Imagine it’s a beautiful Saturday morning and you’re at the local farmer’s market, sipping a coffee and browsing the stalls. You decide to buy some apples and carefully select those with bright, firm skin. When you get home, you put them in your fruit bowl – but you don’t get around to eating them. A week later, those apples are shrivelled, shrunken and discoloured.
Hold those two images – a fresh apple and a shrivelled one – in your mind as we turn our attention to the four stages of cirrhosis of the liver.
What is cirrhosis of the liver?
A healthy liver is soft, smooth and hard-working. Its lengthy job description includes:
- Detoxifying (cleaning) your blood to remove alcohol, drugs and other chemicals
- Making, storing and supplying glucose (sugar) and fat
- Producing essential proteins to clot your blood and fight infections
- Balancing hormones that drive your metabolism
- Controlling your cholesterol
- Storing essential vitamins and minerals
- Producing bile to aid digestion.
Your liver will soldier on, even when badly damaged. Eventually, though, that long-term damage can lead to cirrhosis of the liver.
Liver cirrhosis means your liver is scarred, shrunken, hard and lumpy. It can no longer do its countless jobs well, which can affect your overall health, quality of life and life expectancy.
Cirrhosis is thought to affect at least 1 in 200 Australians. It develops slowly, often without obvious symptoms and in recognised stages.
Cirrhosis of the liver stages
‘Staging’ a disease means using objective, medical criteria to assess how far it has progressed. It’s a useful tool that helps us judge the severity of a condition so that we can recommend appropriate treatment.
Here are the 4 stages of liver cirrhosis.
Stage 1: Liver steatosis
All livers contain some fat. But you may have fatty liver disease (liver steatosis) if fat makes up more than 5-10% of your liver.
You’re at risk of developing fatty liver disease if you:
- Are overweight or obese
- Have a medical condition like diabetes, polycystic ovary syndrome or an underactive thyroid
- React to some medications
- Drink too much alcohol.
About 1 in 3 Australians are thought to have fatty liver disease making it a widespread problem. Many won’t know about it, since it may cause no obvious symptoms in the early stages – or vague ones like fatigue and abdominal pain.
Often signs of fatty liver are picked up on a routine blood test or ultrasound when your doctor is investigating something else.
Fatty liver disease can be managed by eating a healthy diet and cutting back on sugary, fatty food and alcohol. Without these lifestyle changes, fatty liver disease may progress to a condition known as steatohepatitis, which causes inflammation in your liver.
Stage 2: Liver fibrosis
Liver fibrosis refers to scarring in your liver.
Your liver tries to heal itself when it experiences injury or inflammation. When it has to do this repeatedly over many years, your liver may begin to lose the ability to repair itself. The protein cells that were meant to help your cells heal, instead build up in your liver and form scar tissue (fibrosis).
Research shows 6-7% of adults may have liver fibrosis without knowing it. That’s because there may be no symptoms in the early stages when it is most treatable. As liver fibrosis progresses, you may experience:
- Loss of appetite
- Confused thinking
- Fluid retention in your legs or stomach
- Nausea
- Weight loss
- Yellowing skin or eyes (jaundice).
If we catch liver fibrosis in its early stages, we may be able to treat it by:
- Lifestyle changes – weight loss, dietary changes or cutting out alcohol can all help
- Treating underlying conditions like hepatitis
- Prescribing medications to slow the progression of fibrosis (an emerging area of research and treatment).
Stage 3: Liver cirrhosis
Liver cirrhosis is late-stage liver disease. By this point, your liver is covered in scar tissue, which blocks blood flow and prevents your liver from functioning properly.
A well-functioning liver is vital to your health. You rely on your liver to filter your blood, store vitamins and minerals and produce bile to support your digestion. Those are just 3 of its estimated 500 jobs.
Liver cirrhosis disrupts your liver’s function. And because those functions are so important, it’s a serious problem.
There’s no cure for liver cirrhosis so treatment aims to prevent it from worsening and manage symptoms or complications. It’s important to avoid anything that places extra stress on your liver such as alcohol.
Once you have liver cirrhosis, your liver won’t get better – but it may not get worse either. Life expectancy with cirrhosis of the liver varies greatly depending on factors such as the degree of scarring and your overall health. It can range from 2-15 years. A liver transplant may be considered in severe cases to extend your life expectancy.
Stage 4: Chronic liver failure
Chronic liver failure is a potentially life-threatening condition that occurs when your liver can’t function any longer. It’s considered end-stage liver disease.
By this point, you may be experiencing many distressing symptoms including:
- Intensely itchy skin
- Jaundice
- Swollen lower limbs and belly
- Nausea
- Vomiting blood
- Bruising or bleeding easily
- Confusion and fatigue.
You may need treatment in an intensive care unit and may be considered for a liver transplant.
Get a liver scan
As you can see, one of the biggest problems with liver disease is that it can happen without symptoms. Your liver may be struggling for years before you’re aware that there’s a problem. And if you don’t know your liver’s in trouble, you’re less likely to take steps to protect it.
A liver scan is an important, non-invasive procedure similar to an ultrasound. It helps determine if you have fatty liver, fibrosis, or cirrhosis, and help us assess the severity of your condition. These insights are vital and can be both life-changing and life-saving.
It’s important to note that liver function tests (blood tests) often do not detect fatty liver and other liver issues effectively. We’ve encountered patients with cirrhosis or fatty liver who had minimal or no changes in their liver function tests. This is why we recommend having a liver scan at least once to understand what’s happening with your liver.
Moonee Valley Specialist Centre is one of the only private clinics in Victoria to possess a liver scanning machine – the FibroScan® 502 Touch. You don’t need a referral for this, you can simply book an appointment at a time that suits you. It could be the best thing you ever do for your liver.
Disclaimer
All information is general and is not intended to be a substitute for professional medical advice. Moonee Valley Specialist Centre can consult with you to confirm if a particular treatment or procedure is right for you. Any surgical or invasive procedure carries risks. A second opinion may help you decide if a particular treatment is right for you.
References
- Liver Foundation, About the liver, https://liver.org.au/your-liver/about-the-liver/, [Accessed 4 July 2024]
- Liver Foundation, Cirrhosis, https://liver.org.au/your-liver/liver-diseases/cirrhosis/, [Accessed 4 July 2024]
- Liver Foundation, Fatty liver disease, https://liver.org.au/your-liver/liver-diseases/fatty-liver-disease/, [Accessed 4 July 2024]
- The Lancet Gastroenterology and Hepatology, Screening for liver fibrosis in the general population: a call to action, https://www.thelancet.com/journals/langas/article/PIIS2468-1253(16)30081-4/abstract, [Accessed 4 July 2024]
- Johns Hopkins Medicine, Liver: anatomy and functions, https://www.hopkinsmedicine.org/health/conditions-and-diseases/liver-anatomy-and-functions#, [Accessed 4 July 2024]
- Cleveland Clinic, Cirrhosis of the liver, https://my.clevelandclinic.org/health/diseases/15572-cirrhosis-of-the-liver, [Accessed 4 July 2024]
- Liver Foundation, Liver failure, https://liver.org.au/your-liver/liver-failure/, [Accessed 4 July 2024]