What is liver cirrhosis, and how does it develop?
Cirrhosis is the irreversible scarring of the liver—the gradual replacement of functional liver tissue with fibrosis and regenerative nodules—leading to the loss of liver function. It is the common end stage of many chronic liver diseases. Arnaud, Ph.D. in Pharmacy, notes that semiannual ultrasound monitoring is essential for all patients with cirrhosis. See our hub on liver disorders.
- Chronic alcoholism: the leading cause in France — > 20 g/day for women, > 30 g/day for men for > 10 years — steatosis → alcoholic hepatitis → cirrhosis — complete abstinence from alcohol = the only intervention that alters the prognosis
- Chronic hepatitis B and C: HCV → cirrhosis within 20–30 years in 20–30% of cases — antiviral treatment (DAAs for HCV) can stabilize or even reverse early fibrosis — see our hepatitis page
- NASH (nonalcoholic steatohepatitis): a rapidly increasing cause — linked to obesity, type 2 diabetes, and metabolic syndrome — 7–10% weight loss = documented improvement in fibrosis
- Less common causes: primary biliary cirrhosis, sclerosing cholangitis, hemochromatosis (iron overload), Wilson’s disease (copper)
- Liver fibrosis: stages F0–F4 (METAVIR) — Fibroscan (pulse elastography) assesses fibrosis without a biopsy — F4 = established cirrhosis
Complications of cirrhosis and warning signs
- Portal hypertension (PH): obstruction of portal blood flow → increased pressure in the portal vein → esophageal and gastric varices (risk of rupture and massive gastrointestinal hemorrhage)
- Ascites: accumulation of fluid in the abdominal cavity — hypoalbuminemia + PHT — treatment: strict salt-restricted diet (< 2 g/day) + diuretics (spironolactone) + paracentesis if resistant
- Hepatic encephalopathy: accumulation of undetoxified ammonia → confusion, asterixis, coma — oral lactulose (acidifies the colon, traps NH3) + rifaximin — see our page on liver failure
- Hepatocellular carcinoma (HCC): occurs in 3–5% of patients with cirrhosis each year — mandatory screening: ultrasound + α-FP every 6 months — treatment: ablation, chemoembolization, transplantation depending on the stage
- Jaundice: see our jaundice page — unconjugated bilirubin accumulates in decompensated cirrhosis — sign of poor prognosis (Child-Pugh score + MELD)
Treatment, Nutrition, and Additional Support
- Total alcohol abstinence: an absolute requirement—improves survival even in advanced cirrhosis—possible regression of fibrosis in early stages
- Liver transplantation: the only curative treatment—criteria: MELD > 15 or refractory complications—6 months of proven alcohol abstinence required—5-year survival: 75–80%
- Nutrition in cirrhosis: protein 1.2–1.5 g/kg/day (myth of protein restriction — myopathy = major prognostic factor) — 5–6 small, frequent meals — evening snack rich in complex carbohydrates (limits catabolism) — salt < 2 g/day if ascites is present
- Milk thistle (silymarin): hepatoprotective as adjunctive therapy — documented antifibrotic effect at high doses — positive data in compensated cirrhosis — medical consultation required
- Zinc 25–45 mg/day + vitamin D3 (nearly universal deficiency in cirrhosis): immune and metabolic support — in addition to specialized hepatological follow-up
Medical follow-up, prevention, and psychological impact
- Specialized hepatological follow-up: consultation every 3–6 months — laboratory panel (PT/INR + AST/ALT + bilirubin + albumin + creatinine + complete blood count) — Annual Fibroscan — α-FP + ultrasound every 6 months (HCC screening)
- Upper gastrointestinal endoscopy (EGD): initial evaluation and monitoring of esophageal varices — prophylactic treatment with propranolol or ligation if significant varices are present
- Vaccinations: hepatitis A and B (if not immunized), pneumococcal, annual flu vaccine — relative immunosuppression associated with cirrhosis
- Psychological impact: frequent anxiety and depression — psychological support + patient organizations (AFEF, SOS Hépatites) — hepatic encephalopathy may mimic psychiatric disorders
- Medications to avoid: NSAIDs (renal failure + gastrointestinal bleeding), aminoglycosides, acetaminophen > 2 g/day — always consult a specialist before starting any new medication or supplement
