When the liver is damaged it produces new tissue that allows it to heal, but if it is cirrhotic it is unable to regenerate properly, because it begins to produce connective tissue and change its structure. If cirrhosis is early stage, the process can be reversed by treating the underlying cause, but when it is advanced, it is usually irreversible and a liver transplant becomes necessary. If not treated properly, cirrhosis can lead to liver failure and / or cancer. Knowing the signs of this disease will help you deal with it from its early stage, which is treatable.
Steps
Part 1 of 4: Knowing the Risk Factors
Step 1. Consider the amount of alcohol you consume
Alcohol damages the liver by blocking its ability to process carbohydrates, fats and proteins. When these elements accumulate at dangerous levels in the liver, the body reacts with inflammation which, consequently, leads to hepatitis, fibrosis and cirrhosis. However, excessive alcohol consumption alone is not enough to cause alcoholic liver disease. Only one in 5 habitual drinkers develops alcoholic hepatitis, while 1 in 4 develops cirrhosis.
- Men are considered "heavy drinkers" if they consume 15 or more alcoholic beverages in a week. Women, on the other hand, are considered "heavy drinkers" with 8 or more drinks per week.
- Know that cirrhosis can develop even after you stop drinking. In any case, abstinence still remains the best advice for individuals suffering from cirrhosis, because it improves the effects of the treatment and facilitates recovery, regardless of the stage of the disease.
- Although it is a more common disease in men, cirrhosis in women is much more often a direct consequence of alcoholism.
Step 2. Get tested for hepatitis B and C
Chronic inflammation of the liver and lesions resulting from both viruses can, after several decades, turn into cirrhosis.
- Risk factors for hepatitis B include unprotected sex, blood transfusions, and drug injection with contaminated needles. It is a much less common pathology in Western and developed countries thanks to vaccinations.
- Risk factors for hepatitis C include infections resulting from injectable drug use, blood transfusions and body piercings, and tattoos.
- Hepatitis C cirrhosis is the most common cause of liver transplantation.
Step 3. Keep in mind that there is a correlation between cirrhosis and diabetes
In 15-30% of people with cirrhosis, diabetes is a risk factor for the development of "non-alcoholic steatohepatitis (NASH)". Diabetes is also common in chronic hepatitis C infections - a widespread factor responsible for cirrhosis - possibly due to decreased function of the pancreas.
- Another cause of cirrhosis, often related to diabetes, is hemochromatosis.
- This pathology is characterized by iron deposits in the skin, heart, joints and pancreas; in the latter case it leads to diabetes.
Step 4. Take into account your current weight
Obesity carries a wide variety of health problems, from type 2 diabetes and heart disease to arthritis and stroke. However, the excess fat in the liver causes inflammation and the damage could lead to nonalcoholic steatohepatitis.
- To understand if you are within the weight range considered normal, you can use an online BMI (body mass index) calculator.
- The BMI calculation takes into account age, height, gender and weight.
Step 5. Know the risks of autoimmune and heart disease
If you suffer from an autoimmune disorder such as inflammatory bowel disease, rheumatoid arthritis or thyroid disease, be cautious. Although these conditions do not directly contribute to the development of cirrhosis, they do increase the risk of complications from other disorders that lead to it. Heart disease is a risk factor for nonalcoholic steatohepatitis which leads to cirrhosis. In addition, heart conditions that weaken the right side of the heart can cause liver stasis (“nutmeg liver”) and heart cirrhosis.
Step 6. Review your family's medical history
Some types of liver disease that cause cirrhosis are related to an inherited genetic factor. Check your family members' medical history regarding diseases that can increase the risk of cirrhosis:
- Hereditary hemosiderosis.
- Wilson's disease.
- Alpha-1 antitrypsin (AAT) deficiency.
Part 2 of 4: Recognizing the Symptoms and Signs
Step 1. Recognize the symptoms of cirrhosis
If you encounter these signs, you should bring them to the attention of a doctor as soon as possible: he will be able to formulate a professional diagnosis and indicate a therapy to start immediately. If, on the other hand, you are trying to understand if another person besides you suffers from cirrhosis, be sure to include her in your evaluation, as she may have symptoms that are not noticeable from the outside. Symptoms of cirrhosis are:
- Feeling tired or tired.
- Predisposition to bruising and bleeding.
- Edema (swelling) in the lower extremities.
- Yellow skin and eyes (jaundice).
- Fever.
- Loss of appetite or weight loss.
- Nausea.
- Diarrhea.
- Intense itching.
- Increase in abdominal circumference.
- Confusional state.
- Sleep disorders.
Step 2. Pay attention to varicose veins
The most correct terms for this pathology are spider angioma, stellar angioma or telangiectasia. It is an abnormal cluster of veins that emerge from a central blood vessel through a lesion. They usually appear on the trunk, face and upper limbs.
- To check if it really is a stellar angioma, press a piece of glass over the suspected group of veins.
- The red dot in the center of the spot will appear to pulsate because it turns red as blood enters it and then turns white as blood passes to the small newly formed veins.
- If spider angiomas are large and numerous, they indicate more severe cirrhosis.
- However, be aware that these are also common signs during pregnancy and severe malnutrition. Although rarely, they are visible even on healthy individuals.
Step 3. Look at your palms for redness
Palmar erythema presents with reddish spots on the palms and is caused by a metabolic change in sex hormones. This disorder primarily affects the outer edges of the palms, along the thumb and little finger, and typically spares the central area.
Other causes of palmar erythema can be pregnancy, rheumatoid arthritis, hyperthyroidism and problems with the circulatory system
Step 4. Pay attention to any changes in your nails
Liver disease, in general, often affects the skin, but if you look at the nails you can get more useful information. Muehrcke's lines are pairs of horizontal whitish lines that cross the nail bed and are the consequence of an insufficient production of albumin, which is processed exclusively by the liver. Pressing on these nails the white stripe disappears for a moment, before quickly reappearing.
- In the case of Terry's nails, 2/3 of the nail plate closest to the knuckle appears white, while the third closest to the fingertip is red. Again, the reason is due to an inadequate amount of albumin.
- Digital hippocratism (drumstick fingers) consists of a rounding and / or widening of the base of the nail and the tip of the finger. When severe, the fingers can look like drum sticks, hence the name "drumstick fingers". This problem is most often seen in biliary cirrhosis.
Step 5. Check for swelling in the long bone joints
If you notice recurrent swelling in the knee or ankle, for example, it can be a sign of "hypertrophic osteoarthropathy" (HOA). You may also feel a form of arthritis in the joints of the fingers and shoulders. This is the consequence, even quite painful, of chronic inflammation in the connective tissue surrounding the bone.
Know that the most common cause of HOA is lung cancer, so it is imperative to rule out this condition in order to be diagnosed
Step 6. Check if your fingers appear curled
"Dupuytren's contracture" is a thickening and shortening of the palmar fascia, the tissue that connects the different parts of the palm, which causes flexibility problems in the fingers, causing them to curl permanently. It is a more common feature in the ring and little fingers, and is often accompanied by pain and itching. The subject has difficulty holding objects, as the disturbance interferes with grip strength.
- Dupuytren's disease is common in alcoholic cirrhosis and occurs in about 30% of cases.
- However, smokers can also be affected, as well as alcohol users who do not have cirrhosis, workers who have to move their hands repeatedly, and people with diabetes mellitus and Peyronie's disease.
Step 7. Check for a firm mass in the male breast
Gynecomastia is a growth of glandular tissue in the male breast that extends from the nipples, as a result of an increase in the hormone estradiol, and is found in up to 2/3 of cases of cirrhosis. This disorder can also appear as a pseudogynecomastia; in this case, the enlargement of the male breast is due to fat, rather than to glandular development.
- To distinguish these two conditions, lie on your back and place your thumb and forefinger on each side of the breast.
- Approach them slowly. You should feel a firm, concentric rubber-like disc of tissue directly under the nipple area.
- If you feel a mass of tissue, it means gynecomastia is present. Otherwise, it is a pseudogynecomastia.
- Other pathologies with tissue proliferation, for example tumors, present with clusters in an off-center position with respect to the nipple.
Step 8. Look for symptoms of male hypogonadism
Men who have chronic liver problems, such as cirrhosis, have decreased testosterone production. Symptoms of hypogonadism include impotence, infertility, loss of sexual desire, and withered testicles. This disorder can also be caused by a testicle injury or a problem with the pituitary gland or hypothalamus.
Step 9. Look out for possible abdominal pain and swelling
These may be signs of ascites, a buildup of fluid in the peritoneal (abdominal) cavity. Be aware that if a lot of fluid builds up, you may also have difficulty breathing.
Step 10. Check your abdomen for prominent veins
Caput medusae is a pathological situation in which the umbilical vein opens, causing blood to rise up in the portal venous system. That blood is then diverted into the umbilical vein and then into the veins of the abdominal wall, making them highly visible on the abdomen. This increased prominence is called caput medusae because it resembles the head (caput) of Medusa, the figure of Greek mythology.
Step 11. Smell your breath for a musty smell
This indicates "fetor hepaticus", and is caused by a very serious hypertension, the same that causes caput medusae and Cruveilhier-Baumgarten syndrome. The smell comes from a greater amount of dimethyl sulfide, as a consequence of hypertension.
The venous murmur in the abdominal area becomes quieter when the doctor flattens the blood vessels by applying pressure to the skin above the navel
Step 12. Check if the eyes and skin are yellow
The cause of this staining is attributable to jaundice, a disease due to the increase in bilirubin when the liver is unable to process it effectively. Mucous membranes may also turn yellow, while urine may appear darker.
Know that yellow skin can also be a consequence of excessive intake of carotene through food (carrots). However, carrots do not cause the sclera of the eyes to turn yellow, as happens with jaundice
Step 13. Check your hands for asterisks
Ask the person you suspect may have cirrhosis to extend their hands out in front of them with the palms facing down. Your hands should start moving and "flapping" at the wrist like a bird's wings.
Asterisks can also occur in those suffering from uremia and severe heart failure
Part 3 of 4: Getting a Medical Diagnosis
Step 1. Ask your doctor to check for a change in the size of the liver or spleen
On abdominal palpation, the cirrhotic liver appears firm and nodular. Splenomegaly (enlarged spleen) is due to hypertension which in turn causes congestion in the spleen. Both of these conditions are signs of cirrhosis.
Step 2. See your doctor for Cruveilhier-Baumgarten syndrome
Most general practitioners are unable to check for this condition. The disorder consists of a form of ringing in the veins, which can be heard through a stethoscope in the epigastric (upper middle) region of the abdomen. As with the caput medusae, this problem can be caused by the ways in which different venous systems connect to each other in the case of venous hypertension.
The doctor will have to perform the Valsalva maneuver, a diagnostic technique that increases abdominal pressure; in this way he will be able to hear more clearly if the abdominal murmur is present, a symptom of Cruveilhier-Baumgarten disease
Step 3. Undergo the appropriate investigations
Your doctor will prescribe blood tests for cirrhosis. You will be taken blood and subjected to various laboratory tests, in order to obtain an accurate diagnosis of your problem. These analyzes may include:
- A complete blood count (or simply blood count) that checks, among other things, for the presence of anemia, leukopenia, neutropenia and thrombocytopenia, all of which are commonly found in cases of cirrhosis.
- A test for high serum transaminases and levels of other enzymes that might suggest alcoholic cirrhosis. Alcoholic cirrhosis usually has an AST / ALT ratio greater than 2.
- A total bilirubin measurement to compare your levels to those considered acceptable. Results may be normal in the first few months of the disease, but levels tend to rise as cirrhosis worsens. Keep in mind that increased bilirubin is not a good warning sign in primary biliary cirrhosis.
- A measurement of albumin levels. If the liver is cirrhotic, it is unable to synthesize albumin; it follows that the levels are lowered. However, this can also be seen in patients suffering from congestive heart failure, nephrotic syndrome, malnutrition and some intestinal diseases.
- The doctor may also undergo other blood tests such as: alkaline phosphatase, gamma-glutamyl transpeptidase (GGT), prothrombin time, globulins, serum sodium and hyponatremia.
Step 4. Undergo diagnostic imaging tests
These tests can help recognize cirrhosis, but are more useful for identifying its complications, such as ascites.
- Ultrasound is a non-invasive examination and widely available in hospitals. A cirrhotic liver appears small and nodular during an ultrasound. The classic manifestation of this disorder consists in the reduction of the right lobe of the liver and the enlargement of the left one. Nodules that appear with this test can be benign or malignant and need to be biopsied. Ultrasound is also able to detect if the caliber of the portal vein has increased or if collateral veins have formed that suggest portal hypertension.
- Computed tomography (CT) is generally not performed for cirrhosis, as it provides the same information as ultrasound, but in addition involves exposure to radiation and contrast media. Ask for medical reasons and a second opinion if this test is recommended.
- The use of magnetic resonance imaging is limited by the cost of the examination and the patient's possible intolerance, since it is a rather long and inconvenient procedure. Low signal strength on T1-weighted images indicates iron overload from hereditary hemochromatosis.
Step 5. Undergo a biopsy to get a definitive diagnosis
Checking for signs and symptoms and having blood tests are all great ways to confirm the suspicion of cirrhosis. However, the only way to really know for sure if the liver is cirrhotic is to do a liver tissue biopsy. Once the sample has been processed and examined under a microscope, your doctor will be able to tell you for sure if you have this disease.
Part 4 of 4: Undergo Treatments
Step 1. Allow the medical team to set up an appropriate treatment
Cases of mild or moderate cirrhosis are usually managed on an outpatient basis, with some exceptions. If the patient has major gastrointestinal bleeding, severe infection or septicemia, kidney failure, or altered mental status, hospitalization is required.
- The doctor will ask you to refrain from consuming alcohol and drugs and from taking medications if you have liver toxicity. In any case, it will evaluate this aspect individually, on a case-by-case basis. Also be aware that some herbs, such as kava and mistletoe, can cause further liver damage. Talk to your healthcare provider about any herbal or alternative medicine treatments you are currently undergoing.
- The doctor may also decide to undergo vaccines against pneumococcal disease, influenza and hepatitis A and B.
- The doctor will also invite you to stick to the NASH protocol, which provides a plan to lose weight, exercise and respect an optimal intake of lipids and glucose (fats and sugars / carbohydrates).
Step 2. Take your medications following the directions given to you
As previously explained, there are many underlying problems that can cause cirrhosis. The doctor will prescribe a personalized and specific drug for your individual case. Generally, these are medicines that treat the general pathology (hepatitis B, hepatitis C, biliary cirrhosis, etc.), as well as the symptoms that result from cirrhosis and consequent liver failure.
Step 3. Be prepared for the possibility of having surgery
Doctors don't always recommend it, but it can be indicated if you are experiencing certain conditions due to cirrhosis. Among these conditions are:
- Varices or dilated blood vessels that can be treated with ligation (the vessels are surgically tied).
- Ascites, a buildup of fluid in the peritoneal cavity, which is treated with paracentesis, a drainage procedure.
- Fulminant liver failure, a rapid onset of encephalopathy (alteration in the structure and / or function of the brain within 8 weeks of the diagnosis of liver cirrhosis). This condition requires a liver transplant.
- Hepatocellular carcinoma, which is the development of liver cancer. Treatment attempts include radiofrequency ablation, resection (surgical removal of the carcinoma) and liver transplantation.
Step 4. Know your prognosis
Once cirrhosis has been diagnosed, patients can typically expect 5-20 years to live with the disease, with few or no symptoms. When symptoms become severe and disease-related complications occur, death usually occurs within 5 years if no transplant is performed.
- Hepatorenal syndrome is a serious complication due to cirrhosis. It consists in the development of kidney failure in those suffering from liver disease and requires treatment.
- Hepatopulmonary syndrome is another serious complication caused by the enlargement of the pulmonary arteries in individuals who have liver disease. This condition causes shortness of breath and hypoxemia (low oxygen levels in the blood). A liver transplant is required to treat this syndrome.
Advice
- Do not take any medications until, or unless prescribed by your doctor. Stay active, take vitamins, eat fruit or drink juices.
- The early stages of cirrhosis can potentially be reversible by treating the root cause, for example by controlling diabetes, abstaining from alcohol, treating hepatitis and reversing obesity by reaching a normal weight.
