Liver Cirrhosis

What is Liver Cirrhosis?

Liver cirrhosis is an advanced stage of liver scarring or fibrosis.

What causes Liver Cirrhosis?

The most common causes of liver cirrhosis include:

• Viral hepatitis B and C
• Fatty liver disease
• Alcoholic liver disease

What are the symptoms of Liver Cirrhosis?

• There are often no symptoms in early stages of liver cirrhosis
• Fatigue
• Jaundice
• Ascites (fluid retention in the abdomen)
• Encephalopathy (altered mental status)
• Internal bleeding from varices (dilated blood vessels in the esophagus or stomach)

Is Liver Cirrhosis reversible?

Research shows that liver fibrosis and cirrhosis are reversible, provided the underlying cause is diagnosed at an early stage and optimally treated. The reversal of fibrosis or cirrhosis is more likely when the liver scarring is in the early stages. Once cirrhosis is at an advanced stage, medications are primarily used to control the symptoms or complications of cirrhosis.

What is the Child-Pugh classification?

The Child-Pugh classification is a scoring system that determines the degree of liver failure in patients with cirrhosis. This, in turn, allows doctors to prognosticate the disease course and predict patient survival. The classification system is also a gauge of the likelihood of complications developing. For example, patients at Stage C cirrhosis are more likely to develop variceal haemorrhage than those at Stage A.

How Is the Child-Pugh Score Determined?

The Child-Pugh scoring system takes into consideration five factors, and allocates points based on specific factors. The total number of points the patient scores determines which stage he is in.

What are these Five Factors?

1. Albumin, a protein made by the liver
2. Bilirubin, a substance produced during the normal breakdown of red blood cells
3. Prothrombin time (PT), a measure of how quickly the blood clots
4. Ascites, fluid retention in the abdomen
5. Encephalopathy, mental status ranging from mild confusion to deep coma

What are the stages of Liver Cirrhosis?

Based on the Child-Pugh classification, liver cirrhosis can be grouped into 3 stages:

1. Stage A (least severe) – 5-6 points on the Child-Pugh scale
2. Stage B (moderately severe) – 7-9 points on the Child-Pugh scale
3. Stage C (most severe) – 10-15 points on the Child-Pugh scale

What are the symptoms of Stage A Liver Cirrhosis?

Patients often have no symptoms or may experience non-specific symptoms such as fatigue and lethargy. The one-year survival rate is up to 100%.

What are the symptoms of Stage B Liver Cirrhosis?

Patients at this stage have increased blood pressure within the major veins in the liver. Complications such as esophageal varices and ascites may occur. The one-year survival rate for patients at this stage is about 80%.

What are the symptoms of Stage C Liver Cirrhosis?

Apart from ascites, patients may experience more symptoms, including extensive itchiness, loss of weight and appetite, confusion, swelling of the lower leg, breathlessness, jaundice, and internal bleeding from varices. Patients at this stage have the lowest one-year survival rate—approximately 45%. At this stage, the chance of regression of cirrhosis and fibrosis is low, and such patients may be referred and assessed for liver transplantation.