Quick Answer
Liver cirrhosis is the end-stage scarring of the liver caused by long-standing injury (alcohol, hepatitis, fatty liver, autoimmune disease). Dr. Anando Sengupta manages cirrhosis with cause-specific treatment, prevention of complications (variceal bleed, ascites, encephalopathy), 6-monthly liver cancer surveillance, and timely liver transplant referral when needed.
What is cirrhosis?
Cirrhosis is the final, irreversible stage of chronic liver damage. Normal liver tissue is replaced by fibrous scar that disrupts both the liver's function (synthesis of proteins, clearance of toxins) and its blood flow (causing portal hypertension).
Two stages of cirrhosis
| Compensated | Decompensated |
|---|---|
| No or minimal symptoms; near-normal life expectancy if cause is treated | Major complications: ascites, jaundice, variceal bleed, encephalopathy, kidney failure |
| Detected on routine LFT or ultrasound | Often presents as emergency hospitalisation |
Causes
- Alcoholic liver disease
- Chronic hepatitis B (most common chronic hepatitis in India)
- Chronic hepatitis C
- NAFLD / NASH — rising rapidly
- Autoimmune hepatitis
- Primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC)
- Wilson's disease, haemochromatosis, alpha-1-antitrypsin deficiency
- Drug-induced liver injury
- Cardiac cirrhosis (right heart failure)
Symptoms & signs
- Fatigue, weakness, weight loss
- Loss of appetite, nausea
- Jaundice (yellow eyes/skin)
- Easy bruising, prolonged bleeding
- Swelling of feet and abdomen (ascites)
- Itching, dark urine
- Confusion, sleep reversal, drowsiness (hepatic encephalopathy)
- Vomiting blood or black tarry stools (variceal bleed)
- Spider naevi, palmar erythema, gynaecomastia in men
Cirrhosis emergencies: vomiting blood, black tarry stools, fever with abdominal pain (?spontaneous bacterial peritonitis), severe drowsiness or confusion, reduced urine output. These need same-day hospital admission.
Diagnosis & severity assessment
| Test | Purpose |
|---|---|
| LFT (bilirubin, AST, ALT, ALP, GGT, albumin), INR | Liver injury & synthetic function |
| Hepatitis B/C, autoimmune panel, ferritin, ceruloplasmin | Identify the cause |
| Ultrasound + Doppler / CT / MRI | Liver morphology, portal vein, splenomegaly, HCC screening |
| FibroScan | Non-invasive assessment of fibrosis |
| Upper GI endoscopy | Variceal screening |
| Child-Pugh & MELD scores | Severity, prognosis, transplant priority |
| Alpha-fetoprotein + 6-monthly USG | Liver cancer (HCC) surveillance |
Treatment
1. Treat the underlying cause
- Hepatitis B — lifelong antiviral therapy (entecavir, tenofovir)
- Hepatitis C — 8–12 weeks of direct-acting antivirals (cure rate >95%)
- Alcohol — complete abstinence; rehab support
- NAFLD — weight loss, diabetes control
- Autoimmune hepatitis — corticosteroids and azathioprine
2. Manage complications
- Varices: beta-blockers (propranolol, carvedilol) and/or endoscopic banding
- Ascites: salt restriction, diuretics, paracentesis with albumin for tense ascites
- Hepatic encephalopathy: lactulose + rifaximin
- SBP: third-generation cephalosporins + albumin
- Hepatorenal syndrome: terlipressin + albumin
- Pruritus: cholestyramine, rifampicin
3. HCC surveillance & transplant evaluation
Every 6 months — ultrasound and AFP. Suspicious nodules are evaluated with multiphase CT or MRI. Transplant referral is planned for advanced disease before crisis decompensation.
4. Nutrition & lifestyle
- 1.2–1.5 g/kg/day protein — including evening snack to prevent overnight muscle catabolism
- Salt < 2 g/day if ascites or oedema
- Fat-soluble vitamin (A, D, E, K) supplementation in cholestatic disease
- Vaccinate against hepatitis A, B, influenza, pneumococcus
- Avoid hepatotoxic herbal & over-the-counter drugs
Frequently Asked Questions
Cirrhosis is the end stage of long-standing liver injury where normal liver tissue is replaced by scar tissue (fibrosis), distorting blood flow and impairing liver function.
Alcohol, chronic hepatitis B and C, NAFLD/NASH, autoimmune hepatitis, Wilson's disease, haemochromatosis and primary biliary cholangitis. NAFLD-related cirrhosis is now the fastest-growing cause.
Many people have no symptoms early on. Fatigue, easy bruising, mild jaundice, swelling of feet, reduced appetite, weight loss, and itching are common. Decompensation presents with ascites, jaundice, vomiting blood (variceal bleed), or confusion (encephalopathy).
Early fibrosis can regress if the underlying cause is removed (e.g. successful hepatitis C treatment, weight loss in NAFLD, alcohol abstinence). Established cirrhosis with nodules is generally not reversible, but progression can be halted with optimal care.
Every 3–6 months: clinical review, LFT, INR, albumin, kidney function, alpha-fetoprotein, and ultrasound for HCC surveillance. Endoscopy at diagnosis for variceal screening, then every 1–3 years.
When the MELD score is high (typically >15), or in decompensated disease (recurrent ascites, encephalopathy, variceal bleeding) not controlled medically, or in early hepatocellular carcinoma within transplant criteria.
Yes. Dr. Anando Sengupta consults at North Delhi Nursing Home, Ashok Vihar Phase II (Mon–Sat, 5:30–7:30 PM) — within easy reach of Model Town (3 km), GTB Nagar, Mukherjee Nagar, Wazirpur and Shastri Nagar. Morning slots and procedures (endoscopy, colonoscopy, ERCP, EUS) are at Fortis Hospital, Shalimar Bagh (~3 km from Pitampura, with cashless insurance on all major panels). Both clinics serve patients from across North Delhi.
