Stage 5 Cirrhosis
Cirrhosis results from the necrosis of the liver cells. It is characterized by fibrosis, formations of scar tissue and regenerative nodules. The disease of Cirrhosis and its stages leads to some or complete loss of liver function. It may occur at any age of life.
CAUSES OF CIRRHOSIS
Cirrhosis is most commonly caused by extensive and excessive drinking of alcohol. There are other causes which include:
* Postnecrotic cirrhosis
– Hepatitis B
– Hepatitis C
* Non-alcoholic fatty liver disease
* Autoimmune disease
– Primary sclerosing cholingitis
– Autommune hepatitis
* Metabolic disorders
– Wilson’s disease
– Alpha-antitrypsin defeciency
– Primary biliary cirrhosis
– Secondary biliary cirrhosis
– Cystic fibrosis
– Wilson’s disease
* Chronic venous outflow obstruction
– Budd-Chiari syndrome
PATHOLOGY OF CIRRHOSIS
Liver cirrhosis is characterized by the formation of regenerative nodules with loss of normal structure. There are three types of cirrhosis:
a- Micronodular Cirrhosis:
In this type, the whole of the liver is uniformly involved. Regenerative nodules are on the small side being less than 3mm in size. This is due to excessive alcohol consumption
b- Macronodular Cirrhosis:
In this type, some sections of the liver are normal. The size of the nodules will be variable and this type of cirrhosis is seen in chronic viral hepatitis.
c- Mixed Cirrhosis:
In some cases, a mixture of both small and large nodules are visible on and through the liver
There are 4 stages of liver cirrhosis. Knowledge about the stages of liver cirrhosis is important for better prevention, early diagnosis and effective preventative treatment. Stage 1 is the earliest stage which is characterized by minimal damage and a good prognosis for recovery and prevention whereas in the final stage 4, the liver is virtually completely damaged and a liver transplant is the only treatment of choice. Read on to find out more about the different stages of cirrhosis:
The first stage is known as the ‘compensated stage’. This stage is characterized by inflammation of the liver tissues. Inflammation is confined to the portal area and does not involve other areas of the liver. This inflammatory process leads to minor connective tissue formation and scarring of the liver. But as the name says, these changes can be compensated for by the body, meaning the body will adapt to offset the disease effects. This stage is usually asymptomatic but on close examination, some patients may have:
* Mild jaundice
* Loss of appetite
* Weight loss
* Dry mouth
* Swelling of the abdomen
* Abdominal pain
The second stage of cirrhosis is also characterized by inflammation of the liver tissues, but at this stage, the liver starts to show areas of fibrosis. Fibrosis are the ‘stiff bands‘ that are formed by the replacement of normal liver tissues with the scar tissue. It is irreversible and can never return back to normal liver tissue, however, new liver cells can generate. In this stage, inflammation is not only limited to the portal area,but involves the whole liver. The changes in this stage can be compensated for by the body.
In the third stage, the inflammation and fibrosis start to involve other areas of the liver and the condition becomes more severe. As the fibrosis extend to the other tissues, it forms bridging fibrosis. Bridging fibrosis not only impairs the normal functioning of the liver but also affects the blood pressure levels in the liver, a condition known as portal hypertension. A patient with stage 3 cirrhosis will not be able to digest fat so he may present with fat-soluble vitamin deficiencies (Vitamin A, D, E and K).
Stage 4 of liver cirrhosis is also known as the ‘Decompensated stage‘. It is the most advanced stage and in this stage, the body can no longer compensate for the damaged liver. Fibrosis extends to every part of the liver and a liver transplant is needed to save the patient’s life. Stage 4 may also involve the spleen and kidneys. A patient with the 4th stage of liver cirrhosis may develop the following symptoms in addition to the symptoms of the 1st stage:
* Pedal edema
* Plamar erythema
* Easy bruising
Stage 4 liver cirrhosis increases the risk of many complications.e.g. Ascites, variceal hemorrhage, spontaneous bacterial peritonitis, hepatic encephalopathy and liver cancer. Some of these complications can be life-threatening
INVESTIGATIONS OF CIRRHOSIS:
The following tests are performed to check which stage and what type of liver cirrhosis the patient may have:
– Liver function tests ( Albumin, Prothrombin time)
– Liver biochemistry ( Serum alkaline phosphatase, Serum aminotransferase)
– Serum electrolytes ( Sodium level)
– Serum creatinine
– Viral markers
– Serum autoantibodies
– Serum immunoglobulins
– Iron indices and ferritin
– Copper, ceruloplastin
In addition to these laboratory investigations, imaging studies check for the changes in the size and shape of the liver. Some of these include Ultrasound, CT scan, Endoscopy and MRI scan. A liver biopsy is usually necessary to confirm the type and severity of liver disease.
MANAGEMENT OF CIRRHOSIS of the Liver:
In the compensated stage, treatment of the underlying cause of cirrhosis can reverse the cirrhotic changes in the liver if caught early enough and patients can lead a normal life. Patients should reduce their salt intake and should avoid aspirin, NSAIDS and alcohol. In the de-compensated stage, management of complications should be done. Ultrasound tests should be done after every 6 months to detect the early development of hepatocellular carcinoma. A liver transplant is usually needed in the 4th stage.
PROGNOSIS OF CIRRHOSIS:
In general, the survival rate of cirrhosis is 50% but this varies with the etiology, stage and presence of complications.
Much can be done through early intervention and looking at lifestyle factors such as the foods you eat and following a strict liver friendly diet, complimentary medicines,no alcohol,exercise, supplements to boost your whole system and especially taking care to look after yourself on every level when you have cirrhosis of the liver.