Understanding Liver Cirrhosis
Liver cirrhosis is the end-stage of chronic liver disease where normal liver tissue is progressively replaced by scar tissue (fibrosis), impairing liver function. Despite the seriousness of the diagnosis, early and expert management can halt progression, prevent complications, and significantly extend life quality.
At Dhaara Speciality Hospital, our gastroenterology team led by Dr. Srinivas Bojanapu provides comprehensive cirrhosis care — from diagnosis with FibroScan to managing ascites, preventing variceal bleeding, and evaluating patients for liver transplantation.
What Causes Liver Cirrhosis?
Most Common Causes
- Fatty liver disease (NAFLD/NASH) — #1 cause in India
- Chronic alcohol use
- Hepatitis B — 40 million carriers in India
- Hepatitis C infection
- Autoimmune hepatitis
Less Common Causes
- Primary biliary cholangitis (PBC)
- Wilson's disease (copper overload)
- Haemochromatosis (iron overload)
- Drug-induced liver injury
- Budd-Chiari syndrome
Stages of Liver Cirrhosis
| Stage | Description | Key Features | 5-Year Survival |
|---|
| Compensated (Child A) | Liver still functioning adequately | No ascites, no bleeding, no confusion | ~80% |
| Compensated (Child B) | Mild liver dysfunction | Mild ascites, bilirubin slightly elevated | ~60% |
| Decompensated (Child C) | Significant liver failure | Ascites, jaundice, encephalopathy, bleeding | ~35–45% |
Recognising Symptoms
Cirrhosis is often silent for years — the liver has remarkable reserve capacity. By the time symptoms appear, significant damage has occurred.
Early Symptoms
- Fatigue and weakness
- Loss of appetite, weight loss
- Nausea, especially after fatty meals
- Mild upper right abdominal discomfort
- Easy bruising or bleeding
Advanced Symptoms (Decompensation)
- Ascites — fluid accumulation in abdomen
- Jaundice — yellow skin and eyes
- Vomiting blood (variceal haemorrhage)
- Confusion, memory lapses (hepatic encephalopathy)
- Leg and ankle swelling
- Spider angiomas on skin
⚠ Seek Emergency Care Immediately If: You or a family member vomits blood, passes black tarry stools, becomes confused or drowsy, or develops sudden severe abdominal pain. Variceal bleeding is a life-threatening emergency.
How We Diagnose Cirrhosis
- FibroScan (Transient Elastography): Non-invasive ultrasound-based test that measures liver stiffness. Highly accurate, no needle required.
- Blood tests: LFT, CBC, PT/INR, albumin, bilirubin, AFP (for liver cancer screening)
- Ultrasound abdomen + Doppler: Assesses liver size, texture, portal hypertension, spleen enlargement
- Upper GI endoscopy: Screens for oesophageal varices — dilated veins that can rupture and bleed
- Liver biopsy: Gold standard when non-invasive tests are inconclusive
- MELD/Child-Pugh scoring: Quantifies severity to guide treatment and transplant eligibility
Our Treatment Approach
1. Treating the Underlying Cause
The most impactful intervention is removing what caused the cirrhosis. Stopping alcohol, antiviral therapy for Hepatitis B/C, weight reduction for NASH, and immunosuppressants for autoimmune hepatitis can halt — and sometimes partially reverse — fibrosis.
2. Managing Complications
Ascites (Abdominal Fluid): Treated with low-sodium diet, diuretics (spironolactone + furosemide). Large-volume ascites requires therapeutic paracentesis. Refractory ascites may need TIPS (transjugular intrahepatic portosystemic shunt).
Variceal Bleeding Prevention: Non-selective beta-blockers (propranolol/carvedilol) reduce portal pressure. Endoscopic variceal band ligation (EVL) is performed prophylactically when large varices are found. Emergency banding + vasopressors for acute bleeding episodes.
Hepatic Encephalopathy: Lactulose to reduce ammonia production, rifaximin (gut-specific antibiotic), dietary protein adjustment, identification and treatment of precipitating factors.
Spontaneous Bacterial Peritonitis (SBP): Infection of ascitic fluid — treated with IV antibiotics and IV albumin. Norfloxacin prophylaxis for high-risk patients.
Hepatorenal Syndrome: Kidney failure due to advanced cirrhosis — requires IV albumin, terlipressin, ICU-level care.
3. Liver Transplant Evaluation
For patients with decompensated cirrhosis (MELD score ≥15) or hepatocellular carcinoma within Milan criteria, liver transplantation offers a curative option. We provide complete pre-transplant workup and coordinate with transplant centres in Bangalore. Learn more about liver transplant →
4. Hepatocellular Carcinoma Surveillance
All cirrhotic patients need 6-monthly liver ultrasound + AFP testing to detect liver cancer at an early, treatable stage.
Why Early Diagnosis Matters
Compensated cirrhosis with no complications has a median survival of over 12 years. Once decompensation occurs (ascites, bleeding, encephalopathy), median survival drops to 2–4 years without transplantation. This is why regular monitoring is critical — catching complications early saves lives.
Frequently Asked Questions
Can liver cirrhosis be reversed?
Early fibrosis (F1–F2) can regress with treatment of the underlying cause. Established cirrhosis (F3–F4) cannot be fully reversed but progression can be halted and complications prevented. Some patients show significant improvement in liver function with weight loss (NASH) or antiviral therapy (Hep B/C).
Is FibroScan available at Dhaara Hospital?
Yes. FibroScan (transient elastography) is available at our Yelahanka centre. It is a painless, 10-minute test that accurately grades liver fibrosis without a biopsy. It's recommended for all patients with chronic liver disease.
How often do I need a check-up if I have cirrhosis?
Compensated cirrhosis: 6-monthly blood tests, annual endoscopy, 6-monthly ultrasound + AFP. Decompensated cirrhosis: more frequent monitoring. Our team will personalise your follow-up schedule.
What diet should a cirrhosis patient follow?
Low sodium (2g/day) to prevent ascites, adequate protein (1.2–1.5g/kg), small frequent meals, avoid alcohol completely, restrict raw shellfish, stay well-hydrated unless fluid-restricted. Our team provides specific dietary counselling.