Cirrhosis (hepatic, biliary, alcoholic): what is it? Is there a cure?

Liver disease is the 8th leading cause of death in Brazil, according to the Brazilian Society of Hepatology.

Among one of its complications is cirrhosis, which can be considered the final stage of a chronic liver injury.

As it is a condition that cannot be cured, it is important to keep medical exams up to date in order to identify any abnormalities.

Some factors can aggravate cirrhosis.

To find out more, just check out the article!

What is cirrhosis?

Cirrhosis is classified as one of the final stages of a liver disease, being an irreversible change . The condition is due to inflammation and previous injuries, in which the liver tissue is replaced by regenerative nodules.

Considered one of the main chronic changes in the liver, the condition may be related to other factors, such as infections and changes in metabolism.

The biggest causes related to cirrhosis are viral hepatitis (B and C), fatty liver disease and alcohol abuse.

For this reason, it is important to maintain a routine of frequent examinations, in order to diagnose any changes in the liver early, before they evolve to cirrhosis.

The condition can be found in the ICD-10 through the codes:

  • K70.3: Alcoholic liver cirrhosis;
  • K74.3: Primary biliary cirrhosis;
  • K74.4 : Secondary biliary cirrhosis;
  • K74.5 : Biliary cirrhosis, unspecified;
  • K74.6 : Other and unspecified forms of liver cirrhosis.

How does the liver work?

The liver represents about 5% of all of our body weight. It is an organ that performs essential functions for the organism, such as storage, reserve and regeneration of substances.

It is located inside the abdomen and is considered the largest gland in the body. It is responsible for excreting substances that are not good for our body.

As we develop liver disorders, the liver ends up losing some of its functioning capabilities, becoming less able to process these substances.

As a consequence, toxins accumulate in the bloodstream, impairing the functioning of the entire organism.

How is the liver of a person with cirrhosis?

When the liver is in the cirrhosis stage, its structure is modified, with nodules commonly associated with excessive alcohol consumption or viral hepatitis. The liver loses its smooth appearance, which is replaced by a rough appearance.

Hepatitis Guide

Is cirrhosis cancer?

No . Cirrhosis is a condition responsible for the replacement of liver cells by scar tissue. However, these physiological changes can develop into nodule formation and lead to the development of liver cancer .

According to the National Cancer Institute (INCA), about 50% of cases of hepatocarcinoma (the most common type of cancer in the liver) also have liver cirrhosis.

Thus, the relationship between conditions is evident. That is, in some cases, the changes resulting from cirrhosis can be malignant for the patient.

And when we talk about the types of cancer, we can classify them as primary or secondary. The differentiation between them occurs in the way the tumor was developed.

The primary cases are those that start in the liver itself, that is, as a result of some condition in the organ.

Secondary types, on the other hand, are those resulting from the evolution of some other condition, being more frequent at the expense of tumors of the large intestine or rectum.

In the case of cirrhosis, the risk is increased for primary liver cancer.

Types of cirrhosis

Cirrhosis is a condition that can vary according to the cause and the way it manifests itself in the body. The condition has some specific types, which we will explain further below:

Hepatical cirrhosis

A condition with the highest occurrence, liver cirrhosis is caused by damage to liver cells, which are replaced by scar tissue. It can be understood as the final stage of fibrosis of the liver, in which most cases are irreversible.

To try to fight these cells, the body begins to reproduce abnormally, causing lumps in the liver.

Cirrhosis can have several causes, such as excessive consumption of alcohol and fats, some medications, viruses and liver diseases.

Alcoholic cirrhosis

Alcoholic cirrhosis is a condition resulting from the excessive use of alcoholic beverages. It can be understood as the advanced stage of alcoholic liver disease, represented by the appearance of diffuse fibrosis and regenerative nodules.

Biliary cirrhosis

This condition can be subdivided into primary and secondary, resulting from an abnormality in the immune system, which causes inflammation and the destruction of some bile ducts (structures along the bile).

Bile is a fluid produced by the liver, responsible for participating in the process of digesting fats and absorbing nutrients.

In biliary cirrhosis, the normal flow of bile to the intestine is blocked.

Post-necrotic cirrhosis

As the name suggests, this condition is related to the necrosis (death of cells) of parts of the liver, often due to the use of drugs or exposure to bacteria.

In addition, one of the main causes of the development of post-necrotic cirrhosis is infection with viral hepatitis (B and C).

Stages of cirrhosis

Cirrhosis can be classified into stages, understood as:

  • Stage 1 : It presents mild inflammation of the liver, with some scars, but few symptoms. It is also known as compensated cirrhosis ;
  • Stage 2 : This stage is characterized by an increase in portal hypertension (abnormal increase in blood pressure in the portal vein), in addition to the appearance of varicose veins;
  • Stage 3 : This stage is classified as decompensated cirrhosis , with complications such as hemorrhages, encephalopathy and others. It is possible to notice the development of abdominal swelling, in addition to the advancement of the scars present in the liver;
  • Stage 4 : Patients in this stage develop Terminal Hepatic Disease, in which a transplant is necessary to maintain the patient’s life.

Causes

Cirrhosis is a slow condition that develops over time. Thus, it is necessary to be aware of the possible factors that cause the development of the condition, among which we can mention:

Alcoholism

Alcohol is a substance that, if consumed in excess, causes swelling of the liver. After years of consuming the substance, the consequence may be the development of cirrhosis.

Infections with viral hepatitis B or C

Hepatitis by itself is already configured as an inflammation in the liver, which means that the chances of some type of complication occurring are greater, as the organ will already be affected.

The condition is silent and without proper treatment, it can develop into cirrhosis.

Liver fat (fatty liver)

The accumulation of fat in the liver makes it difficult to metabolize the food eaten. If not treated through diet and weight loss, that fat may develop cirrhosis.

Medicines

The liver is responsible for the storage, reserve and regeneration of all substances ingested and processed by the body.

Thus, some types and quantities of medications can end up causing an overload of this organ, which as a consequence, triggers cirrhosis.

Other causes

In some cases, the appearance of cirrhosis may be due to:

  • Digestive disorders;
  • Cystic fibrosis;
  • Iron accumulation in the body;
  • Malformation of the bile ducts;
  • Alpha-1 antitrypsin deficiency (genetic disease where there is less production of the AAT protein in the liver).

Risk factors

Cirrhosis is a condition that can present several risk factors, such as diabetes and dyslipidemia (increased cholesterol in the body), which are the most frequent.

Among the other factors we can mention:

  • Arterial hypertension;
  • Anabolic steroids;
  • Hypogonadism (malfunction of the gonads);
  • Hypothyroidism;
  • Deficiency of acid lipase (hereditary disease caused by the lack of enzyme lipase);
  • Chemicals;
  • Obesity;
  • Alcoholism;
  • Family history.

What are the symptoms of cirrhosis?

Cirrhosis is known to be a silent condition, that is, the symptoms are only noticed when there is already extensive liver damage.

In the initial stages it is possible for the person to have: red and stained palms, nausea and nausea, tenderness and pain in the liver region, in addition to angiomas (small red spots) located above the waist.

It is also possible for the patient to notice the following symptoms:

Weight loss and appetite

Weight loss and appetite are due to the liver’s difficulty in absorbing fats and vitamins , since the organ is not performing its functions properly.

Fatigue

It affects more than half of people who have cirrhosis, however, it is a symptom present even at the beginning of the condition. Its explanation is not yet proven, but this is a symptom widely observed in patients with liver disease.

Insomnia

This is considered a common symptom among patients at the onset of cirrhosis. This is because cirrhosis is a condition that is associated with obstructive sleep apnea, that is, the person has their airways obstructed, leading to difficulties and even stops breathing while sleeping.

Other symptoms

In addition to these, it is also possible to present symptoms that represent a greater wear and tear of the liver, already at a slightly more advanced stage of the condition, as is the case of:

  • Hair loss;
  • Vomiting with the presence of blood;
  • Swelling in the legs, ankles and feet;
  • Dark urine;
  • Muscle cramps;
  • Tachycardia;
  • White nails;
  • Impotence and decreased libido;
  • Irregular menstruation or absence of menstruation (in women);
  • Breast enlargement and testicular shrinkage (in men).

Complications: symptoms of advanced cirrhosis

In the most advanced stage of the condition, the liver is no longer able to function properly. The most frequent complications are:

Ascites

This condition can be understood as an accumulation of fluid in the abdominal cavity.

This occurs due to pressure in the portal vein, which as a consequence causes a swelling in the abdomen region.

The ascites can lead to liver failure to produce certain substances, such as albumin.

Jaundice

This condition can be seen in the change in the color of the skin and eyes, which turn yellow. This is because when the liver is damaged, it cannot eliminate enough bilirubin, a substance present in bile.

Portal hypertension

Cirrhosis is a condition that causes changes in the structure of the liver, compromising its functions. This causes, when trying to take the blood from the intestine to the liver, exaggerated pressure in the blood capacity of the portal vein. As a result, portal hypertension arises.

Encephalopathy

Encephalopathy is characterized by neuropsychiatric disorders. When the liver is damaged, the elimination of toxins by the body cannot be ideal. These substances accumulate in the brain, causing mood swings and mental confusion.

How is the diagnosis made?

Because, in the early stages, asymptomatic, cirrhosis is a condition that is usually diagnosed by means of a blood test.

In addition, your hepatologist may find it necessary to perform some imaging tests, as we will explain below:

Liver function tests

These tests aim to detect any change in the functioning of the liver, such as excess bilirubin. They can include AST, ALT, alkaline phosphatase, GGT, albumin, total bilirubin tests, etc.

Through the results it will be possible to diagnose the causes behind cirrhosis, as well as the severity of the condition.

Image tests

Imaging tests often do not detect liver depreciation, however, they can be used to identify possible complications from cirrhosis.

Among them, the most used is the magnetic resonance elastography (MRE). It is also possible for the doctor to order a CT scan or ultrasound.

Endoscopy

This examination aims to check for the existence or development of varicose veins in the esophagus or stomach. The procedure is performed with the aid of a mini camera (endoscope).

Liver biopsy

Biopsy is the removal of a piece of the liver for clinical analysis. The procedure is performed with a small needle that goes through the skin, until it reaches the liver and collect the sample for testing.

Is there a cure?

No . Cirrhosis is a condition that permanently damages the liver. The available treatments seek only to prevent its progression and to address the underlying causes. However, there is the possibility, depending on the case, of having a liver transplant. Thus, the patient has a chance of recovering his health.

What is the treatment?

As it does not have a specific cure, the most effective treatment option ends up being liver transplantation itself.

However, it is possible to treat symptoms and causes, as a way to control them and, consequently, fight the evolution of this condition:

Use of medicines

The drugs used to treat cirrhosis are aimed at relieving symptoms, such as fatigue and discomfort, or to treat an underlying condition, such as hepatitis. That is, they are not indicated for cirrhosis itself.

It is important to talk to the doctor responsible for the treatment and check the possibility of using a drug.

Interruption of alcohol consumption

Cirrhosis patients should stop alcohol consumption permanently. In some cases, the doctor may find it necessary to refer the patient to a support group in order to improve dependency control.

Pressure control of the portal vein

The vein responsible for supplying blood to the liver is known as the portal vein. In some cases, the blood may recede and, as a result, cause high blood pressure in the region. Some medications are indicated to decrease and correct these changes.

Injection sclerotherapy

In order to contain the possible bleeding caused by the portal vein, an endoscopy is performed, injecting a substance that forms a blood clot, in order to control the bleeding.

Screening exams

In some cases, the doctor may feel the need to perform a battery of tests, both blood and imaging, in order to control and track a possible development of liver cancer.

Liver transplant

Depending on the stage the condition is in, doctors may find it necessary to have a liver transplant. In this procedure, the damaged liver is replaced with a “new” one, coming from a healthy donor.

This option is usually indicated only when the patient is life-threatening, when there is commonly a diagnosis of terminal liver disease.

Living together

The important thing for people living with this condition is to be alert to any symptoms and follow a healthy lifestyle.

This includes exercising, avoiding alcohol consumption and maintaining a balanced diet, since excessive consumption of fats can further damage the liver.

In addition, it is super important to maintain a medical routine, always monitoring the development or appearance of new complications resulting from cirrhosis. Another factor that can also help is to protect yourself from colds and flu, keeping vaccination up to date.

Prognosis and life span

Cirrhosis is an irreversible and progressive condition. However, with adequate treatment and early diagnosis it is possible that the patient has a good quality of life and the progression of the condition is even halted.

However, in the more advanced stages, when the liver’s functions are already quite compromised, there are risks to the patient’s life.

Thus, the prognosis will depend a lot on the underlying cause and the stage in which the cirrhosis is.

There are currently several ways to determine a person’s life expectancy. Cirrhosis is a condition that can be determined from a score for liver disease.

These scores are defined according to the classification of each person’s individual condition. They may involve methods such as the Child-Turcotte-Pugh Score (CTP) and the MELD Scale.

We reinforce that these classifications are made by a specialist, after clinical evaluation.

Deaths from cirrhosis

The main causes of death from cirrhosis are due to liver failure or internal bleeding, also known as varicose veins, which occur due to portal hypertension.

It is estimated that 48% of cirrhosis deaths are due to excessive consumption of alcoholic beverages.

However, the same study, carried out by Revista Brasileira de Epidemiologia, also pointed to a reduction in mortality rates due to cirrhosis (from 11.4 to 9.5), in addition to a stabilization in the number of cases of liver cancer (1, 5 to 1.9) between the years 1990 and 2015.

How to prevent cirrhosis?

It is recommended that people with a tendency to develop cirrhosis and viral hepatitis, follow some habits, such as:

Avoid alcohol abuse

Excessive consumption of alcoholic beverages can make the liver unable to metabolize the amount ingested, altering or, in some cases, even destroying liver cells.

Therefore, the ideal is to avoid drinking, or at least reduce consumption. If you have a liver disease, it is recommended not to drink alcohol.

Keep exams up to date

Regular medical follow-up with a hepatologist is important. If any condition is diagnosed, it will still be in its initial stage, facilitating the treatment process.

Avoid sharing personal items

Some conditions like hepatitis B can be transmitted through fluid exchange with an infected person.

That is, when sharing needles and syringes, for example, the chances of you contracting this condition are significantly increased.

Get vaccinated

Another important and significant measure is to keep vaccines up to date to avoid contracting viral infections. Hepatitis A and B have a vaccine.

Using condoms

Some conditions, in particular viral hepatitis, can be contracted through sexual intercourse. In addition, there is a risk of contracting STDs. So always use a condom .


Cirrhosis is an irreversible chronic alteration, in which the liver tissue is replaced by abnormal regenerative nodules. However, it is a condition that can be alleviated and controlled through healthy habits.

So, if you know someone who has cirrhosis and needs to take better care of themselves, share this text so that more people can know how to act in the face of this condition!

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