Liver cirrhosis causes nodular transformation of liver parenchyma with progressive deterioration of liver function. Liver Transplantation is a sustainable curative option for liver cirrhosis.
The patients of liver cirrhosis may live for a long time without needing liver transplantation, if they stay away from chemicals harming liver like alcohol, certain drugs and include a balanced, protein rich diet and regular exercise in their lifestyle. They must be in regular follow up with their physician with regular blood reports and imaging reports, as advised by the doctor.
There are certain alarming symptoms and signs in liver cirrhosis, which must prompt the patient to reach the doctor or the hospital immediately.
1) Blood in vomitus or stool or coffee colored vomitus or black colored stool
Blood in vomiting or vomiting of ground coffee color is suggestive of bleeding from dilated veins (varices) in food pipe (esophagus) or stomach. Black colored stool with tar-like appearance is also suggestive of bleeding in gastrointestinal tract. These bleeding episodes may often turn to be life-threatening. One must immediately reach the hospital in event of any such episode. One may require upper GI endoscopy or colonoscopy to find the source of bleeding and control it.
2) Increasing abdominal girth
Increasing abdominal girth may be suggestive of fluid accumulation in abdomen, also known as ascites in medical term. Ascites formation is indication of deteriorating liver function. One must consult the doctor as control of ascites may require some diet modification and/or addition of some medicines, known as diuretics. Ascites, which is not controlled by diuretics (refractory ascites), or intolerance to diuretics (diuretic-intolerant ascites) may warrant an early liver transplantation.
3) Altered sensorium, altered sleep cycle or loss of consciousness
Ammonia is detoxified by liver. Once liver function deteriorates, ammonia is not excreted out and starts building up in blood. High ammonia circulating in blood, may cause altered sensorium, altered sleep cycle or loss of consciousness, also known as hepatic coma. The conglomeration of these features is also known as hepatic encephalopathy, which may turn out to be a life-threatening condition. Onset of any of these symptoms warrants urgent hospitalization. Control of blood ammonia levels may require certain measures like lactulose enema and lactulose syrup.
4) Jaundice – yellowish discoloration of eyes, skin and urine
New onset of jaundice may be related to a binge of alcohol drinking or may be indicative of worsening function of liver. One must visit the doctor in such situation to get evaluated.
5) Reduced urine output
Decreasing urine output in liver cirrhosis may be due to multiple causes like infection, hepatorenal syndrome (kidney dysfunction due to liver disease) or may indicate worsening of liver function. It may warrant hospitalization in some situations especially if it is associated with deranged kidney function tests or infection.
6) Acute pain in abdomen
Acute pain in abdomen in liver cirrhosis may be because of infection in fluid in abdomen (spontaneous bacterial peritonitis). It is a serious complication of liver cirrhosis and warrants hospitalization and intravenous antibiotics with tapping of fluid (ascites).
7) Fever
Liver cirrhosis compromises the immune system of a patient. Such patients are at risk of recurrent infections which may affect any part of the body, commonly – lungs, urinary system, and biliary system. It will require antibiotics and often hospitalization if infection is serious.
8) Difficulty in breathing
Patients with liver cirrhosis, may often develop fluid accumulation in abdomen or chest. Excessive fluid collection in abdomen can cause difficulty in breathing and/or difficulty in eating. Excessive fluid collection in chest can cause difficulty in breathing. One should immediately reach the hospital in any such situation. One may need removal of fluid and modification in medicines to relieve the symptoms and prevent further complications.
9) Significant weight loss
Sudden and significant weight loss (involuntary weight loss – more than 10% of weight in last 6 months or more than 5% of weight in last one month) may be indicative of worsening of liver function or onset of a new complication like liver cancer. In event of significant weight loss, one must immediately contact the doctor and get evaluated.
10) An abnormal mass or lesion on routine ultrasound or CT scan
Liver cirrhosis is a pre-malignant (cancer predisposing) condition. This is the reason, why, regular scans in form of ultrasound are advised for the patient. If during such scan, any mass or lesion in liver is detected, it warrants further evaluation in form of blood tests and CT scan or MRI. Such patients may require liver transplant, surgical resection of tumor containing part, ablation, TACE or chemotherapy, depending on the stage of the tumor, functional status of the liver, and general health status of the patient.
Conclusion
The patients with liver cirrhosis must stay in regular follow up with their physicians. Onset of any of the above symptoms must prompt them to reach the hospital and get evaluated by their physician.
The above is the management in brief about liver cirrhosis. If you have any patient suffering from liver problems, do consult your Liver specialist. To know more, feel free to call +91 6359 602647
