Liver failure and liver cirrhosis are two different pathologies but they are connected to each other. Liver failure can occur at any time after the onset of insult depending on the type and severity of insult. It is diagnosed from the appearance of signs and symptoms of decompensation as stated above. Liver cirrhosis is basically a stage of liver failure that is seen by fibrosis and scarring of the liver parenchyma causing them to not function well,
Liver cirrhosis is diagnosed based on several investigations including laboratory, imaging and liver biopsy. Liver cirrhosis can further progress to a more dangerous stage known as the hepatocellular carcinoma, thus requiring frequent health checkup with several laboratory and imaging investigations.
Liver failure occurs when the liver could not carry out its normal function such as detoxifying drugs, producing bile efficiently, producing plasma proteins and clotting factors. This could be due to multiple reasons as stated below;
- Viral hepatitis or bacterial hepatitis
- Primary sclerosing cholangitis or primary biliary cirrhosis
- Primary or secondary liver cancer
- Autoimmune hepatitis
- Wilson’s disease
When you have a liver failure, you will develop signs and symptoms of decompensation as below:
- Ascites simply means abdominal distension due to extravasation of plasma out from the portal vein and this is due to increase in the portal pressure.
- Drowsiness and confusion. Urea and ammonia can accumulate in the body and reaches to the brain resulting in hepatic encephalopathy. They can also present with fitting episodes.
- The liver could not produce and process proteins responsible for coagulation and hence the bleeding of mucosa.
- Yellow discolouration of skin and the eyes. This is due to injury to liver parenchyma and bile ducts resulting in hepatic and post hepatic jaundice.
You can experience these symptoms at any point of the liver failure depending on the severity of liver injury and type of insult. Generally, liver failure can be categorized into acute and chronic liver failure.
- Acute liver failure : Signs and symptoms of decompensation appears very quickly and before 6 months from the onset of insult. Usually the type of insult is toxic causes such as overdosage of medication or binge drinking.
- Chronic liver failure: Signs of decompensation appear late and after 6 months from the onset of insult.
So how about liver cirrhosis? Liver cirrhosis is basically a stage of liver failure. Once you have liver failure it can progress to different stages from being a healthy liver to an inflamed liver and a cirrhotic liver.
This cirrhotic liver can then progress to malignancy commonly called as hepatocellular carcinoma. This is the reason why cirrhotic liver patients are frequently being followed up in clinics with various investigations such as ultrasound scan, alpha fetoprotein tumor markers and liver function test.
How do we diagnose liver cirrhosis?
- Laboratory investigations such as liver function tests to look at liver enzymes, total bilirubin and total protein count will also be taken to see the liver damage and the extent of it.
- Imaging investigations. The primary imaging is the liver ultrasound followed by more advanced imaging such as CT scan and MRI. Newer technology will include a magnetic resonance elastography to detect liver injury and the extent of the disease.
- Liver biopsy. Liver biopsy from fine needles is often not taken by doctors unless imaging does not help in confirming the diagnosis of liver cirrhosis.
Treatment of liver cirrhosis includes, treating the underlying cause of liver injury and providing supportive treatment to improve patients quality of health. Frequent monitoring is also done to prevent disease progression to hepatocellular carcinoma.