Liver cirrhosis

Disease Description (Causes and Symptoms)

• Definition summary: Liver cirrhosis (hepatic cirrhosis) is a condition in which chronic liver injury leads to progressive liver fibrosis, destruction of the normal liver structure, increased portal pressure (portal hypertension), and reduced liver function. Reduced hepatocyte synthesis and detoxification functions, along with impaired blood flow, cause various complications.
• Main causes (reflecting prevalence patterns in Korea): Chronic hepatitis B (approximately 70%, the main cause), heavy alcohol consumption (alcohol-related liver disease), chronic hepatitis C, nonalcoholic steatohepatitis (NAFLD/NASH), autoimmune hepatitis, bile duct diseases (including primary biliary cholangitis), and genetic diseases such as Wilson disease. Some cases have no identifiable cause.
• Pathophysiology (key points): Repeated or persistent hepatocyte injury → progressive fibrosis → distortion of the liver structure → increased portal pressure (ascites, esophageal varices, etc.) and reduced synthetic function (low albumin, reduced clotting factors) → jaundice, hepatic encephalopathy, and increased risk of liver cancer.
• Main symptoms: Initially asymptomatic (compensated stage) → as the disease progresses, fatigue, weight loss, loss of appetite, nausea, abdominal discomfort, ascites (abdominal distension and lower-extremity edema), jaundice, skin changes (spider angiomas and palmar erythema), changes in sex hormones (such as gynecomastia in men), bleeding tendency (variceal bleeding), and changes in consciousness (hepatic encephalopathy).

Treatment Methods

• Definitive treatment
  • Treatment of the cause: Chronic hepatitis B can be treated with nucleos(t)ide analog antivirals (e.g., entecavir, tenofovir, etc.), and chronic hepatitis C can be treated with direct-acting antivirals (DAAs; e.g., sofosbuvir-based treatment, etc.) to suppress or reverse disease progression.
  • Complete abstinence from alcohol (mandatory): All patients with cirrhosis must completely abstain from alcohol, regardless of whether alcohol is the cause.
  • Nonpharmacological management: Weight control, regulation of blood sugar and lipids (for NAFLD-related disease), and vaccination (for people who are nonimmune to hepatitis A and B) are recommended.
• Treatment by complication
  • Ascites: A low-sodium diet (sodium restriction, generally <2 g Na/day), diuretics (spironolactone first, with a loop diuretic added if necessary), therapeutic paracentesis (for massive ascites), and consideration of TIPS (transjugular intrahepatic portosystemic shunt) for recurrent or refractory ascites.
  • Spontaneous bacterial peritonitis (SBP): Empirical antibiotics at diagnosis (such as cephalosporins), and primary or secondary antibiotic prophylaxis for high-risk groups (there are cases in which quinolones or cefixime are recommended).
  • Esophageal and gastric variceal bleeding: Emergency treatment (fluid and blood replacement), vasoconstrictors (such as terlipressin and octreotide), endoscopic ligation (band ligation), and prophylactic nonselective beta-blockers (propranolol and nadolol). TIPS may be considered for recurrent bleeding or bleeding that does not respond to emergency treatment.
  • Hepatic encephalopathy: Lactulose (oral or enema) as first-line treatment, with rifaximin added for recurrent or refractory cases. Correct precipitating factors (gastrointestinal bleeding, infection, medications, etc.).
  • Hepatorenal syndrome (HRS): Administration of vasoconstrictors (such as terlipressin) and high-concentration albumin; the definitive treatment is liver transplantation.
  • Hepatocellular carcinoma (HCC) surveillance and treatment: Surveillance with ultrasound ± AFP testing at 6-month intervals. If detected, treatment may include resection, liver transplantation, or locoregional treatment (radiofrequency ablation, transarterial chemoembolization, systemic treatment, etc.), depending on the size, number, and liver function.
• Surgery and transplantation
  • Liver transplantation: A treatment option for advanced (decompensated) liver failure that cannot be compensated, refractory complications, or liver cancer with an indication for transplantation. Eligibility for transplantation is assessed using the MELD and CTP scores.
• Medication and medication precautions
  • Take caution with drugs metabolized by the liver and hepatotoxic medications (e.g., some herbal medicines and herbs, high-dose acetaminophen, etc.). NSAIDs, anticoagulants, and antiplatelet drugs increase the risk of bleeding and worsening kidney function.
  • Do not start new medications or folk remedies without consulting a doctor.

Checklist Before an Outpatient Visit (Including What to Bring and Example Questions)

• Items to prepare (bring with you)
  • A list of all medications currently being taken (including prescription drugs, OTC drugs, herbal medicines, and nutritional supplements), including doses and administration times
  • Previous test results (liver function tests, INR, albumin, platelet count, AFP, ultrasound/CT/MRI findings); if possible, bring the reports or photographs
  • Previous treatment history (whether antiviral drugs were used, endoscopic treatment, history of paracentesis or hospitalization, and records related to liver biopsy or liver transplantation)
  • Records of recent changes in weight and abdominal circumference, changes in daily urine output and salt intake, and whether bleeding (vomiting blood or bloody stool) or changes in consciousness (confusion or drowsiness) have occurred
  • Alcohol consumption history (recent amount and duration of alcohol use)
• Key items to report to the doctor during the outpatient visit (examples)
  • "How much has my abdominal distension increased recently? (I can provide records of changes in weight and abdominal circumference.)"
  • "Have there been any recent changes in fatigue, jaundice, fainting, or bleeding (nosebleeds, gum bleeding, or blood in the stool)?"
  • "Please check whether any of the medications I am currently taking are dangerous for my liver."
• Test preparation information
  • If necessary, prepare for fasting blood tests (liver and kidney function, electrolytes, and coagulation tests), abdominal ultrasound, upper gastrointestinal endoscopy (to assess varices), and, if ascites is present, paracentesis with culture and cytology.

General Example Questions to Ask the Doctor

• "Is my liver condition compensated or decompensated (symptomatic)? How is my prognosis assessed?"
• "Do I need liver cancer surveillance? Which tests (ultrasound/AFP) should I have, and how often?"
• "Are there any medications I should avoid (or medications requiring dose adjustment) among those I am currently taking?"
• "Apart from abstaining from alcohol, what specific dietary and exercise guidelines should I follow?"
• "Please explain whether liver transplantation is a possibility for me, as well as the procedure and waiting period."

Examples of Disease-Specific Questions (1–2 Specific Questions)

• "In my case (if test values and imaging findings are attached), how is the degree of cirrhosis progression assessed using the Child–Pugh class and MELD score? Is my condition currently severe enough to require evaluation for liver transplantation?"
• "My ascites keeps recurring. If it cannot be controlled with a low-sodium diet and diuretics, what is the next step (large-volume paracentesis, TIPS, preparation before transplantation, etc.)?"

Additional guidance: Regular follow-up (especially liver cancer surveillance every 6 months), immediate medical attention if infection or bleeding is suspected, and strict adherence to vaccinations and medication adjustments recommended by the doctor are important for improving the prognosis.