Cirrhosis of the liver

What is cirrhosis of the liver?

Cirrhosis is a disease of the liver in which the normal architecture of the organ is destroyed. Liver tissue is gradually replaced by non-functioning connective tissue. This means that the liver can no longer perform vital tasks completely or at all – namely digesting fat, storing energy and detoxifying. The tissue becomes increasingly scarred, hardened and shrunken. This is why cirrhosis of the liver has its colloquial name, „shrunken liver.“

Diseases are often to blame for cirrhosis of the liver

Various diseases of the liver can damage the vital organ to such an extent that the end result is cirrhosis of the liver. Diseases that affect the liver are, for example:

• Alcoholic fatty liver due to long-term alcohol overconsumption
• Non-alcoholic fatty liver, usually due to metabolic syndrome: a „tetrapack“ of obesity, impaired sugar metabolism and decreased insulin sensitivity, elevated blood lipids, and hypertension.
• Chronic viral infection of the liver (especially chronic hepatitis B and C infection).

In most cases, cirrhosis of the liver is the result of a decades-long process in which the harmful influences have to act on the liver for years. This is because the organ actually has enormous regeneration potential. To a certain extent, the liver can always renew itself, compensate for damage and recover – provided you take countermeasures in good time, for example with regard to alcohol consumption or diet.

However, if the destructive influences continue to act, the liver will eventually „give out“. It initiates remodeling processes and replaces liver tissue with functionless connective tissue. However, scarred and hardened tissue is less well supplied with blood. Therefore, the function of the liver gradually decreases.

The earlier we treat cirrhosis of the liver, the better the chances of survival. In advanced stages, liver disease is very dangerous and can cost lives. Worldwide, cirrhosis of the liver is responsible for more than one million deaths per year – and the incidence of this liver disease is increasing.

How common is cirrhosis of the liver?

In industrialized nations, cirrhosis of the liver is not uncommon: about 250 out of every 100,000 people have the disease. The most common reason in Europe is long-term alcohol overconsumption. Men are affected about twice as often as women, and they are also twice as likely to die from cirrhosis. According to the Swiss Federal Statistical Office (SFSO), 312 men and 129 women died of alcohol-related cirrhosis of the liver in Switzerland in 2016.

Liver cirrhosis: Causes are manifold

Various liver diseases are possible causes of cirrhosis. What they all have in common is that harmful influences act on the liver over a long period of time and gradually destroy it. The connective tissue multiplies and knots and shrinking scars are formed. The following causes of liver cirrhosis are common:

• Alcoholic fatty liver (AFL): The cause is long-term alcohol overconsumption, which causes the liver to become increasingly fatty. Alcohol damages liver cells, disrupts fat metabolism locally, and fats accumulate in the liver. In Europe and the U.S., about 60 percent of liver cirrhosis cases result from excessive alcohol consumption. A daily consumption of about 40 grams of alcohol in men and 20 grams of alcohol in women can already irreparably damage the liver. Those who continue to drink alcohol damage the liver more and more. The organ then converts healthy liver tissue into functionless connective tissue.
• Non-alcoholic fatty liver (NAFL): The cause is usually a combination of four factors: Obesity, decreased insulin sensitivity of the body’s cells, elevated blood lipids, and hypertension. Doctors speak of metabolic syndrome.
• Chronic viral disease of the liver: Infection with various hepatitis viruses is responsible for this liver disease. Doctors differentiate – depending on the triggering virus – between hepatitis B, C, D and, very rarely, E. About 30 percent of liver cirrhoses are due to viral hepatitis of type B or C. The most common cause is hepatitis B.

Symptoms: Liver cirrhosis first causes general complaints

Cirrhosis of the liver is not so easy to recognize at first. This is because it usually does not cause any symptoms at the beginning. Doctors often discovered them as part of a routine examination when determining liver values. In addition, cirrhosis of the liver usually causes only very general symptoms. These also occur in the context of a wide variety of other diseases. However, the further the destruction of the liver progresses, the more pronounced the symptoms become.

Cirrhosis of the liver: symptoms are often general in nature

The following signs may indicate cirrhosis of the liver in its early stages:

• Tiredness, fatigue
• Decreased performance
• Feeling of pressure or fullness in the upper abdomen
• Flatulence
• Nausea

In addition, there are various skin changes, the so-called skin signs:

• Formation of new vessels that visually resemble a spider web (vascular spiders) or a star – they often appear on the face, neck and upper body
• Itching of the skin
• Loss of hair on the abdomen and chest („belly and chest baldness“), increased vascularization on the abdomen
• White colored nails (white nails), bent, distended nails (watch glass nails)
• Thickened tendons on the inner surfaces of the hands
• Red palms
• Thin, parchment-like skin with dilated vessels shining through (bill skin)
• Shiny and reddened lips and tongue (varnish lips, varnish tongue)

Furthermore, hormonal disorders may develop. Men often suffer from potency problems, libido disorders, loss of hair, enlarged breasts (gynecomastia) and deformed testicles. Women often experience menstrual irregularities.

Always consult your doctor if you experience such symptoms. There may be liver disease behind it, but not necessarily. We can get to the bottom of the cause.

Advanced cirrhosis of the liver: symptoms

As cirrhosis progresses, other symptoms develop. These include, for example:

• Jaundice (icterus): Yellow discoloration of the skin and eyes (eye whites) because the damaged liver can no longer process the bile pigment bilirubin as quickly and stores it in the tissue. In addition, the urine turns dark and the stool becomes light in color.
• Water retention in the legs (edema) or in the abdomen (abdominal dropsy, ascites) – the abdominal girth increases; shortness of breath when water is deposited in the lungs.
• Bleeding from the nose
• Significant weight loss, emaciation
• Increased blood pressure in the hepatic circulation(portal hypertension)
• Varicose veins in the esophagus or stomach, then bleeding from the esophagus, stomach or intestines (tarry stools and vomiting blood) may follow
• Impaired brain function, confusion and even coma (hepatic encephalopathy)
• Liver cancer as a late consequence

Cirrhosis of the liver: diagnosis with us

At the beginning, we always ask you about your medical history in an anamnesis interview. The following points are of interest for him to track down a possible liver cirrhosis:

• What complaints do they have, since when and how pronounced are they?
• What about your alcohol consumption? It is important that you answer honestly!
• Do you have any known diseases?
• Have you recently been traveling and may have contracted an infectious disease?
• Are you taking any medications? If yes: Which ones and since when?
• Have you previously used drugs or received blood products prior to 1990?
• Where were you born?

Their answers already provide us with initial clues as to whether liver cirrhosis may be present. This is followed by a physical examination, during which we palpate the abdomen. The size and position of the organs can be assessed well in this way. A hardened liver or enlarged spleen can often be palpated from the outside. Any skin changes also allow conclusions to be drawn about cirrhosis of the liver.

Cirrhosis of the liver: medical examinations

After the initial history, further examinations follow, for example:

• Blood test: The blood values provide information on how well the organs are functioning. Bilirubin levels are elevated when the liver can no longer adequately filter the blood. In contrast, albumin, various blood clotting factors (INR/Quick value) are decreased. With portal hypertension and an enlarged spleen, there are fewer platelets and white blood cells. Elevated transaminases indicate liver cell damage. Elevated ammonia levels are a sign of brain dysfunction. A viral infection (e.g. hepatitis B, C) can be diagnosed on the basis of antibodies against these viruses or direct detection of viral components.
• Ultrasound examination (sonography) of the abdomen: we insert a transducer that emits and receives sound waves. On the monitor he sees images from inside the body and the condition of the organs, including the liver. The liver tissue looks patchy and the surface of the organ is irregular. Abdominal dropsy, enlarged spleen or newly formed blood vessels can also be seen.
• Special ultrasound procedures: Transient elastography provides information on how high the proportion of connective tissue in the liver already is.
• Tissue sample (biopsy): Sometimes we take a tissue sample from the liver, which is then analyzed under the microscope by a pathologist. Altered tissue is indicative of cirrhosis of the liver.
• gastroscopy (gastroscopy): In this procedure, we use a flexible instrument with a light source and camera. They advance this endoscope through the mouth and esophagus into the stomach. Varicose veins in the esophagus and stomach can be detected in this way.
• Psychometric tests, for example writing tests, provide initial indications of disturbed brain functions.

Cirrhosis of the liver: prevention, early detection, prognosis

There are some risk factors that promote the development of cirrhosis of the liver, and you have control over them. First and foremost, this includes alcohol consumption. If you use alcohol sparingly and carefully, you can prevent cirrhosis of the liver to some extent.

You can protect yourself from hepatitis B, which is also one of the triggers of cirrhosis of the liver, by vaccination. No vaccination against hepatitis C is yet possible. But here, too, there are some protective measures: Wear gloves when coming into contact with bleeding injuries on others.

There are no concrete measures for early detection of liver cirrhosis. Doctors often discover them by chance during a routine examination. Always have diseases that can lead to cirrhosis of the liver adequately monitored and treated – this allows liver disease to be diagnosed early.

Course and prognosis in cirrhosis of the liver

The course and prognosis of liver cirrhosis always depend on how far the liver disease has progressed. So the stage plays a crucial role. The onset of liver cirrhosis can often still be halted with appropriate therapies. It is also important to adequately treat diseases that lead to cirrhosis of the liver. Without treatment, it progresses and the liver loses its ability to function.

We divide liver disease into different degrees of severity according to the Child-Pugh score – prognosis and life expectancy also depend significantly on this. They evaluate liver function on the basis of five criteria, for each of which they award one to three points. These include INR (a measure of blood clotting), albumin, bilirubin, ascites, and brain dysfunction (encephalopathy). So there are five to 15 points to be achieved. Finally, they add up all the points and divide sufferers into one of three stages.

• Child A (5 to 6 points): Early stage liver cirrhosis – Mean survival 12 years.
• Child B (7 to 9 points): One year after diagnosis, 85 percent of those affected are still alive.
• Child C (10 to 15 points): The liver cirrhosis is far advanced – only 35 percent of those affected live longer than one year.

Cirrhosis of the liver can result in various complications. These include, for example:

• Water retention in the abdomen (ascites, abdominal dropsy)
• Metabolism disorders
• Bleeding in the esophagus and stomach (varicose veins)
• Loss of brain function because the liver no longer provides adequate detoxification
• Liver cancer (liver carcinoma)
• Liver failure

Cirrhosis of the liver: treatment depends on the cause

Treatments for cirrhosis of the liver always depend on the cause. Without therapy, more and more liver tissue is destroyed and the liver loses its function. Although cirrhosis of the liver cannot be cured, its progression can often still be slowed down with therapies. Complications can also often be prevented therapeutically.

Treatments for cirrhosis of the liver – depending on the cause

• Abstain from alcohol
• Reduction of overweight
• Avoiding substances that are harmful to the liver
• Treatment of hepatitis B and C
• Treatment of inherited metabolic diseases
• Liver transplant