Cirrhosis

Cirrhosis is late-stage scarring of the liver. Repeated liver injury replaces healthy tissue with scar tissue, and the liver slowly loses function. Cirrhosis often develops over years without symptoms, then reaches a tipping point where the liver can no longer keep up. Early cirrhosis is sometimes reversible; later stages are not, but progression can still be slowed.

Main causes in India

• Chronic hepatitis B and C.
• Alcohol — most cases in Indian men with established cirrhosis have a significant alcohol history.
• Non-alcoholic fatty liver disease (NAFLD/MAFLD) — now rising rapidly with urban obesity and diabetes.
• Autoimmune and genetic causes (Wilson's disease, haemochromatosis).
• Long-term bile duct disease.

Symptoms of advanced disease

• Persistent tiredness, weight loss, muscle loss.
• Yellow eyes/skin (jaundice).
• Swelling of the abdomen (ascites) and legs.
• Easy bruising or bleeding.
• Itching.
• Confusion, drowsiness, sleep reversal (hepatic encephalopathy — urgent).
• Vomiting blood or black stools (variceal bleed — emergency).

Red flags — dial 112

• Vomiting blood, black tarry stools.
• Sudden confusion, unusual behaviour, drowsiness.
• Severe abdominal pain with fever.
• Sudden breathlessness.

Treatment

• Treat the underlying cause — antivirals for hepatitis B/C (hepatitis C is now curable), absolute avoidance of alcohol, weight loss for NAFLD, specific treatment for Wilson's/autoimmune disease.
• Monitoring — ultrasound every 6 months and blood tests to catch liver cancer early; endoscopy to look for varices.
• Vaccines — hepatitis A/B (if not immune), annual flu, pneumococcal.
• Diet — adequate protein (unlike older advice), low salt (for fluid), no alcohol, regular small meals.
• Avoid drugs that stress the liver — NSAIDs, unregulated ayurvedic/herbal products.
• Liver transplant — for advanced cirrhosis in selected patients; available in a growing number of Indian centres with good outcomes.

A diagnosis of cirrhosis is serious but not hopeless — with stopping the cause, strict adherence to monitoring, and modern treatment, many people live well for years.