Liver Cirrhosis Treatment

The liver plays a vital role in detoxification and digestion. However, when the liver tissue is scarred by diseases, infections, or alcoholism, it can lead to hepatic cirrhosis, commonly known as liver cirrhosis. It is an advanced-stage liver disease that gradually deteriorates the liver’s function over time. While the damage is usually irreversible, several effective strategies can help slow its progression. As a leading centre for liver disease treatment in India, Artemis Hospitals, Gurgaon offers a comprehensive range of liver cirrhosis treatments including medications, surgery, and transplant procedures, delivered by a team of eminent hepatologists with demonstrated expertise in managing and treating liver disorders. 

When to Consult a Doctor for Liver Cirrhosis?

Liver cirrhosis is a progressive disease that worsens over time, making it essential to seek medical care as soon as possible. Here are some of the reasons to consult a top hepatologist at Artemis Hospitals, Gurgaon: 

Noticeable Early Symptoms of Liver Cirrhosis 

Symptoms of hepatic cirrhosis are often not noticeable until the disease has progressed to an advanced stage. When symptoms do appear, they can resemble those of other non-liver diseases. That said, here are some early signs and symptoms of liver cirrhosis that should be reported to a doctor:

• Loss of appetite

• Nausea

• Weakness

• Vomiting

• Abdominal pain

• Prominent spider-like blood vessels of the skin

In some cases, the signs and symptoms of cirrhosis of the liver may indicate specific complications of the disease. For example, portal hypertension, which is the compression of the portal vein that runs through your liver due to scar tissues. Specific symptoms of liver disease complications include:

• Frequent bleeding and cuts

• Abdominal pain 

• Swelling in the face, legs, and hands

• Blood in poop

• Shortness of breath

Similarly, the following symptoms of hepatic cirrhosis may indicate a declining liver function:

• Pale coloured stools

• Impotence 

• Reduction in sex drive

• Yellowing of the eyes and skin

• Sudden weight loss

• Fat deposits or yellow bumps on the skin or eyelids

• Gynaecomastia (enlargement of breasts in men)

• Irregular menstrual cycle 

Apart from advise on the signs and symptoms, you can also consult a liver specialist at Artemis Hospitals for the following reasons:

• Existing Liver Disease: Regular monitoring and tailored treatment plans can help control symptoms and prevent further damage.

• Alcohol-related Liver Issues: The team at Artemis Hospitals, Gurgaon offers comprehensive support for managing liver damage caused by alcohol use, including medical treatments and lifestyle guidance.

• Concerning Results in Liver Function Test: If liver function test reveals unusual enzyme levels or other concerning markers, it’s important to undergo further evaluation.

• Seeking a Second Opinion: Getting an expert second opinion ensures you have considered all available treatment options.

• Preventative Care and Risk Assessment: Our hepatologists can assess your risk factors for liver disease, offering strategies to prevent its onset.

Causes and Risk Factors for Liver Cirrhosis

Many types of diseases and conditions, such as hepatitis B and cystic fibrosis, can lead to liver cirrhosis. Here are some of the causes of liver cirrhosis:

• Viral Hepatitis B, C, or D: It refers to liver inflammation caused by a viral infection. Hepatitis B and C are the most common causes of liver infection, often transmitted through contaminated blood, bodily fluids, or sharing needles. Hepatitis D occurs only in those already infected with hepatitis B, compounding liver damage.

• Autoimmune Hepatitis: It is a condition in which the immune system mistakenly attacks liver cells, resulting in chronic inflammation and liver damage.

• Excessive Alcohol Consumption: Alcohol abuse can damage liver cells over time, impairing their ability to metabolise alcohol and function properly, resulting in inflammation and scarring of liver tissue.

• Primary Biliary Cholangitis (PBC): It is a chronic liver disease in which the bile ducts gradually degenerate. This condition impedes the flow of bile (a digestive fluid) leading to a buildup of toxins in the liver, which can cause scarring, liver failure, and cirrhosis.

• Biliary Atresia: It is a rare congenital condition where the bile ducts are abnormally narrow, blocked, or absent, disrupting the flow of bile from the liver to the gallbladder, leading to liver damage and cirrhosis if not treated.

• Wilson’s Disease: It is a genetic disorder in which the body accumulates excess copper, which is normally excreted by the liver, causing progressive liver damage and potentially leading to liver failure.

• Haemochromatosis: It is an inherited condition where the body absorbs too much iron from food, leading to iron buildup in various organs including the liver, causing liver inflammation, fibrosis, and cirrhosis.

• Non-Alcoholic Fatty Liver Disease (NAFLD): It refers to a range of liver conditions in which fat builds up in the liver in individuals with obesity, diabetes, and metabolic syndrome. In some cases, NAFLD can progress to non-alcoholic steatohepatitis (NASH), which causes inflammation and scarring, potentially leading to cirrhosis.

• Cystic Fibrosis: It is a genetic disorder that primarily affects the lungs and digestive system, including the liver. The condition causes thick, sticky mucus to build up, which can block the bile ducts and disrupt normal liver function. Over time, this can lead to liver inflammation, scarring, and cirrhosis.

• Certain Medications: Some medications, such as anaesthesia, birth control pills, and methyldopa, have been linked to liver inflammation or injury. The liver metabolises these substances, and in some cases, prolonged use or high doses can impair liver function, leading to conditions such as drug-induced hepatitis.

While some of the causes of liver cirrhosis are controllable, others are not. However, one thing is clear: undiagnosed and untreated liver diseases can lead to cirrhosis. Don’t wait till things get worse; consult cirrhosis doctors at Artemis Hospitals to explore the best treatment options. 

Types of Liver Cirrhosis Treated at Artemis Hospitals

As a leading centre for liver cirrhosis treatment and care, Artemis Hospitals offers specialised care for all types of liver cirrhosis, ensuring that every patient receives the best possible treatment and care. Liver cirrhosis can be categorised based on aetiology, morphology, and stage of the disease. Here’s a quick overview:

Aetiology of the Cirrhosis of the Liver (Causes)

• Toxin-related or Alcoholic liver cirrhosis: Due to excess alcohol consumption 

• Cholestasis or Biliary cirrhosis of the liver: Due to damage or blockage in the bile ducts

• Autoimmune Hepatitis: Due to an autoimmune disease affecting liver functioning

• Viral cirrhosis of the liver: Due to chronic hepatitis B, C, or D infections

• Metabolic cirrhosis of the liver: Due to non-alcoholic fatty liver disease, Wilson’s disease, or haemochromatosis

• Vascular cirrhosis of the liver: Due to conditions like Sinusoidal Obstruction Syndrome or Cardiac cirrhosis

• Cryptogenic cirrhosis of the liver: When other causes of liver cirrhosis are ruled out and there is no definitive clinical evidence for a particular reason. 

Morphology of Cirrhosis of the Liver 

This classification is based on the size of the liver nodules, which are clusters of abnormal liver cells that form as the liver tries to repair itself.

• Micronodular: Nodules are less than 3mm

Common causes include heavy alcohol use (alcoholic liver cirrhosis), long-term bile duct issues (chronic biliary), or problems with blood flow out the liver (hepatic venous outflow)

• Macronodular: Irregular, with variations above 3mm

Common causes include chronic hepatitis B and C infections and primary biliary cholangitis (a disease that damages bile ducts)

• Mixed: Features of both types present

Note: The morphological classification is not as reliable as the aetiology of liver cirrhosis, which is based on the causes. Most liver cirrhosis doctors prefer the aetiological classification for diagnosis.

Liver Cirrhosis Stages

Cirrhosis refers to advanced stages of liver disease, specifically stages three and four. It can be further classified as:

• Compensated Liver Cirrhosis: It refers to the third stage of liver disease where scar tissues develop slowly, but the liver can still perform most of its functions, compensating for the inflammation. Very few symptoms are visible at this stage. 

• Decompensated Liver Cirrhosis: It refers to the fourth stage of liver disease where the liver function significantly declines. At this stage of liver cirrhosis, prominent symptoms, such as abdominal swelling and jaundice, begin to appear.

At Artemis Hospitals, we provide treatments for all stages of liver cirrhosis. 

Complications of Liver Cirrhosis Treated at Artemis Hospitals

Cirrhosis involves chronic and progressive scarring of the liver, which impairs its function to filter out toxins, produce blood proteins and bile, and metabolise essential nutrients. Unmanaged liver cirrhosis can lead to several serious complications:

• Ascites: Fluid buildup in the abdomen due to the liver’s compromised functioning and increased pressure on the portal vein. It can lead to issues such as swelling, discomfort, and difficulty in breathing or moving around.

• Hormonal inflammation: High levels of hormones such as oestrogen due to the liver’s failure to regulate them, contributing to issues like the growth of breast tissue in men, irregular menstrual cycle in women, fatigue and mood swings, in general.

• Malabsorption: Deficiency in key nutrients due to the inability of the liver to absorb, which can lead to symptoms like weight loss, muscle weakness, and brittle bones.

• Compromised immunity: Weakened immune system due to the impaired filtration of toxins by the liver, increasing the risks of bacterial infections. 

• Oedema, swelling in the legs and the abdomen: Swelling in the legs due to the liver’s failure to produce enough proteins to keep fluid in the blood vessels, leading to a leakage in surrounding tissues. It causes pain and discomfort.

• Portal hypertension: Increased pressure in the veins supplying blood to the liver (portal vein) due to the scarring of the liver. It can lead to issues like ascites and varices (enlarged veins in the oesophagus or stomach).

• Fracture due to bone disease: Weakened bone and increased risk for fractures because of conditions like osteoporosis, which happens due to the liver’s inability to produce or activate sufficient vitamin D. 

• Kidney failure: A failure in the functioning of the kidneys due to improper blood flow from the liver, which can lead to life-threatening complications.

• Liver cancer: Formation and uncontrollable growth of abnormal liver cells due to long-term liver damage. 

At Artemis Hospitals, our hepatologists utilise various liver cirrhosis treatment strategies, helping patients alleviate symptoms and prevent complications.

Liver Cirrhosis Treatment at Artemis Hospitals

Artemis Hospitals, one of the best hospitals for liver cirrhosis treatment in India, offers comprehensive care treatment plans for liver cirrhosis, covering everything from initial assessment and diagnosis to treatment and ongoing care. 

Diagnosis of Liver Cirrhosis

During the initial consultation, our cirrhosis doctors at Artemis Hospitals typically discuss the patient’s symptoms and perform a clinical examination. They may order a variety of techniques to diagnose liver cirrhosis, including biopsy and ultrasound. Here’s a list of diagnostic procedures available at Artemis Hospitals:

• Liver function tests: To identify signs of liver failure, such as out-of-range bilirubin and liver enzymes. At Artemis Hospitals, we have a well-equipped laboratory with the latest technologies to provide quick and precise results. 

• Blood Tests for Viral Hepatitis: To test for hepatitis B, C, or D infections that can cause or worsen liver cirrhosis.

• Imaging Tests: To get a better picture of the liver, including its shape, texture, and size, using techniques like CT Scan, MRI, and Ultrasound. At Artemis Hospitals, state-of-the-art equipment such as the Tesla MRI, 1.5 T CT scanner, and the 4D Affinity 50 ultrasound offer high-precision imaging for accurate diagnosis and monitoring of liver conditions.

• Transient Elastography (FibroScan): To measure liver stiffness, which can indicate the extent of liver fibrosis or cirrhosis.

• Endoscopy: To examine the oesophagus and stomach using a flexible tube with a camera. The aim is to look for enlarged veins (varices), which can occur due to cirrhosis-related complications like portal hypertension.

• Autoimmune Markers: To detect autoimmune conditions that may contribute to liver cirrhosis, such as autoimmune hepatitis, through a blood test.

• Hollow-needle liver biopsy: To assess the condition of the liver through tissue samples. Our hepatologists are experts at percutaneous, transvenous, and surgical liver biopsies. 

Liver Cirrhosis Treatments Available at Artemis Hospitals

Artemis Hospitals, Gurgaon has state-of-the-art facilities and a team of experienced gastroenterologists to offer comprehensive care for liver cirrhosis. Depending upon the factors involved, our approach to liver cirrhosis treatment may include:

Medical Management

Medical management of liver cirrhosis focuses on slowing disease progression, managing symptoms, preventing complications, and improving quality of life. Artemis Hospitals offers a range of medical interventions tailored to address the underlying causes and potential complications, aiming to improve the patient’s quality of life and liver function. The approach typically includes:

Addressing the Underlying Cause

• Alcohol-Induced Cirrhosis: In cases of alcohol-induced cirrhosis, complete cessation of alcohol is crucial to prevent further liver damage. Artemis Hospitals provides counselling and addiction support programs to assist patients in achieving and maintaining sobriety.

• Viral Hepatitis (Hepatitis B and C): For patients with cirrhosis due to hepatitis B or C, antiviral medications are prescribed to suppress or eradicate the virus. These treatments reduce viral load, slowing liver damage and reducing the risk of liver cancer.

• Nonalcoholic Fatty Liver Disease (NAFLD): Patients with NAFLD are encouraged to lose weight through diet and exercise. For those with insulin resistance, medications such as metformin may be used to improve metabolism and reduce liver fat accumulation.

Management of Portal Hypertension

• Beta-Blockers: Non-selective beta-blockers, such as propranolol or nadolol, are prescribed to reduce blood pressure in the portal vein, decreasing the risk of variceal bleeding (a dangerous complication).

• Diuretics: Medications such as spironolactone and furosemide may be used to manage fluid retention caused by portal hypertension, reducing ascites and preventing related complications.

• Paracentesis: In cases of severe ascites, paracentesis (draining fluid from the abdomen) may be necessary to relieve discomfort and reduce infection risk.

Endoscopic Procedures

Endoscopic procedures are minimally-invasive techniques used to diagnose and treat a variety of complications related to liver cirrhosis. At Artemis Hospitals, endoscopic procedures are central to managing cirrhosis-related GI issues, offering targeted solutions to prevent and treat complications. Here are some of the endoscopic procedures performed at Artemis Hospitals:

• Esophagogastroduodenoscopy (EGD) or Upper GI Endoscopy: Used to examine the lining of the oesophagus, stomach, and the first part of the small intestine. During EGD, our doctors perform procedures such as banding or injecting medication directly into varices to control or prevent bleeding.

• Endoscopic Variceal Ligation (EVL): EVL, often referred to as "banding," is a first-line treatment used to prevent recurrent bleeding in cirrhotic patients, and is preferred due to its efficacy and lower risk of complications. During this procedure, elastic bands are placed around the varices to cut off blood flow, causing them to shrink. 

• Endoscopic Sclerotherapy: Sclerotherapy is another treatment for esophageal varices, particularly for patients who may not respond to EVL. This procedure involves injecting a sclerosing agent (a medication that hardens tissue) directly into the varices, causing them to clot and scar, which reduces the risk of bleeding.

• Endoscopic Retrograde Cholangiopancreatography (ERCP): ERCP combines endoscopy with X-ray imaging to diagnose and treat liver-related complications affecting the bile ducts and pancreas. In cirrhotic patients, ERCP is used to manage complications such as bile duct blockages, which can occur due to liver scarring. 

• Endoscopic Ultrasound (EUS): EUS uses an ultrasound device attached to the endoscope to get detailed images of organs surrounding the GI tract, including the liver and pancreas. EUS can be used to evaluate liver structure, detect liver masses, and check for portal hypertension. It is also useful for guiding biopsies and monitoring liver changes.

Interventional Radiology

Artemis Hospitals has a team of skilled interventional radiologists with experience in liver cirrhosis management, who work in collaboration with our gastroenterologists and hepatologists to ensure that each patient receives a comprehensive treatment plan. Here is a quick overview of some of the most common interventional radiology procedures for liver cirrhosis performed at Artemis Hospitals, Gurgaon:

• Transjugular Intrahepatic Portosystemic Shunt (TIPS): This procedure reduces high blood pressure in the portal vein by creating a new pathway for blood flow within the liver. A stent is inserted to maintain this new channel, reducing complications such as variceal bleeding and ascites.

• Paracentesis with Imaging Guidance: This procedure drains excess fluid (ascites) from the abdomen using ultrasound or CT guidance. It relieves abdominal discomfort and reduces the risk of infection. Imaging guidance ensures accuracy, minimising injury to surrounding tissues.

• Percutaneous Ablation for Liver Tumours: Cirrhotic patients are at risk of hepatocellular carcinoma (HCC). Percutaneous ablation uses minimally invasive methods such as radiofrequency, microwave energy, or alcohol injection to destroy small liver tumours. This treatment provides effective tumour control with shorter recovery and lower risks.

• Balloon-Occluded Retrograde Transvenous Obliteration (BRTO): This is an advanced procedure used to treat gastric varices that can develop from portal hypertension. A balloon temporarily blocks the vein while a sclerosing agent is injected to close off the varices, preventing bleeding and reducing the risk of life-threatening complications.

• Biliary Drainage and Stenting: This procedure addresses bile duct obstructions, which can cause jaundice, infections, or liver dysfunction. A catheter or stent is inserted to restore bile flow, alleviating symptoms and preventing further liver damage.

• Liver Biopsy with Imaging Guidance: Liver biopsy helps assess disease severity or detect liver cancer. Under imaging guidance, a needle is inserted to obtain a tissue sample, providing precise diagnostic information while minimising the risk of bleeding.

• Portal Vein Embolization (PVE): PVE encourages liver growth before surgery, which may be necessary for patients with cirrhosis who also need liver cancer treatment. By blocking part of the portal vein, this procedure helps increase the volume of healthy liver tissue, making surgery safer.

Surgery for Acute Liver Damage

Surgery is rarely recommended for liver cirrhosis unless it is to treat complications. Our team of doctors at Artemis Hospitals can perform several liver cirrhosis surgeries, including, but not limited to:

• Band Ligation: A procedure used to treat bleeding varices (enlarged veins) in the oesophagus or stomach by placing elastic bands around them to stop bleeding and prevent future occurrences.

• Liver Resection: A procedure for surgical removal of a portion of the liver that may be damaged or affected by tumours, helping to manage complications like liver cancer or severe cirrhosis.

• Shunt Surgery: A procedure for creating a new pathway for blood flow to bypass a blocked or scarred area in the liver, reducing high blood pressure in the portal vein (portal hypertension) and preventing variceal bleeding.

• Portal Vein Reconstruction: A surgical procedure to restore normal blood flow through the portal vein, often used when the vein is blocked or narrowed due to cirrhosis.

Liver Transplant

A liver transplant is recommended in severe cases of liver damage, acute liver failure, or when other treatments are ineffective. It is a major surgery that involves removing the damaged liver with a healthy liver from a donor. After a liver transplant, the patient requires lifelong medications and care to prevent organ rejection by the immune system. 

Artemis Transplant Centre is fully equipped for both deceased donor (cadaveric) transplants and living donor transplants, and our affiliation with the ORBO (Organ Banking and Retrieval Organisation) and MOHAN (Multi-Organ Standard of Care and Harvesting and Networking) helps ensure timely and life-saving transplants.

Artemis Hospitals offers a thorough liver transplantation program encompassing:

• Evaluation: A multidisciplinary team assesses the patient's overall health, liver disease severity, and suitability for transplantation. This includes diagnostic tests, imaging studies, and consultations with specialists.

• Surgery: Experienced transplant surgeons perform the liver transplant procedure, replacing the diseased liver with a healthy donor organ. The hospital's state-of-the-art facilities ensure the highest standards of surgical care.

• Post-Transplant Care: After surgery, patients receive continuous monitoring and support to prevent complications and promote recovery. This includes immunosuppressive therapy to prevent organ rejection and regular follow-up appointments.

Liver Cancer Treatments

Patients who develop cancer due to liver cirrhosis and the ones with cancer who develop cirrhosis are recommended cancer treatments, which may include partial hepatectomy (removal of a portion of a liver), chemotherapy, radiation, and liver transplantation. 

Nutritional and Lifestyle Support

The team at Artemis Hospitals works with patients to create personalised plans to help improve their liver health and quality of life.

• Personalised Dietary Counselling: Our dietitians provide customised nutrition plans to meet each patient's unique needs. These plans focus on balanced, liver-friendly diets, manage protein intake, and minimise sodium to control fluid buildup and reduce strain on the liver.

• Lifestyle Adjustments for Liver Health: Artemis offers a range of support services to help patients adopt healthy lifestyle changes. These include:

• Alcohol Cessation Programs: Recognizing the importance of complete alcohol abstinence in slowing liver damage, we provide counselling and support programs designed to help patients quit alcohol.

• Weight Management Programs: For patients with nonalcoholic fatty liver disease (NAFLD), structured weight management plans are available to help reduce liver fat and inflammation, aiming to improve liver function and overall health.

Through these comprehensive programs, Artemis Hospitals empowers patients with liver cirrhosis to make sustainable dietary and lifestyle changes to better manage their condition and enhance outcomes.

Why Choose Artemis Hospitals for Liver Cirrhosis Treatments?

Artemis Hospitals is a top choice for world-class liver cirrhosis treatments in India. Here’s why patients prefer us:

• Eminent Hepatologists: Our highly skilled hepatologists work closely with a multi-disciplinary team including nutritionists, gastroenterologists, and other specialists to deliver comprehensive, personalised care for every patient.

• Advanced Treatments: We offer a wide variety of advanced liver cirrhosis treatments, tailored to address each patient’s unique condition. From medication plans and minimally invasive procedures to liver transplants, our comprehensive approach ensures high-quality care. 

• State-of-the-Art Facilities: Artemis Hospitals has cutting-edge diagnostic tools and advanced laparoscopic and open surgery options. We also have state-of-the-art da Vinci Robotic Surgical System for minimally invasive robotic surgeries, and have plans to introduce many more advanced procedures, including faecal microbiota transplantation. 

Liver Cirrhosis Prevention Programmes at Artemis Hospitals

At Artemis Hospitals, we emphasise proactive health management. Our preventative care programmes are designed to help patients reduce the risk of liver-related complications, providing guidance on lifestyle changes, regular monitoring, and early interventions to maintain optimal liver health. Individuals, with no history of the disease, are advised to take the following steps to prevent liver cirrhosis:

• Vaccinations against Hepatitis A and B

• Management of underlying health conditions, such diabetes and cholesterol

• Dietary advice for a healthy liver

• Alcohol abuse prevention programmes

Other Recommendations

• Practise safe sex to prevent Hepatitis B and C

• Avoid excess consumption of painkillers

• Maintain a healthy weight

• Practise safe hygiene to avoid hepatitis infections

• Avoid sharing needles to prevent viral hepatitis transmission

• Use medications responsibly and only as prescribed

• Exercise regularly to support overall liver function

• Get regular liver function tests if at risk

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