Chronic liver disease is considered to be one of the leading causes of death around the world.

According to the World Health Organization (WHO) as late as 2015 liver diseases were contributing to over 1.1 million annual deaths, with 720,000 deaths attributed to cirrhosis and 470,000 deaths attributed to primary liver cancer.

What is it?

According to the Centre for Disease Control, chronic liver disease is the umbrella for various liver diseases while cirrhosis is the end stage of the chronic liver disease.

Cirrhosis is referred to as the end stage mainly because it occurs after all the other stages of damage to the liver have occurred.

According to the Johns Hopkins Medicine, cirrhosis is the result of healthy liver tissue being replaced with scarred tissue. This replacement prevents the liver from working as normally as a healthy liver should.

Dr. James Thuku, the head of radiology at the MP Shah Hospital, further explains that “when a patient has chronic liver disease, the liver tends to become hard or stiff.” This stiffness, says Dr. Thuku, is due to the formation of small scars on the liver. “As the disease progresses this stiffening of the liver tissue increases,” he says.

Your liver will not stop working the moment you get cirrhosis. It will continue to function even in the presence of cirrhosis. However, this disease will progress to liver failure with fatal complications.

Causes

Currently, non-alcoholic fatty liver disease, Hepatitis B and C are attributed as the two main causes of chronic liver disease.

According to Kenya’s Ministry of Health, up to 60 per cent of chronic liver disease cases in Kenya are the result of chronic infection with the Hepatitis B virus. Over 200,000 people in Africa die from the complications of viral Hepatitis B and C-related liver disease annually.

Non-alcoholic fatty liver disease on the other hand can easily progress to liver fibrosis and cirrhosis once the liver starts to scar and cells start to die. Johns Hopkins Medicine lists the primary causes of cirrhosis as including:

• Hepatitis: Infection with hepatitis B or C for a long time
• Alcohol abuse: Drinking too much alcohol over a long time
• Nonalcoholic fatty liver disease: (This is caused by conditions such as obesity, high cholesterol and triglycerides, and high blood pressure)
• Autoimmune disorders: This is where your immune system attacks your healthy tissue
• Blocked or damaged bile ducts: These transfer bile from the liver to the intestine
• Long term use of certain medicines
• Repeated episodes of heart failure with blood buildup in the liver
• High blood galactose levels
• Cystic fibrosis
• Porphyria: This is a disorder in which certain chemicals build up in the blood

Symptoms

The symptoms you get from chronic liver disease and, or cirrhosis will vary depending on the stage of disease you are in.

For example, in the early stages of cirrhosis, you may experience zero to mild symptoms only. According to Johns Hopkins Medicine, the symptoms you experience from this disease will include the following:

• Having fluid buildup that causes swollen legs or swollen tummy
• Feeling nauseous or vomiting. The vomit usually has blood from bleeding in the blood vessels in the food pipe known as esophagus
• Gallstones
• Feeling itchy
• Having a yellowing skin and eyes (also known as jaundice)
• Getting kidney failure
• Losing weight and muscle mass
• Losing your appetite
• Losing your sex drive, interest, and libido
• Bleeding or bruising easily
• Spider-like veins in the skin
• Low energy and weakness (fatigue)
• Confusion as toxins build up in the blood
• Having dark urine or excretes that looks like tar

Diagnosis

When you present to the hospital with signs and symptoms of cirrhosis, medical tests will be conducted to determine if you have had chronic liver disease whose end stage is cirrhosis.

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According to Johns Hopkins Medicine, you may have to undergo tests that include:

• Blood test: These will seek to find out if the liver is functioning properly and whether your blood is able to clot
• Liver biopsy: This will see small tissue taken from the liver for examination
• Scan: This will usually involve a CT Scan, an MRI or an ultrasound

In addition, MP Shah’s Dr. Thuku cites that the stiffness of your liver might be evaluated. “By estimating the stiffness of the liver, it is then possible to classify the seriousness of the liver condition and formulate a plan for the management of the disease,” he says.

Treatment

Currently, there is no cure for cirrhosis. It is not possible to revers the damage to your liver that comes from chronic liver disease and, or cirrhosis. Dr. Thuku explains that after diagnosis, the primary focus is on stopping further deterioration of the liver.

“The end stage of chronic liver disease is cirrhosis and is irreversible. This means that most of the liver has been replaced by scar tissue – it shrinks in size and cannot do its normal function,” he says.

“Stopping further deterioration becomes urgent or else liver failure ensues – only a liver transplant from a donor can help the patient.”

According to Johns Hopkins Medicine, the treatment plan will also look at what brought the disease in the first place for treatment in order to stop further liver aggression.

“The treatment plan may include a treatment for the condition that led to cirrhosis. For example, the patient might be put on anti-viral medicines to treat hepatitis C. This may stop cirrhosis from getting worse,” cites Johns Hopkins.

Other triggers that you might be asked to avoid will include alcohol and smoking. You might also be asked to lose weight if you’re overweight or obese, maintain high standards of hygiene to avoid infections, take a healthy diet, and engage in regular physical exercises to reduce muscle loss.

“Some of the other treatment plans that may be specific to the cause of the cirrhosis will include controlling excessive iron or copper levels, or using immune suppressing medicines,” Johns Hopkins Medicine states.

Complications

Having chronic liver disease and, or cirrhosis might trigger a series of health complications. According to Johns Hopkins Medicine, these complications will usually include:

• Kidney disease
• Swollen or bleeding veins
• Encephalopathy (problems with brain function)
• Type 2 diabetes
• Liver cancer
• Peripheral oedema (buildup of fluid in your legs or ankles)
• Ascites (buildup of fluid in your stomach)
• Portal hypertension