surgery. Those individuals with alcohol-induced cirrhosis are typically not candidates for transplant surgery due to the increased likelihood that they will damage a new liver if they are unable to treat their addiction and/or dependency on alcohol (Mayo Clinic, 2021).

This disease impacts all levels of society, though it is especially difficult on the individual and family levels. Cirrhosis and the potential complications it can bring, ranging from liver cancer to an increased susceptibility to bone disease, make managing and living with this disease challenging for the patient and their family. The fact that there is no cure for this disease and no way to reverse damage to the liver makes it important for those impacted by this disease to seek treatment for the underlying causes to immediately stop damaging their liver.

Liver cirrhosis can occur in several different mechanisms, the most common being alcohol abuse. But also chronic viral infections such as hepatitis B and C can also lead to liver cirrhosis. Finally, an unhealthy lifestyle leading to obesity and high amounts of body fat can also lead to liver cirrhosis. Each time your liver filters alcohol, some of the liver cells die. The liver can develop new cells, but prolonged alcohol misuse (drinking too much) over many years can reduce its ability to regenerate. This can result in serious and permanent damage to your liver. Hepatitis causes damage to the liver mainly in the form of inflammation, which then leads to scarring or fibrosis. Hepatitis  results in the death of liver cells. It is uncertain whether the virus kills the cells or if it is the immune system's response to invasion by the virus. In cases of liver cirrhosis there is necrosis and apoptosis. Necrosis is actually death of living tissue, but apoptisis is the death of cells which occurs as a normal and controlled part of an organism's growth or development. Overuse of alcohol or infections like hepatitis increase apoptosis and lead to liver cirrhosis. Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss. A liver damaged by cirrhosis isn't able to clear toxins from the blood as well as a healthy liver can. This build up of toxins overtime can lead to other conditions such as hepatic encephalopathy which is the build up of our body’s toxins in the brain. The earlier liver cirrhosis is diagnosed, the less likely you are to have serious complications like this, it is important to watch out for the common symptoms. Such as;

-Easily bleeding or bruising.

-Loss of appetite.

-Swelling in your legs, feet or ankles (edema)

-Weight loss.

-Itchy skin.

-Yellow discoloration in the skin and eyes (jaundice).