What is the last stage of fatty liver?

Fatty liver disease is a condition characterized by the buildup of excess fat in the liver cells. It can range from simple fatty liver, which is usually harmless, to more advanced conditions like non-alcoholic steatohepatitis (NASH) and cirrhosis. The last stage of fatty liver disease is cirrhosis, which involves permanent scarring of the liver.

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What causes fatty liver disease?

The most common causes of fatty liver disease are:

Obesity
Diabetes
Dyslipidemia (high cholesterol and triglycerides)

Poor diet high in fat and calories
Lack of exercise

When fat builds up in the liver, it can trigger inflammation and liver cell damage. Over time, this can lead to scarring of the liver tissue known as fibrosis. If the scarring becomes severe, it results in cirrhosis.

What are the stages of fatty liver disease?

Fatty liver disease typically progresses through the following stages:

Simple fatty liver or steatosis: Excess fat builds up in the liver but there is little or no inflammation or liver damage. This stage does not usually cause symptoms.
Non-alcoholic steatohepatitis (NASH): This more serious stage involves inflammation and liver cell damage in addition to fat buildup. This can lead to scar tissue formation.

Fibrosis: Scar tissue begins accumulating in the liver, which can disrupt normal functioning. Most people have no symptoms in this stage.
Cirrhosis: Severe scarring of the liver. This is the final and most serious stage of fatty liver disease.

What are the symptoms of cirrhosis, the last stage of fatty liver disease?

Cirrhosis has a number of symptoms and complications, including:

Jaundice – yellowing of the skin and eyes
Itchy skin
Abdominal swelling or fluid buildup (ascites)

Easy bruising or bleeding
Chronic fatigue
Loss of appetite and unintended weight loss

Spider-like blood vessels under the skin
Redness in the palms
Confusion, sleepiness and forgetfulness

Failure of other organs like the kidneys

Many of these symptoms result from a buildup of toxins in the body that would normally be filtered out by the liver. They signify that the liver has suffered severe damage.

What are the complications of cirrhosis?

Some potential complications of cirrhosis include:

Liver cancer – People with cirrhosis have an increased risk of liver cancer.
Gastrointestinal bleeding – Cirrhosis can cause increased pressure in the portal vein bringing blood to the liver, resulting in enlarged veins that can rupture and bleed.
Infections – Cirrhosis weakens the immune system, increasing susceptibility to bacterial infections as well as sepsis.

Kidney failure – The kidneys can fail as toxins build up in the body.
Fluid in the abdomen (ascites) – Cirrhosis impairs the flow of blood through the liver, increasing pressure in the portal vein. This causes fluid from the blood vessels to leak into the abdominal cavity.
Hepatic encephalopathy – Buildup of toxins can affect brain function, causing confusion, personality changes and coma.

What tests diagnose cirrhosis?

Cirrhosis may be suspected based on symptoms, risk factors and physical exam, but other tests are needed to confirm the diagnosis. These can include:

Blood tests to check liver function
Imaging tests like ultrasound, CT scan or MRI to evaluate liver damage

FibroScan – Uses vibration waves to measure liver stiffness and scarring
Liver biopsy – The definitive diagnostic test where a tissue sample is examined under a microscope

What is the life expectancy with cirrhosis?

Life expectancy with cirrhosis depends on several factors:

Cause of cirrhosis – Viral hepatitis shortens lifespan more than fatty liver disease or autoimmune cirrhosis.
Stage of cirrhosis – Early cirrhosis has a better prognosis than decompensated cirrhosis with major complications.
Response to treatment – Treating the underlying cause and managing complications can improve prognosis.

Overall health – Younger patients in otherwise good health may live longer.

On average, studies show:

Cirrhosis from chronic hepatitis C: 16-20 years of life expectancy after diagnosis.

Cirrhosis from nonalcoholic fatty liver disease: 8-10 years.
Decompensated cirrhosis with complications: 1-3 years.

But there is high variability between individuals based on many factors.

Can cirrhosis be reversed?

Unfortunately, cirrhosis itself cannot be reversed. However, treating the underlying cause can stop or slow the progression of liver damage. For example:

Fatty liver disease can be improved with weight loss, diet changes and better control of diabetes and cholesterol.
Abstaining from alcohol can halt liver damage in alcoholic liver disease.

Antiviral medications can suppress viral replication in hepatitis B and C, slowing cirrhosis progression.
Medications and dietary changes can manage autoimmune diseases like autoimmune hepatitis.

Although cirrhosis cannot be reversed, proper management can stabilize liver function and prevent or delay serious complications.

Can you live a normal life with cirrhosis?

The effects of cirrhosis on daily life depend largely on the stage and severity of liver disease:

Early-stage cirrhosis may not cause any symptoms or impact longevity, allowing a normal lifestyle.
As cirrhosis advances, complications like ascites, variceal bleeding and encephalopathy can significantly impact quality of life.

Routine checkups and optimized management of complications are key to maintaining normalcy.
Avoiding alcohol, infections, certain medications and other liver toxins helps stabilize the condition.
Low-sodium diet, diuretics and paracentesis can control fluid retention and ascites.

Beta blockers, band ligation and other interventions can reduce the risk of variceal bleeding.
A balanced diet, vitamin supplements and reduced protein intake can improve hepatic encephalopathy.
Liver transplantation may be an option for some patients with severe cirrhosis.

Many people with stable cirrhosis can engage in normal work, family and social life with proper medical care. However, the outlook depends greatly on the specific circumstances.

What is the treatment for cirrhosis?

Although cirrhosis is not curable, treatment aims to slow progression, manage complications, and prevent further liver damage. This may involve:

Treating underlying diseases – For example, weight loss for fatty liver or antivirals for hepatitis.

Lifestyle changes – Healthy diet, exercise, alcohol avoidance and smoking cessation.
Medications – Diuretics, beta blockers, antibiotics, laxatives etc.
Therapeutic procedures – Paracentesis, band ligation of varices, endoscopic treatments.

Liver transplant – For end-stage cirrhosis with liver failure.

Treatment is tailored to each patient and evolves as the disease progresses. The best outcomes require diligent monitoring and proactive management by both the patient and their healthcare team.

What is the survival rate for cirrhosis?

Survival rates for cirrhosis vary greatly depending on multiple factors, including:

Cause – 5-year survival is 60-70% for alcoholic cirrhosis, 65-80% for cirrhosis from chronic hepatitis B.
Stage – Compensated cirrhosis has a 5-year survival around 90%. Decompensated cirrhosis has a 15-30% five-year survival.
Availability of transplant – Transplant provides 65% five-year survival for decompensated cirrhosis.

Presence of complications – Refractory ascites, bleeding varices, encephalopathy worsen prognosis.
Response to treatment – Survival is improved with adherence to medications and lifestyle changes.

In summary, early intervention and optimal management are key to improving chances of survival with cirrhosis.

What happens in end-stage cirrhosis?

End-stage or decompensated cirrhosis occurs when extensive liver scarring results in liver failure. Hallmarks of end-stage cirrhosis include:

Portal hypertension – Increased blood pressure in the hepatic portal vein.
Ascites – Fluid accumulation in the abdomen.

Variceal bleeding – Ruptured blood vessels in the esophagus or stomach.
Hepatic encephalopathy – Confusion and altered mental status.
Kidney failure

Impaired blood clotting
Jaundice and fluid retention
Failure to metabolize hormones, toxins and medications.

Patients develop thin, wasted muscles, enlarged spleen, easy bruising and bleeding, itching, and spider-like blood vessels under the skin. Without a liver transplant, most patients with end-stage cirrhosis will eventually succumb to liver failure.

Conclusion

In summary, cirrhosis represents the final stage in the progression of fatty liver disease. It is characterized by widespread scarring that impairs liver function. Symptoms result from the buildup of toxins, portal hypertension, and liver dysfunction. While cirrhosis cannot be reversed, early treatment and careful management can maintain quality of life and improve prognosis. For decompensated end-stage disease, liver transplant may offer the only hope for survival.