Cirrhosis is a disease that causes scaring of the liver. The liver is a big organ in the upper right side of the belly and does many important functions in the body. Liver cirrhosis is a progressing disease in which the normal liver tissue is replaced by scar tissue hence preventing it from performing its functions normally.

When something harms the liver, it tries to fix itself. In the process, scars form. Causes of liver damage include heavy alcohol use (people who abuse alcohol or who are addicted to it) are most at risk for cirrhosis and infection with Hepatitis B or Hepatitis C viruses.

People can catch the viruses by sharing needles or having sex with people who are infected. Nonalcoholic steatohepatitis (NASH) is another condition in which there is fat deposition in the liver causing inflammation and damage to the liver cells and this can progress to scaring of the liver, and it occurs in people who drink little to no alcohol. The exact cause of NASH is not known what, but many people who have it are obese and have diabetes.

Currently in Rwanda, Hepatitis B prevalence is at 3.6 per cent, which has now exceeded HIV prevalence currently at 3 per cent and hepatitis C at 2.5 per cent. Hepatitis B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer.

Symptoms of liver cirrhosis

Some people with cirrhosis have no symptoms initially, but as the condition progresses, they present with symptoms which can be mild to severe such as; swelling in the belly and legs, heavy bleeding from blood vessels in the esophagus (the tube that connects the mouth to the stomach), bruising or bleeding easily, feeling full, feeling tired, trouble getting enough sleep or sleeping too much, yellowing of the skin or whites of the eyes, confusion that can come on suddenly and in severe case can lead to coma. Cirrhosis also makes it more likely that you will get infections, and it can increase your risk of liver cancer.

Cirrhosis of the liver is diagnosed by history taking from the patient of their symptoms, physical examination, laboratory and radiology investigations and is confirmed in most cases by taking off a small tissue from the liver (biopsy) for analysis.

How to prevent liver cirrhosis

You can reduce your chances of getting cirrhosis by; avoiding or stopping alcohol abuse because liver cirrhosis doesn’t only affect heavy drinkers – drinking more than two bottles of alcohol a day increases the risk; getting the vaccine for hepatitis B if you haven’t already; avoiding high risk sexual behaviors such as unprotected sex with multiple partners; not sharing drug needles and sharp objects and eating a well-balanced diet which is low fats and high in fruits and vegetables. Maintaining a healthy weight as obesity increases risks of suffering from fatty liver disease which can eventually lead to liver cirrhosis.

Management of liver cirrhosis

Although cirrhosis cannot be cured, but several treatments are available to minimise cirrhosis-related complications.Treatments depend on the cause of cirrhosis, how severe it is, and what symptoms one has. Treatments fall into a few main categories, including those that;

Treatment to remove the cause of the liver cirrhosis can be prescribed. Some causes of cirrhosis can be treated, such as stopping alcohol in people with cirrhosis caused by alcohol abuse and treatment for chronic hepatitis C or B with medicine.

Treatment to lower the risk of bleeding can be given. Cirrhosis can cause the blood vessels around the esophagus to swell or even burst and bleed. To prevent that from happening, medicines that reduce blood pressure in the liver, and help reduce the chance of bleeding can be prescribed and procedures to tie tiny bands around the swollen blood vessels can be performed

Treatment to decrease fluid buildup in the belly can be prescribed. In people with cirrhosis, the belly sometimes fills with fluid. To decrease fluid buildup, medicines called "diuretics.” that help one to urinate out the extra fluid. People who take diuretic medicines often must also reduce the amount of salt they eat. At times, draining of the fluid from the belly is done

Antibiotics might be prescribed for people with liver cirrhosis. People with cirrhosis have a higher than normal chance of getting infections due to their low immunity status as the liver is responsible for manufacturing antibodies which fight against infection. When they get an infection, they can also get much sicker than people without cirrhosis. As a result, people with cirrhosis sometimes need antibiotics to either treat or prevent infection. Most people with cirrhosis should also get the flu vaccine and other vaccines to prevent common infections.

A liver transplant maybe considered for some patients with severe liver cirrhosis.

Dr Ian Shyaka is a General Practitioner based in Kigali