Cirrhosis

How long can a patient survive with liver damage?

  • Liver disease ranges from asymptomatic benign diseases (like fatty liver, hepatitis B carrier), to chronic hepatitis to cirrhosis and advanced cirrhosis with decompensation and rarely acute liver failure.
  • The question of survival is important only for those with cirrhosis. Since, I don't have exact details of what type of liver damage we are talking about, I am assuming it is cirrhosis.
  • Life expectancy depends on how advanced the cirrhosis is and it's cause
  • 1.Calculate the MELD score and child Pugh score. You can do it free online. After the score you will get the average life expectancy. Although it is good to know for a large group of patients, it is not very accurate for an individual patient. Keep your reports handy while calculating it and pay close attention to the units. Your doctor can help you calculate these scores
  • 2.Cause of liver disease. Some can be corrected, some cant. If they can be corrected, the prognosis is better. e.g. stopping alcohol, eradication of a virus. Look for any contributing causes that can be corrected.
  • A general rule is that cirrhosis have an average life expectancy of 8-10 years and once there is decompensation (like ascites, variceal bleed, encephalopathy, jaundice) the life expectancy is around 2 years. For very advanced cirrhosis with refractory ascites it is 6 months.

If a liver has been damaged more than 90%, is it possible that it repairs itself?

  • I am assuming your doctor has told that the liver is damaged by 90%. Now of course this is an educated guess and not an exact estimate. But for the subsequent discussion, I assume that the evaluation is correct and I am guessing you have cirrhosis and fluid in the abdomen.
  • Cirrhosis is when there is fibrosis throughout the liver. Fibrosis is the deposition of collagen. This process is usually irreversible. Take example of a scar on the skin to understand this. A scar has a similar mechanism of collagen deposition. A scar once developed does not go away. It is permanent. But it does fade over years.
  • Early cirrhosis can be reversed IF the primary cause can be detected and treated effectively. e.g. stopping alcohol in a person with cirrhosis due to alcohol. But it is not always easy to judge how advanced the cirrhosis is without a biopsy. In many cases, liver functioning can improve to a great deal. True reversal of cirrhosis is rare but has been reported

How should a patient suffering from liver cirrhosis maintain his or her diet?

  • The video below will be useful.
  • www.youtube.com/watch?v=YfQJ_kuRLuE
  • Early cirrhosis can be reversed IF the primary cause can be detected and treated effectively. e.g. stopping alcohol in a person with cirrhosis due to alcohol. But it is not always easy to judge how advanced the cirrhosis is without a biopsy. In many cases, liver functioning can improve to a great deal. True reversal of cirrhosis is rare but has been reported

What is a coarsened liver echotexture?

  • Coarse liver echotexture is a sonography finding in patients with chronic liver disease.
  • The spectrum of chronic liver disease can include chronic hepatitis (which is long standing inflammation in the liver due to a variety of reasons) to cirrhosis (the end effect of repeated inflammation and collagen deposition leading to a scarred and grossly dysfunctional liver)

Is human liver able to regenerate?

  • Behold the legend of Prometheus!!
  • The immortal Prometheus was bound to a rock as a punishment for theft, where each day an eagle, the emblem of Zeus, was sent to feed on his liver. The liver would then grow back overnight to be eaten again the next day.
  • This is a paradigm for the organ’s extraordinary ability to regenerate.
  • Patients with acute liver failure develop >90% impairment in liver function. But it is possible for the liver to recover completely from this after treatment.
  • Patient with cirrhosis develop failure after the recovery system is overwhelmed after months to years of relentless of going injury.

Can a person with liver cirrhosis still consume beer in a moderate amount?

  • Absolutely No!
  • Cirrhosis is the end stage result of long standing injury to the liver. For practical purposes, this is irreversible. Why would you risk furthering damage to the liver when it is already functioning at a fraction of what it should?
  • Even if you do not have any symptoms of cirrhosis, it should still be avoided. Alcohol is responsible for acute deterioration in cirrhosis in a sizeable number of patients.
  • For cirrhosis related to alcohol, complete abstinence is the only proven treatment to be effective and alters the natural history of the disease. Other treatments are only supportive. Providing a good micro-environment to the liver and supporting it is vital, and alcohol would lead to continuing injury.
  • Even if the cause of cirrhosis is something other than alcohol, e.g. hepatitis B or C, it is still to be avoided.
  • If you have craving for beer, you can be helped to reduce the craving.

What are the stem cells for cirrhosis of the liver?

  • Stem cells are the base cells that are derived from the bone marrow or cord blood. These cells have been used in cirrhosis with the assumption that they will transform into liver cells and take over the damaged liver and return the functioning back to normal.
  • This has been applied in few clinical studies. The use of stem cell therapy in cirrhosis is still evolving and is not the standard of care at present. Liver transplantation remains the best available mods of treatment for advanced cirrhosis.
  • From the limited experience, there has been some success. But the data is too small to recommend this treatment to anyone. It maybe tried as an experimental therapy with a readiness to accept that failure may happen. What the present studies have shown is that it is safe and feasible. Efficacy has not been established.

How much time does it take to cure regular jaundice in adults?

  • “Regular jaundice”, is usually viral hepatitis.
  • There are 5 types of hepatitis viruses named A, B, C, D and E. Of these, A and E viruses can cause jaundice in the community through contaminated water or food.
  • If you have these viruses, they are self-limiting in >95% of cases. You should be feeling better in 2–4weeks and jaundice should be gone in 4–6 weeks. LFT reports may take longer to normalise completely. The maximum time taken is 6 months- in few cases.
  • If you have other causes of jaundice, this does not apply.

Can a jaundice patient eat pulses?

  • Proteins are very important and as a matter of fact more proteins are required to help in the recovery from illnesses including viral hepatitis.
  • Proteins do not require bile for digestion. There is no evidence to suggest that patients with hepatitis cannot digest proteins.
  • It is a common myth. Also prevalent amongst doctors.
  • Even if the jaundice is due to cirrhosis, protein need to be consumed at least 1g/kg unless there is encephalopathy (brain edema).