Cirrhosis

Cirrhosis is a chronic liver disease characterised by the development of scar tissue (fibrosis) that compromises liver function. As fibrosis progresses, the liver loses its ability to process nutrients, produce proteins and bile, and perform its essential role in digestion.
 

Signs and symptoms

• Fatigue;
• Frequent bleeding;
• Loss of appetite and weight loss;
• Nausea;
• Oedema (swelling) of the legs, ankles or feet;
• Ascites (accumulation of fluid in the abdomen);
• Pruritus (itching);
• Yellowing of the skin and eyes (jaundice);
• Reddened palms of the hands;
• In women: amenorrhoea (absence of menstruation);
• In men: reduced libido, erectile dysfunction or testicular atrophy.

Causes of cirrhosis

Cirrhosis has several possible causes. In Portugal, the most common are alcohol misuse and chronic viral hepatitis B and C. More recently, metabolic syndrome—frequently observed in individuals with obesity or high cholesterol, diabetes and hypertension—may worsen fat accumulation in the liver and lead to fatty liver disease (steatosis), which over the medium to long term can result in cirrhosis.

Other less frequent causes include:

• Alcohol-related liver disease;
• Chronic hepatitis (B, C and D) and autoimmune hepatitis;
• Fat accumulation in the liver (steatosis) and obesity;
• Autoimmune liver diseases (autoimmune hepatitis, primary biliary cirrhosis);
• Haemochromatosis (iron accumulation in the liver);
• Wilson’s disease (copper accumulation in the liver);
• Chronic toxic hepatitis (long-term use of certain immunosuppressive or anti-epileptic medications, for example);
• Congenital diseases of the bile ducts or liver (atresia, biliary cysts).

The diagnosis of cirrhosis is based on the patient’s clinical history, supported by laboratory tests and imaging studies. Blood tests assess bilirubin levels and liver enzymes, while imaging tests such as ultrasound or CT scans help evaluate liver structure. In some cases, a liver biopsy is required to determine the extent of liver damage.

Treatment of cirrhosis depends on the underlying cause and the severity of the disease. In the early stages, it is essential to avoid alcohol consumption, adopt a healthy diet rich in fruit and vegetables, avoid foods high in sodium and saturated fats, maintain an appropriate weight, engage in regular physical activity and manage other conditions that affect the liver.

In more advanced stages, treatment may include medication to control portal hypertension (abnormally increased pressure in the portal vein, which carries blood from the intestine to the liver) and relieve symptoms such as pruritus and fatigue. In severe cases, liver transplantation may be required.