What is Cirrhosis?
Last updated: August 2020
Cirrhosis is a disease of the liver that occurs when inflammation, cell degeneration, and thickened fibrous bands of tissue form in the liver. Hepatitis C is a liver disease that, if left untreated, may cause cirrhosis in approximately 25% of patients.
Cirrhosis is an advanced form of liver disease and can become life-threatening. It may begin in hepatitis C patients after 20 to 30 years of fighting hepatitis C. Liver transplant is the only available treatment to cure advanced cirrhosis. There are many other causes of cirrhosis, but in this article, we will focus on hepatitis C-induced cirrhosis.
What causes cirrhosis?
Contributing factors for the development of cirrhosis in hepatitis C patients are drinking alcohol, smoking, obesity, older age and older age at infection, diabetes, male sex, and co-infection with HIV or hepatitis B. Hepatitis C patients should consider asking their doctor about being vaccinated for hepatitis A and B. There is no vaccine for hepatitis C.
Compensated versus decompensated cirrhosis
There are two phases of cirrhosis called compensated and decompensated cirrhosis. In compensated cirrhosis, the patient’s liver is able to do its many jobs. The liver has over 500 functions that it must accomplish to keep a patient healthy. Patients with compensated cirrhosis often feel relatively well and may be unaware that they have such advanced disease. If symptoms occur at this stage, they may be loss of appetite, weight loss, nausea, difficulty concentrating, easy bruising, swelling of the feet and ankles, itchiness, muscle cramping, spider veins, and redness of the palms of the hands called palmar erythema.
Once the liver starts to decompensate, the patient feels unwell as his liver is not functioning properly. He often has symptoms that are becoming quite obvious. Some of those symptoms may be ascites, or swelling of the abdomen due to retained fluid; hepatic encephalopathy which causes confusion and possibly coma due to a buildup of ammonia in the blood; jaundice; variceal hemorrhage, which is bleeding due to enlarged blood vessels in the esophagus or stomach, and the patient may bleed spontaneously, causing rapid death. There are treatments to control the sequela of events.
Cirrhosis and liver cancer
Hepatitis C patients who have cirrhosis are at increased risk of developing hepatocellular carcinoma (HCC). Once cirrhosis is established, patients have a one to four percent chance of developing HCC per year. Screening for Stage 3 and 4 patients is highly recommended and is done with ultrasound/CT/MRI and alpha fetoprotein blood tests. These tests should be done bi-annually.
Lifestyle changes can help
Treating and curing hepatitis C virus lowers the risk of liver cancer, but does not eliminate it totally. Continued abstinence from alcohol and smoking is advised as well as keeping weight in the normal range. Some studies have shown that drinking 3 cups of coffee daily is protective. Even though the risk is reduced screening should continue once sustained viral response is achieved.1-5