Facts about Cirrhosis
What is cirrhosis?
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism. Each time your liver is injured — whether by disease, excessive alcohol consumption or another cause — it tries to repair itself with scar tissue. As the scarring increases, it replaces healthy liver tissue, resulting in decrease of amount of healthy liver. There are four stages of fibrosis:
F0: no fibrosis
F1: minimal fibrosis
F2: Moderate fibrosis
F3: Advanced fibrosis
F4: Cirrhosis (late stage of scarring (fibrosis)
What causes the cirrhosis?
Any damage to liver tissue due to any reason will result into scarring and fibrosis. Common conditions are alcohol consumption, hepatitis C, hepatitis B, non-alcoholic steatohepatitis, genetic diseases, and many other diseases.
How long it takes to develop cirrhosis?
It varies depending upon the type of disease or injury to liver. It varies from 6 months to 40 years; on an average it takes almost 20 years from beginning of damage to cirrhosis?
How do we identify fibrosis and cirrhosis?
The gold standard test to assess fibrosis is liver biopsy, obtaining liver tissue by means of a needle and examining it under microscope. However, now several tests are available to estimate the amount of scar (fibrous) tissue in liver. These include the following
· Mathematical calculated models: APRI Score, Fib-4 score, NAFLD fibrosis score. These scores are derived from routine blood tests.
· Imaging elastography: Transient elastography (Fibroscan), shear wave elastography (SWE), magnetic resonance elastography (MRE)
Ultrasound, CT scan or MRI scans: These imaging techniques are good only in the setting of significantly advanced cirrhosis, also these routine imaging techniques do not have the ability to quantify the fibrosis, hence can not be used to monitor the response of treatment.
Why is it important to know the degree of fibrosis?
Higher the degree of fibrosis, higher is the risk of life-threatening complications and death
Is fibrosis and cirrhosis reversible?
YES, it is reversible with treatment of cause of liver damage such as treating HCV or HBV, quitting alcohol or management of NASH and liver diseases. Assuring adequate care will help prevent developing life-threatening complications.
What are the complications of cirrhosis?
There are three main groups of life-threatening complications
1. Portal hypertension
2. Liver failure
3. Liver cancer
What happens if someone develops any of the above?
Risk of death is significantly high in the upcoming years also such complications rapidly deteriorate physical functionality of patient with resultant poor quality of life.
What is decompensated cirrhosis?
Once patient develops any of the above life-threatening complications, it is called as decompensated cirrhosis.
When is liver transplantation needed?
Once some one develops decompensated cirrhosis, liver transplantation is needed. But only a proportion of the patients qualify to get on the wait list.
How many types of liver transplantation exists in USA?
There are two types of donors: Deceased donor (DDLT) and living donor (LDLT). Living donor transplantation reduces the time of poor quality of life while waiting for deceased donor liver transplantation.