Cirrhosis

Cirrhosis is advanced scarring of the liver after years of injury. Bands of scar tissue replace healthy liver and distort its structure, which makes blood flow through it harder and gradually reduces what the liver can do. In the compensated stage many people feel well; in the decompensated stage complications such as fluid in the abdomen, bleeding or confusion appear.

Established scarring is largely permanent, but removing the cause, for instance stopping alcohol, curing hepatitis C or suppressing hepatitis B, can halt progression and sometimes allows partial improvement. When the liver can no longer cope, transplantation is the only treatment that replaces its function.

Symptoms

• Often none in the early, compensated stage
• Tiredness, poor appetite and loss of muscle
• Swelling of the abdomen (ascites) and ankles
• Yellowing of the skin and eyes
• Easy bruising and nosebleeds
• Persistent itching of the skin
• Spider-like blood vessels on the chest and red palms
• Confusion, daytime sleepiness or a change in personality (hepatic encephalopathy)
• Vomiting blood or black stools from bleeding varices

Causes and risk factors

The main causes are long-term heavy alcohol use, chronic hepatitis B and C, and fatty liver disease linked to obesity and type 2 diabetes (now called metabolic dysfunction-associated steatotic liver disease). Less common causes include autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis, haemochromatosis, Wilson disease, alpha-1 antitrypsin deficiency and long-standing heart failure. Several causes often act together, for example alcohol plus excess weight.

How it is diagnosed

• Blood tests: Liver enzymes, bilirubin, albumin, clotting and platelet count show how well the liver is working; further tests look for viral, autoimmune and metabolic causes.
• Ultrasound: Shows a nodular liver, an enlarged spleen and ascites, and is repeated every 6 months to screen for liver cancer.
• Elastography (FibroScan): A painless measurement of liver stiffness that estimates the degree of scarring.
• Endoscopy: Looks for enlarged veins (varices) in the gullet and stomach that could bleed.
• CT or MRI: Characterises any nodule found on ultrasound and maps the blood vessels before surgery or transplant.
• Liver biopsy: Reserved for cases where the cause or stage remains unclear.
• Severity scores: Child-Pugh and MELD scores combine blood results and clinical findings to guide prognosis and transplant timing.

Treatment options

• Treating the cause: Complete abstinence from alcohol, antivirals for hepatitis B and C, weight loss and diabetes control for fatty liver, immunosuppression for autoimmune hepatitis.
• Nutrition: Adequate protein and calories, a late evening snack, and limiting salt when ascites is present. Protein restriction is outdated.
• Diuretics and paracentesis: Water tablets for ascites, with drainage of large volumes through a needle when needed.
• Beta blockers and variceal banding: Reduce the risk of bleeding from varices.
• Lactulose and rifaximin: Prevent and treat episodes of hepatic encephalopathy.
• TIPS: A radiological shunt inside the liver that lowers portal pressure in selected people with recurrent bleeding or resistant ascites.
• Liver cancer surveillance and vaccination: Six-monthly ultrasound, plus hepatitis A, hepatitis B, influenza and pneumococcal vaccines.
• Liver transplantation: For decompensated disease or early liver cancer. In Türkiye most transplants use part of the liver from a living related donor, which requires ethics committee approval.

When it is urgent

Vomiting blood, black tarry stools, new confusion or severe drowsiness, fever with abdominal pain when you have ascites, a sharp fall in urine output or rapidly deepening jaundice are emergencies. Call emergency services or go to the nearest hospital; do not travel.

Travelling to Türkiye for treatment

Cirrhosis is a chronic disease that needs a hepatology team close to home. A trip can offer a second opinion, a full staging work-up over a few days, or a planned procedure such as banding or TIPS. Transplant evaluation is possible, but Turkish law requires a living donor who is a relative, with proof of the relationship and ethics committee approval; donors are not arranged for you. If you have decompensated disease, ask your own doctor whether flying is safe.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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