The most common causes are chronic viral hepatitis (chronic hepatitis B and C), chronic alcohol consumption, cholestatic diseases, autoimmune liver diseases, as well as metabolic diseases such as non-alcoholic fatty liver infiltration due to obesity, poor nutrition , diabetes mellitus, hyperlipidemia, etc.

Causes of cirrhosis of the liver

“The most common cause of liver cirrhosis in Eastern countries remains chronic hepatitis B, while in the Western world it is non-alcoholic fatty liver disease (now called metabolically related fatty liver disease). The end result of chronic liver inflammation (regardless of the cause) is the creation of fibrosis (scarring) and regenerative nodules within the liver parenchyma, conditions that prevent proper liver function,” points out dr Dimitrios Karagiannakis MD, PHD Specialist Pathologist-Hepatologist Academic Scholar EKPA Deputy Director of the 3rd Pathology Clinic Hospital Metropolitan General.

Symptoms, complications and their treatment

“Initially, the patient with liver cirrhosis remains completely asymptomatic, as the liver manages to compensate for the damage (compensated cirrhosis).

However, with the progress of the disease, a rupture of the compensation is observed with the appearance of complications such as the ascites (fluid in the abdomen), Spleen enlargement, esophageal varices (distended veins in the esophagus), variceal bleeding (ruptured esophageal varices), hepatic encephalopathy, hepatocellular carcinoma etc.

Ascites is treated by limiting salt in the diet and administering diuretic drugs. In severe cases, it may be necessary to remove the fluid with a needle (evacuation puncture).

For varicose veins we administer beta-blocker medication to reduce the risk of variceal bleeding, which if it occurs is treated with emergency gastroscopy and banding ligation.

Regarding hepatocellular cancer, is treated with surgical excision, cautery, chemoembolization, oral medication or intravenous immunotherapy. The choice of the appropriate treatment depends on the extent of the tumor and the number of foci” explains the expert.

When is a liver transplant performed?

“It should be emphasized,” he continues, “that cirrhosis of the liver is not the end of the path for a patient suffering from a liver disease. Rather, it appears to be a dynamic condition that can not only worsen and progress from a compensated to an uncompensated state, but can also reverse. A basic condition for the latter to occur is the complete removal of the damaging-causative factor (e.g. successful treatment of chronic hepatitis B or C, complete cessation of alcohol, treatment of fatty infiltration, etc.), before the patient reaches very advanced stages of decompensated cirrhosis.

If this is not achieved and the patient presents with advanced decompensated cirrhosis, then the only treatment option is liver transplantation. Tools that help to assess the severity of cirrhosis and therefore the possibility of regression are the measurement of the MELD-Na score (a score that takes into account some hematological parameters), the Child-Pugh score and liver elastography (a special ultrasound technique that measures the degree of liver fibrosis).

In the event that the patient is terminally ill and qualifies for a transplant, he must meet certain conditions (appropriate age, no serious cardiovascular and respiratory diseases, no history of cancer, or if he has been under treatment for the last 5 years etc.). Hepatocellular cancer is not a contraindication for liver transplantation as long as it is within specific criteria (Milan criteria), which practically means that it has not spread to such an extent that it creates a risk of recurrence in the transplant”, concludes Dr. Karagiannakis.