Patients with early liver cirrhosis (compensated cirrhosis) often have no detectable symptoms or signs of disease. Such patients may feel completely well and healthy and are often diagnosed based on abnormal blood tests or liver scans.

Patients with early, compensated cirrhosis are often diagnosed on regular ultrasound screening during follow-up for chronic liver disease (e.g. chronic viral hepatitis or fatty liver disease). Those who are diagnosed thus have, on average, a survival rate of more than 10 years.

Patients with more advanced liver cirrhosis (liver scarring) may develop the following signs and symptoms:

• Swelling of the abdomen due to accumulation of fluid (ascites)
• Swelling of the ankles and feet (pedal oedema)
• Dilated blood vessels on the upper chest and arms (spider naevi)
• Enlarged spleen (splenomegaly)
• Drowsiness or confusion due to inability of the liver to break down toxins in the blood (hepatic encephalopathy)
• Swollen veins in the oesophagus and stomach that develop due to obstruction of blood flow in the liver (varices)
• Vomiting of blood or passage of black stools due to bleeding from ruptured varices (variceal bleeding)
• Yellowing of the eyes and skin (jaundice) associated with dark, tea-coloured urine
• Development of liver cancer

The development of such complications signals that the patient’s cirrhosis has progressed to a late stage (known as decompensated cirrhosis). Decompensated cirrhosis is a serious condition that needs to be managed by a liver specialist as it can lead to various serious complications such as internal bleeding, life-threatening infections, liver failure and liver coma known as encephalopathy.

Most of the symptoms and signs of liver cirrhosis are a result of the development of portal hypertension. This refers to increased blood pressure in the blood vessels supplying the liver (the portal vein).

This is a common complication of liver cirrhosis. The hardened liver obstructs blood flow from the portal vein, leading to raised pressures in the portal vein. This results in enlargement of the spleen (splenomegaly), development of swollen veins in the stomach and oesophagus (varices) and accumulation of fluid in the abdomen (ascites).

Liver cirrhosis (liver scarring) is diagnosed via the following modalities:

• Liver imaging (ultrasound, CT or MRI of the liver)
• Liver stiffness measurement using Fibroscan (non-invasive)
• Liver biopsy (removal of a small sample of liver tissue for histological analysis)

The doctor may suspect liver cirrhosis in people with risk factors for cirrhosis who have abnormal blood tests, abnormal liver imaging or one of the signs and symptoms listed above.

Liver imaging is the most common test for the diagnosis of liver cirrhosis in which the liver has a shrunken and nodular appearance. Early cirrhosis is more difficult to diagnose as these patients may show a normal liver image during the scan. Early cirrhosis is often diagnosed by liver stiffness measurement (Fibroscan). Sometimes a liver biopsy is required to confirm the diagnosis of early cirrhosis.

Ref: Q15

Check out other articles on liver health:

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Fatty Liver: What You Need to Know

How to Reverse Fatty Liver Disease

Liver Inflammation: What Causes It and How to Prevent

Diabetes and Liver Disease: What is the Link

Liver Cancer: Causes, Symptoms and Treatment