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Stages of Cirrhosis of the Liver

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Liver Cirrhosis – Stages

The disease Cirrhosis of the liver takes years to develop. It is not a sudden onset disease and takes years to produce  the harmful liver scarring,It may even take many more years until symptoms become evident and diagnosed correctly.

As you already know, the liver is one of the most important organs within the human body. The liver is responsible for manufacturing blood proteins that aid in blood clotting, oxygen transport and immune system function. It stores excess nutrients and returns some of the nutrients to the bloodstream when needed  and produces bile, a substance needed to help digest food.

Liver Cirrhosis Disease

The liver helps the body store sugar (glucose) in the form of glycogen as well as ridding the body of harmful substances in the bloodstream.
The main task of the liver is to counteract toxic, harmful, and other hazardous substances in the human body; this is a crucial and extremely important process. Cirrhosis is the mixture of several liver- related health issues. Following are some stages that those with liver cirrhosis can use to help identify the disease.

Cirrhosis of the liver – Fatal Disease

A severely dysfunctional liver generally causes death to humans. Cirrhosis of the liver is the seventh  most common fatal disease in world . A major worldwide growth in a diagnosis of cirrhosis disease is usually caused by Hepatitis B and C, and abusing alcohol. Consuming alcohol leads to several liver problems in humans.

General Symptoms – Cirrhosis

  • vomiting,
  • blood in vomit,
  • weight loss,
  • nausea,
  • weakness,
  • jaundice,
  • bleeding
  • hemorrhoids,
  • leg swelling, bruising,
  • small red colored spider like blood vessels on the skin,
  • impotence.

Cirrhosis – Liver Stages

Stage #1:

This is the initial stage of cirrhosis. During the initial stages the patients may experience very few symptoms and it may progress very slowly. If Cirrhosis is diagnosed in this early stage , th epatient has a good rate of survival.The general symptoms include jaundice, dry mouth, fatigue and enlargement of the upper stomach area.

Some patients even suffer from itchiness all over their body. It’s very easy to eliminate cirrhosis in the initial stages. A doctor may diagnosis from an physical  examination, a biopsy, blood test or ultrasound.

Proper and prompt medical care is very important for the wellbeing of the patient. In the initial stages the cirrhosis patients will suffer from abnormal tissue enlargement  and inflammation. An improvement or decrease in liver disease is verified by a liver biopsy.

Stage #2:

Liver Cirrhosis

Without proper medical care stage 1 will progress to the level of stage two. The abnormal damaged tissues formed in initial stage begin to transform into  stiff rigid bands of connective tissue.

The transformation of cell tissue into these rigid bands is known as fibrosis. The inflammation and fibrosis will spread to the patients portal veins and periportal regions, greatly affecting the flow of blood through the liver.

Stage #3:

In stage three, the rigid band of connective tissue formed in the second stage merge with each other. The merging process causes huge enlargement in the affected areas. The enlargement leads to disturbance of normal liver functions. The liver is unable to store nutrients, support blood streaming, or break down fat contents from blood.It is within stage 3 the person may experience an  inability to digest fats.Vitamin deficiency may  also be noticed due to the inability to absorp fat-soluble vitamins.The liver stops removing toxic protein content from the bloodstream. Cirrhosis in this stage leads to several kidney,spleen  and heart problems in humans.

Stage #4:

This is final stage of Cirrhosis of the liver. This stage is considered to be the most deadly stage. The cirrhosis infected patient has little chance of  survival in this stage. The patient needs to opt for a liver transplantation at his or her own risk. In this stage, many of the symptoms will increase considerable because the liver is unable to detoxify the blood and this may even lead to severe confusion and at worst,coma.There may be  kidney failure,spleen enlargement and a loss of bone mass and drop in bone density.

Symptoms – Cirrhosis of the Liver

  • Spider moles
  • Liver shrinkage,dull ache in the liver area
  • Jaundice
  • Intense itching in skin
  • Edema
  • Liver palms
  • Low-grade fever
  • Extreme thirst
  • Severe fatigue, exhaustion, unusual sleepiness
  • Loss of appetite,nausea and bloating
  • Thick coating on the dorsal surface of the tongue
  • Anorexia
  • Stomach pain and cramps
  • Easy bruising and bleeding (especially in the abdominal region)
  • Confusion, slurring of speech
  • Ascites

Stage 5 CirrhosisStages of the Liver Disease Cirrhosis

Cirrhosis results from the necrosis of the liver cells. It is characterized by fibrosis, formations of scar tissue and regenerative nodules. The disease of Cirrhosis and its stages leads to some or complete loss of liver function. It may occur at any age of life.

CAUSES OF CIRRHOSIS

Cirrhosis is most commonly caused by extensive and excessive drinking of alcohol. There are other causes which include:
* Postnecrotic cirrhosis
– Hepatitis B
– Hepatitis C
* Non-alcoholic fatty liver disease
* Autoimmune disease
– Primary sclerosing cholingitisStages of the Liver Disease Cirrhosis
– Autommune hepatitis
* Metabolic disorders
– Hemochromatosis
– Wilson’s disease
– Alpha-antitrypsin defeciency
– Galactosemia
* Biliary
– Primary biliary cirrhosis
– Secondary biliary cirrhosis
– Cystic fibrosis
* Genetic
– Hemochromatosis
– Wilson’s disease
* Chronic venous outflow obstruction
– Budd-Chiari syndrome

PATHOLOGY OF CIRRHOSIS

Liver cirrhosis is characterized by the formation of regenerative nodules with loss of normal structure. There are three types of cirrhosis:
a- Micronodular Cirrhosis:

In this type, the whole of the liver is uniformly involved. Regenerative nodules are on the small side being less than 3mm in size. This is due to excessive alcohol consumption

b- Macronodular Cirrhosis:
In this type, some sections of the liver are normal. The size of the nodules will be  variable and this type of cirrhosis is seen in chronic viral hepatitis.
c- Mixed Cirrhosis:

In some cases, a mixture of both small and large nodules are visible on and through the liver
There are 4 stages of liver cirrhosis. Knowledge about the stages of liver cirrhosis is important for  better prevention, early diagnosis and effective preventative treatment. Stage 1 is the earliest stage which is characterized by minimal damage and a good prognosis for recovery and prevention whereas in the final stage 4, the liver is virtually completely damaged  and a liver transplant is the only treatment of choice. Read on to find out more about the different stages of cirrhosis:

STAGE 1

The first stage is  known as the  ‘compensated stage’. This stage is characterized by inflammation of the liver tissues. Inflammation is confined to the portal area and does not involve other areas of the liver. This inflammatory process leads to  minor connective tissue formation and scarring of the liver. But as the name says, these changes can be compensated for by the body, meaning the body will adapt to offset the disease effects. This stage is usually asymptomatic but on close examination, some patients may have:
* Mild jaundice
* Fatigue
* Loss of appetite
* Weight loss
* Dry mouth
* Nausea
* Swelling of the abdomen
* Abdominal pain

STAGE 2

The second stage of cirrhosis is also characterized by inflammation of the liver tissues, but at this stage, the liver  starts to show areas of fibrosis. Fibrosis are the ‘stiff bands‘ that are formed by the replacement of normal liver tissues with the scar tissue. It is irreversible and can never  return back  to  normal liver tissue, however, new liver cells can generate. In this stage, inflammation is not only limited to the portal area,but involves the whole liver. The changes in this stage can be compensated for by the body.

STAGE 3

In the third stage, the inflammation and fibrosis start to involve other areas of the liver and the condition becomes more severe. As the fibrosis extend to the other tissues, it forms bridging fibrosis. Bridging fibrosis not only impairs the normal functioning of the liver but also affects the blood pressure levels in the liver, a condition known as portal hypertension. A patient with stage 3 cirrhosis will not be able to digest fat so he may present with fat-soluble vitamin deficiencies (Vitamin A, D, E and K).

STAGE 4

Stage 4 of liver cirrhosis is also known as the  ‘Decompensated stage‘. It is the most advanced stage and in this stage, the body can no longer compensate for the damaged liver. Fibrosis extends to every part of the liver and a liver transplant is needed to save the patient’s life. Stage 4 may also involve the spleen and kidneys. A patient with the 4th stage of liver cirrhosis may develop the following symptoms in addition to the symptoms of the 1st stage:
* Fever
* Pedal edema
* Ascites
* Jaundice
* Pruritis
* Plamar erythema
* Easy bruising
* Bleeding
Stage 4 liver cirrhosis increases the risk of many complications.e.g. Ascites, variceal hemorrhage, spontaneous bacterial peritonitis, hepatic encephalopathy and liver cancer. Some of these complications can be life-threatening

INVESTIGATIONS OF CIRRHOSIS:

The following tests are performed to check which stage and what type of liver cirrhosis the patient may have:
– Liver function tests ( Albumin, Prothrombin time)
– Liver biochemistry ( Serum alkaline phosphatase, Serum aminotransferase)
– Serum electrolytes ( Sodium level)
– Serum creatinine
– Viral markers
– Serum autoantibodies
– Serum immunoglobulins
– Iron indices and ferritin
– Copper, ceruloplastin
– Alpha-antitrypsin
In addition to these laboratory  investigations,  imaging studies check for the changes in the size and shape of the liver. Some of these include  Ultrasound, CT scan, Endoscopy and MRI scan. A liver biopsy is usually necessary to confirm the type and severity of liver disease.

MANAGEMENT OF CIRRHOSIS of the Liver:

In the compensated stage, treatment of the underlying cause of cirrhosis can reverse the cirrhotic changes in the liver if caught early enough and patients can lead  a normal life. Patients should reduce their salt intake and should avoid aspirin, NSAIDS and alcohol. In the de-compensated stage, management of complications should be done. Ultrasound tests  should be done after every 6 months to detect the early development of hepatocellular carcinoma. A liver transplant is usually needed in the 4th stage.

PROGNOSIS OF CIRRHOSIS:

In general, the survival rate of cirrhosis is 50% but this varies with the etiology, stage and presence of complications.

Much can be done through early intervention and looking at lifestyle factors such as  the foods you eat and following a strict liver friendly diet, complimentary medicines,no alcohol,exercise, supplements to boost your whole system and especially taking care to look after yourself on every level when you have cirrhosis of the liver.

What is a MELD score?

MELD score or Model for End-stage liver disease is a  scoring system  used to assess the severity of chronic liver disease. Liver disease is defined as being chronic when it is present in a patient for a duration of more than six months. It is a prognostic model which is used to determine the severity and extent of liver disease in order to make decisions regarding specialist medical interventions such as specific medical treatments and or  liver transplantation.


Components of a MELD score

This  type of calculator relies solely  on the use of laboratory values of the following three components to predict survival in a patient of chronic liver disease:

  • Serum bilirubin: This measures liver function by gaging its function levels of bile production and excretion.
  • Serum creatinine: this is a key indicator of kidney function. Impaired kidney function can be a consequence of liver disease, for example in hepato-renal syndrome.
  • International normalized ratio for prothrombin time (PT): This can determine the liver’s ability to produce blood clotting factors.

This score is based  on a numerical scale ranging from values of 6 (less seriously ill) to 40 (severely affected). It can be used for transplant candidates who are 12 years or older in age. It can be used to predict a value of how urgently the individual needs a transplant within duration of the next three months.


Importance of this scoring system

This scoring system helps the treating specialist make many critical decisions concerning welfare and care of a Cirrhosis of the liver,liver disease,meld scorechronic liver disease sufferer. An increasing score value is considered to show a deteriorating and progressively worsening  liver dysfunction. It also predicts the three-month mortality risk. Because of its accuracy in predicting the short-term survival in such patients, this score is effectively implemented in various decisions by the transplant community to prioritize patients awaiting a liver transplant.


The Score Formula

The MELD Score currently used by United Network for Organ Sharing (UNOS) to prioritize transplant organ follows the following formula:

MELD = 3.8[Ln serum bilirubin (mg/dL)] + 11.2[Ln INR] + 9.6[Ln serum creatinine (mg/dL)] + 6.4

Where, Ln is a natural algorithm

UNOS has also made a few modifications to this score. These include:

  • If the patient has been on dialysis within the past 7 days, a creatinine value of 4.0 must be used
  • Any value that is below one,  is given the value of 1.

For example, if bilirubin’s value is 0.7, it is considered to be 1 instead. This is to prevent negative values. As a natural algorithm of the value is used, the natural algorithm of 1 is 0 so any value below 1 might give a negative value.


How does this score predict mortality?

There is a general key of how  this score can be interpreted within a hospital setting. An estimated 3-month mortality is predicted with the help of the scoring value.

  • A score of 40 or more predicts a 71.3% mortality
  • A score between 30 and 39 predicts a 52.6% mortality
  • A score between 20 and 29 predicts a 19.6% mortality
  • A score between 10 and 19 predicts a 6.0% mortality
  • A score below 9 and 1.9% mortality

Special case exemptions to MELD score

There is one special exemption to this method of survival prediction in chronic liver disease mentioned above. This includes a category of seriously ill patients known as status 1.
Less than one percent of liver transplant patients lie in this category.

This category includes patients who have an acute liver failure. This liver failure is sudden in onset and severe in intensity. This causes these individuals to have a life expectancy of a few hours to days if a timely transplant is not performed. Other than this all other patients who are above the age of 12 years are categorized by the MELD scoring system.

Patients who are under the age of 12 years are categorized by another scoring system. This is known as Pediatric End-stage Liver Disease (PELD) scoring system. This scoring system will use different factors according to the growth and developmental needs of the child.

Fluctuation in the value of the MELD Score

The value of this score does not stay constant throughout the patient’s lifetime. There may be fluctuations where the score may go up and down based on the status of the liver disease. This is why patients who are on the transplant list get their scores assessed repeatedly. This ensures that only these patients receive a donor liver who are in the greatest need at that time as assessed by the MELD score.