Ask the Expert: I Have Cirrhosis…What Should I Expect?
The Center for Disease Control and Prevention (CDC) estimates out of every 100 people who are infected with hepatitis, between five and 20 of those will develop cirrhosis over a period of 20 to 30 years. We asked our expert, Sue, what is cirrhosis and what should people expect, and here’s what she had to say:
Cirrhosis is a chronic degenerative disease in which normal liver cells are damaged and are replaced by scar tissue (fibrosis). It has many causes including hepatitis C virus. Cirrhosis in hepatitis C patients is considered stage 4 disease. The scar tissue alters the flow of blood as well as bile through the liver. The consequences of cirrhosis can be life threatening. The longer the patient has hepatitis C, the greater the chance that cirrhosis will occur.
When cirrhosis occurs the blood vessels in the liver narrow which forces blood to back up and cause portal hypertension. Patients in the early stage of cirrhosis (compensated) may have the following symptoms: fatigue, lack of stamina, weight loss, lack of appetite, and spider angiomas which look like little red spider veins on the skin. In compensated cirrhosis the liver is still able to adequately function. Once the cirrhosis becomes decompensated, the patient may develop ascites, jaundice, itching and easy bruising. In later stages of cirrhosis, this process may cause veins to become enlarged in the esophagus (varices) and abdomen. Bilirubin also backs up and the patient may become jaundiced. Ascites occurs when fluids leak out of the blood vessels in the abdomen and the stomach swells. A patient with varices is in danger of having a major bleed and they must be treated immediately to stop the bleeding. Fluid in the abdomen causes rapid weight gain. Physicians can drain the fluid and medicate the patient to help relieve fluid buildup and prevent infection. Inflammation of the lining of the abdomen is a consequence of ascites and is called spontaneous bacterial peritonitis. It is a life-threatening infection of the fluids. Edema in the feet and legs is a common finding in cirrhotic patients. When the patient starts to decompensate they should be evaluated by a liver transplant team as the only cure for cirrhosis is a liver transplant.
Patients with cirrhosis are at risk to develop hepatocellular carcinoma (HCC). They need to be monitored every six months with an alfa fetoprotein test and an ultrasound, MRI or CT scan. At this point there are no cures besides transplant for HCC or cirrhosis although new drugs are being tested to help treat HCC and anti-fibrotics are being investigated.
As you can see, cirrhosis is not a good thing to have. If you have hepatitis C, there are things you can do to protect yourself and slow the progression of the virus. Keep your doctor appointments and make sure he/she knows about your symptoms. Ask about your treatment options and get vaccinated for hepatitis A and B. Most important of all, do NOT drink alcohol. My personal experience with my cirrhosis diagnosis started with my first liver biopsy in 1991. I had contracted hepatitis C in 1966 so had the virus for 25 years before diagnosis. My main symptom was serious fatigue and lack of stamina. I treated with interferon and ribavirin many times but never cleared the virus. I entered a clinical trial in 2012 and had a sustained viral response……a cure! I tried my best to take care of myself after I was diagnosed. I stopped drinking socially immediately. I stopped smoking a few years later. I never missed a doctor appointment and I tried treatment every time a new interferon was approved. I tried to make healthy lifestyle choices. I am telling you this so that you know that even with a diagnosis of cirrhosis, you very well may do just fine. I wish you well.