Symptoms of cirrhosis of the liver are usually not noticed in earlier stages and therefore, prognosis of the disease is generally very poor. Read on, to know how the Child-Pugh classification is used to determine the prognosis of liver cirrhosis and how the prognosis may vary from person to person.
What is cirrhosis of the liver? Various diseases and disorders can cause chronic injury to liver cells. The damaged cells lead to the formation of non-functional scar tissue in the liver. Over the years, scar tissue replaces the healthy tissue and blocks the flow of blood through the liver. The liver gradually deteriorates. The impaired function of the liver results in several health complications. Liver helps control infections and it promotes processing of nutrients, hormones and drugs. It plays an important role in detoxification of your body by removing bacteria and toxins from your blood, and it helps produce bile so that fats and fat-soluble vitamins are properly absorbed in the body. In case of liver cirrhosis, functions of the liver get seriously affected and eventually, the liver stops working.
In normal conditions, when the liver is healthy, it regenerates most of its own cells whenever they are damaged. With end stage cirrhosis, the liver loses its capacity to replace damaged cells and liver failure occurs. Liver transplant can make the prognosis favorable. Symptoms of liver cirrhosis, when detected earlier, can make the prognosis favorable. But normally, the disease is asymptomatic and so cirrhosis of the liver prognosis is usually unfavorable. If the disease is diagnosed at an earlier stage, proper treatment helps improve the survival rate. Liver being a vital organ, it is necessary to maintain its health with proper diet.
Causes of Cirrhosis of the Liver
- Alcohol abuse
- Chronic hepatitis B and hepatitis C
- Nonalcoholic fatty liver disease (NAFLD) which is normally associated with obesity, diabetes, protein malnutrition, coronary artery disease, and corticosteroid medications.
- When the body’s immune system itself attacks liver cells, causing inflammation, damage, and eventually cirrhosis, it is known as autoimmune hepatitis. Statistics show that about 70% of those with autoimmune hepatitis are female.
- Many diseases can damage the ducts that carry bile from the liver, causing bile to back up in the liver, resulting in cirrhosis. Cystic fibrosis, alpha-1 antitrypsin deficiency, hemochromatosis, Wilson disease, galactosemia, and glycogen storage diseases are inherited diseases that interfere with the liver function. Cirrhosis can develop from these conditions.
- Severe drug reactions, prolonged exposure to toxic chemicals, parasitic infections, and repeated bouts of heart failure with liver congestion can cause cirrhosis of the liver.
It has been noticed that many people with cirrhosis have more than one cause of liver damage. Remember, cirrhosis is not caused by trauma to the liver, years of chronic injury can cause cirrhosis.
During the early stage of cirrhosis, the body manages on its own or compensates for the loss caused by malfunctioning of the liver. So the early stage is known as compensated stage. Although most people with liver cirrhosis have no symptoms in the early stages of the disease, with the advancement of the disease, a person may experience the following symptoms.
- Loss of appetite
- Weakness, fatigue
- Spider like blood vessels on the skin
- Nausea, vomiting
- Weight loss
- Itching sensation
- Abdominal pain and bloating due to accumulation of fluid
Liver being a vital organ, liver dysfunction can give rise to a number of complications. Unfortunately, in most patients, such complications are the first signs of the disease. The prognosis may vary from person to person, depending upon the person’s overall health, causes of the disease, the stage at which the disease is diagnosed, possibility of advanced treatment like liver transplant, etc. Following health complications are generally noticed in patients diagnosed with liver cirrhosis.
- Gallstones: As liver cirrhosis prevents free flow of bile to and from the gallbladder, the bile hardens and leads to the formation of gallstones.
- Easy Bruising and Bleeding: As the liver slows or stops producing the proteins required for blood clotting, the person bruises or bleeds easily.
- Sensitivity to Medications: As the liver loses its capacity to filter medications from the blood, the person becomes more sensitive to medications and their side effects.
- Jaundice: As the liver loses its capacity to remove bilirubin from the blood, symptoms of jaundice are usually noticed. Yellowing of the skin and whites of the eyes, and darkening of the urine are the main signs observed.
- Edema and Ascites: In advanced stage cirrhosis, fluid accumulates in legs (edema) and abdomen (ascites). Ascites can lead to bacterial peritonitis, a serious type of infection.
- Portal Hypertension: Liver cirrhosis slows the normal flow of blood from the spleen and intestine to the liver, which in turn increases the pressure in the portal vein. This condition is called portal hypertension.
- Splenomegaly: Enlarged spleen is another effect of portal hypertension. The spleen holds white blood cells and platelets, reducing the numbers of these cells in the blood. A low platelet count may therefore, be the first sign of liver cirrhosis.
- Esophageal Varices and Gastropathy: Portal hypertension can cause enlarged blood vessels in the esophagus (called varices), or in the stomach (called gastropathy), or both. When these enlarged blood vessels burst due to thin walls and increased pressure, serious bleeding can occur in the esophagus or upper stomach, requiring immediate medical attention.
- Hepatic Encephalopathy: As the liver does not work properly, the toxins present in the blood eventually accumulate in the brain. The buildup of toxins in the brain is known as hepatic encephalopathy which affects mental function of the person and can even result in coma. Confusion, personality changes, memory loss, trouble concentrating, and a change in sleep habits are some of the signs of hepatic encephalopathy.
- Insulin Resistance and Type 2 Diabetes: Cirrhosis causes resistance to insulin. Therefore, the muscles, fat and liver cells cannot use insulin properly. The pancreas starts producing more insulin, but excess glucose builds up in the bloodstream causing type 2 diabetes.
- Other Problems: Hepatocellular carcinoma is a type of liver cancer that can occur in people with cirrhosis. Cirrhosis can lead to immune system dysfunction, increasing the risk of infections. Cirrhosis can also cause kidney, lung and heart failure.
Diagnosis of liver cirrhosis is confirmed with the help of physical examination, blood tests, biopsy and imaging. Taking into consideration the person’s medical history and symptoms, the treatment is designed to slow down the progression of scar tissue in the liver and prevent or treat the complications of the disease. Lifestyle changes like avoiding alcohol and other harmful substances and following a nutritious diet help slow down the growth of the disease. Medications are given to treat various underlying conditions. Both diet and medication help lower the symptoms of cirrhosis to a certain extent.
When the complications developed are not controlled with normal treatment, liver transplant is recommended. Liver transplant dramatically improves the prognosis of liver cirrhosis. If the disease is detected at its earlier stage, cirrhosis life expectancy is about 15 to 20 years. Life expectancy decreases to about 6 to 10 years, when cirrhosis is detected during the second stage. But these patients have enough time and can opt for liver transplant. They have various treatment options and medicines which help control the advancement of the disease. When cirrhosis of the liver is diagnosed during the last stage, the life expectancy is very poor, about 1-3 years, depending upon the patient’s overall health, prompt use of advanced treatment, etc.
The Child-Pugh Classification
The Child-Pugh classification is a scoring system which helps determine the prognosis of liver cirrhosis. Here, scoring is based upon several factors: albumin, ascites, total bilirubin, prothrombin time, and encephalopathy, as follows:
|Name of the Factor||Score: 1 Point||Score: 2 Points||Score: 3 Points|
|Serum Albumin (g/dL)||Higher than 3.5||3.0 – 3.5||Lower than 3.0|
|Serum Bilirubin (mg/dL)||Lower than 2.0||2.0 – 3.0||Higher than 3.0|
|Prothrombin time (seconds)||1 – 4||4 – 6||Higher than 6.0|
Three classes are formed and their scores are:
- Class A – score of 5 – 6
- Class B – score of 7 – 9
- Class C – score higher than 9
- About 50% of patients with a score of 10 or more (in the Class C category) survive for one year.
- Patients with Class A or B: Have a better prognosis. The 5-year survival rate is 70% – 80%.
- Refractory ascites, albumin < 3.2 gm/l, and an episode of SBP (spontaneous bacterial peritonitis): One-year survival of 50% or less.
This article is for informative purposes only, and should not be used as a replacement for expert medical advice. Studies show that liver cirrhosis affects men slightly more often than women and each year, thousands of people die because of this disease. Healthy diet, regular exercise, healthy eating habits and stress-free lifestyle help keep away deadly diseases like liver cirrhosis.