Is liver cirrhosis a silent killer?

What is liver cirrhosis?

Liver cirrhosis is a chronic disease that causes progressive scarring of the liver tissue over many years. The scarring replaces healthy liver tissue with fibrous scar tissue, which prevents the liver from functioning properly. Cirrhosis is the final stage of various chronic liver diseases such as chronic viral hepatitis (hepatitis B and C), alcohol abuse, and fatty liver disease.

The main causes of cirrhosis include:

• Chronic alcohol abuse: Drinking too much alcohol over many years can cause liver inflammation and lead to cirrhosis. Alcohol abuse is the most common cause of cirrhosis in the United States.
• Chronic viral hepatitis: Hepatitis B and C viruses cause liver inflammation and damage that can eventually lead to cirrhosis. Hepatitis C is the most common cause of cirrhosis needing liver transplant.
• Nonalcoholic fatty liver disease (NAFLD): The buildup of fat in the liver can lead to liver cell damage, inflammation, and eventually cirrhosis. NAFLD is becoming a more common cause of cirrhosis.
• Autoimmune disorders: Autoimmune diseases like primary biliary cirrhosis and autoimmune hepatitis cause the body’s immune system to attack and destroy healthy liver tissue leading to inflammation and eventually cirrhosis.
• Inherited diseases: Genetic disorders like hemochromatosis, Wilson’s disease, alpha-1 antitrypsin deficiency, and glycogen storage diseases can damage the liver and lead to cirrhosis.

When scar tissue replaces healthy cells, the liver is unable to perform its vital functions normally. Some of these functions include:

• Filtering harmful substances from the blood
• Processing nutrients, medications, and hormones
• Storing energy and nutrients
• Regulating blood clotting
• Releasing bile to help digest fats

As cirrhosis gets worse, the liver slowly starts failing. Serious complications can then develop.

What are the symptoms of cirrhosis?

The early stages of liver cirrhosis often have no symptoms. That’s why it has been called “the silent killer.” As the disease gradually progresses, some signs and symptoms may develop. However, the symptoms are usually vague and nonspecific. They may include:

• Fatigue and weakness
• Loss of appetite and unintended weight loss
• Nausea or vomiting
• Abdominal pain or discomfort
• Itchy skin
• Jaundice (yellowish discoloration of skin and eyes)
• Swelling in legs, feet, and ankles (edema)
• Spider-like blood vessels on the skin
• Enlarged abdomen due to fluid accumulation

Some people may also experience psychological changes like forgetfulness, confusion, or impaired concentration and attention.

As the liver becomes more damaged, more obvious signs and symptoms can appear:

• Fluid accumulation in the abdomen (ascites)
• Easy bruising and abnormal bleeding
• Portal hypertension – high blood pressure in veins bringing blood to liver
• Varices – enlarged and swollen veins especially in the esophagus and stomach
• Yellowing of skin and eyes (jaundice)

These symptoms indicate severe liver damage. People with advanced cirrhosis are at high risk of liver failure.

Why is cirrhosis called a silent killer?

There are a few reasons why cirrhosis has been dubbed a “silent killer”:

• It can develop slowly over many years with vague or no symptoms initially. Many people are unaware they have liver damage in the early stages.
• Symptoms when they do appear are nonspecific and mimic other conditions. Symptoms like fatigue and weakness are not unique to liver disease.
• There are no pain receptors in the liver, so even severe liver damage doesn’t cause pain. Pain typically appears when the disease is advanced.
• Liver function tests detecting cirrhosis can be entirely normal early in the disease. Normal lab tests may give false reassurance.
• People at highest risk (alcoholics) often avoid medical care. By the time they do get diagnosed, the disease is advanced.

Without treatment, cirrhosis tends to gradually get worse over time. Catching it early and stopping its progression is key. But its silent nature means many cases go undetected until late stages when serious complications arise.

What are the complications of advanced cirrhosis?

As scar tissue replaces healthy liver tissue, the liver slowly loses its ability to function normally. This eventually leads to serious complications:

• Portal hypertension: Scar tissue blocks normal blood flow through the liver. This increases pressure in the portal vein (brings blood from spleen and intestines).
• Ascites: High pressure in the portal vein causes fluid leakage into the abdomen (ascites). Patients accumulate large amounts of fluid requiring drainage.
• Varices: Increased portal pressure causes veins in the esophagus and stomach to dilate and swell. These varices are fragile and prone to rupture and severe bleeding.
• Gallstones: Impaired bile flow leads to gallstone formation.
• Splenomegaly: The spleen frequently enlarges and sequesters platelets and white blood cells.
• Liver cancer: Cirrhosis increases the risk of liver cancer.
• Liver failure: End-stage cirrhosis results in decompensated liver failure.
• Infections: Patients are more prone to serious bacterial infections.
• Kidney failure: The failing liver cannot adequately process waste products, toxins, and drugs. This can lead to kidney damage and failure.
• Mental confusion (encephalopathy): Toxins buildup can cause confusion and altered level of consciousness.

Cirrhosis was the 12th leading cause of death in the United States in 2018. Most deaths are due to complications of advanced liver failure.

Can cirrhosis be cured?

Currently, there is no cure for cirrhosis. However, progression of the disease and serious complications can often be prevented. Key is early diagnosis and prompt treatment.

If caught early, stopping the insult to the liver can halt progression of damage. For example, abstaining from alcohol prevents further damage in alcohol-related cirrhosis. Effective antiviral treatments for hepatitis B and C can slow or stop liver damage. Losing weight and managing diabetes helps stabilize nonalcoholic fatty liver disease.

Medications can treat some of the complications of cirrhosis. For example, diuretics (“water pills”) rid the body of excess fluid accumulation. Beta-blocker drugs decrease portal blood pressure. Antibiotics treat infections. Other drugs help reduce enlarged spleen and decrease collateral vessel formation.

The only definitive treatment for advanced cirrhosis is liver transplant. However, transplantation is not always feasible due to donor liver shortage and cost.

Some ways to prevent the progression of cirrhosis include:

• Stop drinking alcohol completely. Alcohol cessation is essential for alcohol-related cirrhosis.
• Take all prescribed medications for viral hepatitis. New treatments can effectively suppress hepatitis B and cure hepatitis C before cirrhosis develops.
• Lose weight and control diabetes and cholesterol through diet, exercise, and medications. This helps stabilize nonalcoholic fatty liver disease.
• Avoid certain medications that can worsen liver disease such as acetaminophen, steroids, and methotrexate.
• Get vaccinated against hepatitis A and B to prevent viral-induced liver damage.
• Treat autoimmune disorders causing liver inflammation and damage.
• Have regular medical check-ups to detect liver disease early.

Following these preventive steps provides the best chance to stop cirrhosis progression and avoid serious, potentially fatal complications.

What tests diagnose cirrhosis?

If cirrhosis is suspected based on risk factors, symptoms, and physical exam, a combination of blood tests and imaging studies are used to confirm the diagnosis:

• Blood tests: Liver function blood tests check levels of proteins, liver enzymes, bilirubin, and other markers of liver damage. Complete blood count assesses for anemia and low platelet count.
• Imaging tests: An abdominal ultrasound, CT scan, or MRI provides images of the liver and checks for scarring, nodularity, enlargement of the spleen, and fluid in the abdomen.
• Transient elastography: A special ultrasound called FibroScan measures the stiffness of the liver, which correlates with the degree of cirrhosis scarring.
• Liver biopsy: Removing a small sample of liver tissue to examine with a microscope is the most definitive way to diagnose and determine the severity of cirrhosis.

Based on the test results, doctors determine the extent of liver damage. They also try to pinpoint the cause, which guides appropriate treatment.

What are the risk factors for cirrhosis?

Certain behaviors and conditions increase the risk of developing cirrhosis:

• Chronic alcoholism: Drinking heavily for many years is the most common risk factor in the United States.
• Chronic hepatitis B or C infection: Chronic viral hepatitis can cause progressive liver inflammation and damage.
• Nonalcoholic fatty liver disease (NAFLD): Fat accumulation in the liver, often due to obesity and diabetes, can lead to cirrhosis.
• Autoimmune disorders: Diseases like autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis attack liver cells.
• Genetic diseases: Inherited disorders such as hemochromatosis, Wilson’s disease, and alpha-1 antitrypsin deficiency affect the liver.
• Type 2 diabetes: Poorly controlled blood sugar increases the risk, especially when accompanied by obesity.

The following behaviors also raise the risk:

• Obesity
• Metabolic syndrome
• Smoking
• Family history of liver disease
• Long-term exposure to toxins

Doctors also screen patients with these high-risk conditions to detect liver disease and cirrhosis earlier.

Conclusion

In summary, cirrhosis is a “silent killer” because it slowly damages the liver over many years with few overt symptoms initially. Many people are unaware of their liver disease until it’s quite advanced.

Catching cirrhosis early and halting liver damage reduces the risk of serious, life-threatening complications from liver failure. That’s why at-risk individuals should maintain regular doctor visits for evaluation and prompt treatment. Controlling underlying liver disease provides the best way to prevent cirrhosis progression and ultimate liver failure.