Liver cirrhosis is a liver disease that affects approximately 200,000 people in France with 15,000 deaths each year. The average age of diagnosis is 55 years. Causes, first symptoms, risk of liver cancer, diagnosis, treatment, life expectancy… Know everything.
In France, cirrhosis of the liver causes about 15,000 deaths per year and the average age of diagnosis is 55 yearsaccording to’Health Insurance. Cirrhosis is liver disease which is characterized by inflammation of liver cells and therefore by their destruction. It is often discovered fortuitously, during a clinical examination when the patient consults for another reason. To begin with, cirrhosis of the liver remains silent and does not cause symptoms. We are talking about compensated cirrhosis. When liver damage worsens, symptoms may occur. We then speak of decompensated cirrhosis. Is liver cirrhosis cancer? What are the first signs of cirrhosis of the liver? Can cirrhosis of the liver be cured? What life expectancy?
Definition: what is cirrhosis of the liver?
Cirrhosis of the liver is chronic liver disease characterized by a disorganization of liver architecture. “The liver is hard because it is full of fibers which are the consequence of chronic inflammation of the liver” summarizes Professor Victor de Lédinghen, hepato-gastroenterologist at the Bordeaux University Hospital. This inflammation may be due to hepatitisor alcoholic or non-alcoholic fatty liver disease (hepatic cirrhosis on NASH). Chronic liver cirrhosis may be stable or evolve. “Cirrhosis is a liver that becomes scarred. In other words, it is a liver that has fibrosis which are scars. What happens is that viruses need liver cells to multiply. They therefore enter the liver cells and once inside, they will destroy it (the fact of multiplying will lead to the destruction of the liver cell). If a significant number of liver cells are destroyed, the liver regeneration mechanism is overwhelmed and instead of the liver replacing a destroyed cell with a brand new cell, there will be scars.“
What is compensated cirrhosis?
At its first stage, it has no clinical impact: we speak of compensated cirrhosis. Cirrhosis does not cause symptoms, it evolves silently.
What is decompensated cirrhosis?
At its second stage, when liver failure worsens or in the absence of early treatment, cirrhosis can progress to the next stage: we then speak of decompensated cirrhosis. Complications can occur such as vomiting with blood, blood in the stool, jaundice…
Two scores are used to assess the severity of cirrhosis: the Child–Pugh score and the MELD score. They combine several medical data such as the presence of ascites (accumulation of fluid in the peritoneum), the serum bilirubin level, the INR…
What are the possible causes of cirrhosis of the liver?
- The alcohol (excessive and prolonged consumption) is one of the main causes of cirrhosis, in 50 to 75% of cases.
- Non-alcoholic fatty liver diseaseor fatty liver disease, is another increasingly common cause of cirrhosis.
- Viruses are also the cause of cirrhosis: in France,chronic hepatitis B is involved in about 5% of cases and thechronic hepatitis Cin 10 to 20% of cases.
- metabolic syndrome (diabetes, overweight, hypertension)
- Of the genetic diseases (primary biliary cirrhosis, Wilson’s disease, hereditary alpha-1 antitrypsin deficiency, hemochromatosis, etc.)
- Autoimmune diseases, such as primary biliary cirrhosis.
- Right heart failure.
What are the (first) symptoms of cirrhosis of the liver?
Cirrhosis can pass totally unnoticed before the first manifestations appear, often very late. “This stadium can last for years” says Professor Victor de Lédinghen. When decompensated, cirrhosis is associated with symptoms, such as:
- Esophageal varices, which can cause gastrointestinal bleeding and vomiting blood.
- Jaundice (jaundice)
- Ascites (fluid inside the abdominal cavity)
- One ankle edema.
- Tiredness
- Loss of appetite and weight
- Nausea and vomiting
- Muscle cramps…
Cirrhosis is often discovered during a physical examination. “Cirrhosis may be sought because a person has a risky disease, such as hepatitis. Otherwise, it can be diagnosed with a blood test that reveals a low level of platelets and a coagulation abnormality.“, specifies Professor de Lédinghen. In all cases, the doctor questions his patient about his risk factors, his consumption of alcohol, medication, his history, and looks for signs suggestive of cirrhosis (large and hard liver, large spleen, etc.) When the attending physician suspects cirrhosis, he refers the patient to a hepato-gastroenterologist in town or at the hospital. Diagnosis of cirrhosis is confirmed by blood tests, imaging tests and liver biopsy, although the latter is being performed less and less. L’ultrasound can reveal an anomaly of the liver, as well as the examination FibroScana technique that consists in evaluating the stiffness of the liver in a non-invasive way.
Is liver cirrhosis cancer?
No. Liver cirrhosis is not cancer, but among its possible complications there is indeed liver cancer (hepatocellular carcinoma). Untreated or if it progresses unfavorably, cirrhosis can therefore develop into cancer. Most often, cancer occurs within 15 to 20 years of the onset of cirrhosis. We think that 90% of liver cancer cases are linked to cirrhosis. The diagnosis is most often made during the transformation of a nodule visible on ultrasound. The MRI shows that this nodule is irrigated by numerous blood vessels, and the liver biopsy confirms the presence of cancerous cells.
What are the possible complications of cirrhosis of the liver?
L’Hepatic insufficiency is another complication of cirrhosis; it appears when more than 75% of the liver is destroyed. Cirrhosis may also be responsible forencephalopathy (altered consciousness that can lead to coma) due, in large part, to the inability of the liver to eliminate ammonia produced by bacteria in the digestive tract.
There is no specific treatment for cirrhosis. “The treatment of cirrhosis begins first and foremost with that of its cause” insists Professor de Lédinghen.
► If alcohol is the cause of the diseaseweaning is essential.
► If a hepatitis is involved, the therapeutic strategy aims to treat it.
► In the case of origin linked to a metabolic syndromespecific treatments associated with lifestyle and dietary measures are prescribed. “If you treat the cause and remove the inflammation, then the cirrhosis can regress.”
► In case of decompensated cirrhosis. The drugs available aim to prevent decompensation. In case of esophageal varices, beta-blockers are administered to prevent digestive bleeding. Diuretic drugs allow them to eliminate excess fluid. Excess fluid in the abdomen can be removed during a puncture.
When to do a liver transplant in case of cirrhosis?
A liver transplant may be considered in some people with severe liver failure. Liver transplantation represents the primary treatment for liver cancer in certain specific cases. It can only be offered for small tumors and before the age of 70. Every year, approximately 1,000 patients are transplanted in Francewith a five-year survival of more than 80% and a graft life span of more than 20 years.
What is the life expectancy with cirrhosis of the liver?
People with advanced liver cirrhosis have an average life expectancy of about 2 years.
Thanks to Professor Victor de Lédinghen, Hepato-Gastroenterologist at Bordeaux University Hospital.