Liver Cirrhosis Treatment in Indore

What is Liver Cirrhosis?

The liver, the largest internal organ in the body, is situated in the upper right part of the abdomen. It filters the blood, produces bile to help digest fat, produces proteins such as albumin and clotting factors, stores energy and breaks down medicines and toxins. Repeated injury to the liver causes it to patch itself up with scar tissue over a number of years. This scarring ultimately leads to cirrhosis, a condition where normal liver tissue is replaced by hard fibrous bands and nodules, and the structure of the organ is distorted.

A cirrhotic liver cannot filter blood or make proteins as well as a healthy one, and blood flow through it is obstructed, increasing pressure in the portal vein (portal hypertension). Scarring is not reversible but in the early stages controlling the cause can stop or even improve the damage partially and good care can prevent serious complications.

Dr. Kriti Bansal Oza is a liver disease specialist in Indore helps cirrhosis patients understand their stage, preserve their remaining liver function and prevent emergencies like bleeding and infection. Liver cirrhosis treatment in Indore is aimed at treating the cause, preventing complications and protecting nutrition.

Compensated and Decompensated Cirrhosis

Doctors talk about two general phases. In compensated cirrhosis, the liver is still doing its main jobs and a person may have no symptoms for years. The condition is discovered by chance during a test for another purpose. Complications of decompensated cirrhosis include ascites (fluid in the abdomen), jaundice, variceal bleeding, hepatic encephalopathy (confusion), and kidney problems. Decompensation is a change toward a more severe phase, where the focus shifts to managing complications and considering liver transplantation.

Symptoms of Liver Cirrhosis

Early cirrhosis usually has no symptoms. Usually features appear with evolution of the disease.

• Fatigue and weakness: Another common early complaint, along with loss of appetite and weight.
• Jaundice: Yellowing of eyes and skin; dark urine and light stools.
• Swelling of abdomen and legs: Due to ascites and fluid retention
• Easy bruising and bleeding: You get nosebleeds, bleeding gums and bruises because clotting proteins fall.
• Itching: Constant itching is due to the accumulation of bile salts under the skin.
• Vomiting blood and black stools: Bleeding varices or ulcers. This is an emergency.
• Confusion and reversal of sleep: Daytime sleepiness and nighttime wakefulness, forgetfulness, personality change and tremor of the hands suggest hepatic encephalopathy.
• Muscle wasting: Loss of muscle mass especially in the arms, legs and temples.
• Skin and hormone signs: Spider blood vessels, red palms, enlarged breasts in men, shrunken testes and irregular periods.

Causes of Cirrhosis of Liver

Many conditions that injure the liver over years can cause cirrhosis.

• Alcohol-related liver disease: Heavy drinking over a long period of time is a major cause, and the risk increases with the amount and duration.
• Chronic hepatitis B and C: Viral infections that can smolder for decades can cause cirrhosis.
• Metabolic dysfunction-associated fatty liver disease: This fast-growing cause is associated with obesity, diabetes, high cholesterol and high blood pressure.
• Autoimmune hepatitis: The immune system attacks cells in the liver. Diseases of the bile ducts: The bile ducts are damaged in primary biliary cholangitis and primary sclerosing cholangitis.
• Genetic and metabolic disorders: Wilson’s disease, haemochromatosis and alpha-1 antitrypsin deficiency.
• Obstruction of blood flow: Chronic heart failure or obstruction of hepatic vein.
• Medicines and toxins: Certain drugs and herbal remedies can cause long-term damage.
• Cryptogenic cirrhosis: No cause can be identified in some patients.

Cirrhosis Complication Recognition of the complications may help patients and families identify early warning signs.

• Variceal bleeding: Bulging blood vessels in the food pipe or stomach can burst and bleed heavily.
• Ascites and spontaneous bacterial peritonitis: Infection of abdominal fluid
• Liver encephalopathy: Toxins, especially ammonia, damage the brain and cause confusion and coma in severe cases.
• Hepatorenal syndrome: Kidney function deteriorates due to changes in blood flow late in the disease.
• Hepatopulmonary syndrome and portopulmonary hypertension: Lung problems that cause shortness of breath.
• Liver cancer: The main cause of hepatocellular carcinoma is cirrhosis.
• Infections and malnutrition: Weakening of the immune system and muscle loss.
• Bone thinning and clotting problems: Because of poor absorption and reduced protein synthesis.

Cirrhosis Diagnosis

Diagnosis involves blood tests, imaging and sometimes tissue examination. Blood tests include liver function tests, albumin, bilirubin, INR and platelet count which is usually low in cirrhosis due to an enlarged spleen. We do viral markers for Hepatitis B and C, autoimmune markers, iron studies and tests for Wilson’s disease to look for a cause.

Ultrasound shows an irregular, nodular or shrunken liver, enlarged spleen, ascites and a dilated portal vein. Elastography (FibroScan) is a needle-free way of measuring liver stiffness and gives an estimate of the amount of fibrosis. Detail and liver tumors are seen on CT or MRI scans. They do an upper GI endoscopy to look for varices. Liver biopsy confirms diagnosis and etiology in select patients.

Severity and prognosis are determined with scores like Child-Pugh and MELD, which also help guide decisions regarding transplant evaluation. A liver cirrhosis specialist in idnore will stage the disease by means of blood tests, scans and endoscopy.

Treatment of Cirrhosis of the Liver

Caring for the patient has three parts: treat the cause, manage complications and support nutrition and general health.

Treat the underlying cause

The most important step in alcohol-related cirrhosis is to stop drinking alcohol completely, and help from counseling and medicines is helpful. Hepatitis B is treated with antiviral tablets (like tenofovir or entecavir).

Hepatitis C is treated with a short course of direct acting antivirals. Treatment of fatty liver disease includes weight loss, exercise and control of diabetes, blood pressure and cholesterol. Autoimmune hepatitis requires immune-suppressing drugs and Wilson’s disease requires chelating drugs.

Prevention of bleeding from varices

Endoscopically detected varices. Non-selective beta-blockers such as propranolol or carvedilol decrease portal pressure and the risk of bleeding. Band ligation is used for larger varices or when beta blockers are not suitable. Those who have bled require combined therapy to prevent a repeat bleed.

Management of ascitic fluid

First-line measures are a low-salt diet and diuretics. When fluid is large or when drained with refractory paracentesis with albumin. If the ascitic fluid becomes infected it is promptly treated with antibiotics.

Hepatic Encephalopathy Management

Lactulose clears toxins from the gut with two to three soft stools a day. Add rifaximin to prevent recurrence . Triggers such as infection, constipation, dehydration, bleeding, sedatives and electrolyte imbalance are addressed.

Diet

Patients with cirrhosis need more protein and energy than a healthy person does. The recommended intake is about 1.2 to 1.5 grams of protein per kilogram body weight and 35 kilocalories per kilogram. This should be spread over four to six meals, including a bedtime snack to avoid muscle breakdown during sleep. Protein has no boundaries Ascites: In ascities, sodium is restricted. Correct zinc, vitamin D and other deficiencies.

Screening and Immunization

Liver cancer can be found early, when it can be treated, with an ultrasound (with or without an AFP blood test) every 6 months. Recommended vaccinations Hepatitis A, hepatitis B, influenza, pneumococcus and COVID-19.

Transplantation of liver

Decompensated cirrhosis or high MELD score is a definitive indication for liver transplantation. Patients are evaluated at a transplant center and if a suitable donor is available, living donor transplantation is an option. Early referral gives time for assessment and preparation.

Living With Cirrhosis

Avoid alcohol of any kind. Avoid over-the-counter painkillers such as diclofenac or ibuprofen, herbal products or unprescribed supplements, as many strain the liver or kidneys. The usual dose of paracetamol is small, and given on the advice of a doctor. Infections are more serious in cirrhosis, so avoid raw shellfish and unclean water. Keep regular appointments. Take medicines on schedule. Don’t skip endoscopy checks. Report black stools; vomiting blood; fever; belly pain; increased swelling; confusion; or less urine without delay.

Guide for Caregivers: Recognising Hepatic Encephalopathy

“Usually, the first sign that something is wrong is from relatives. Hepatic encephalopathy can start slowly: the person sleeps during the day and is awake at nite, may be irritable or unusually quiet, forgets simple things, has slurred speech, or has a flapping tremor when the arms are outstretched. Later stages include disorientation in time and place, drowsiness and difficult to arouse, and coma. They can be caused by infection, constipation, dehydration, gastrointestinal bleeding, excess diuretics, sedative or sleeping tablets and low potassium or sodium. And if you see these changes, make sure the person is taking lactulose as instructed, make sure bowel movements are occurring and contact the doctor or get to the hospital quickly, don’t wait.

Sample Day of Meals for a Person With Cirrhosis

• Early morning: A glass of milk or a cup of tea with a small quantity of roasted chana or a banana. 
• Breakfast: Vegetable poha or upma with boiled egg or bowl of curd or besan chilla with paneer. 
• Midmorning: One fruit and a handful of unsalted nuts.
• Lunch: Two pieces of roti, dal, one vegetable, salad and curd. Non-vegetarians can add fish or chicken.

• Evening: Sprouts or buttermilk chaat with lemon and less salt.
• Dinner: Rice or roti with a protein dish such as soya chunks, paneer or dal, and vegetables.
• Before bed – A glass of milk with a light snack to minimize muscle loss overnight.
  If ascites is present, add salt sparingly, and follow the doctor’s instructions for portion sizes and the diabetic needs of each patient.

Drugs and Substances to Be Careful Of

A scarred liver metabolizes medicines differently and the kidneys are more fragile. Avoid anti-inflammatory painkillers like ibuprofen, diclofenac and naproxen that can cause kidney failure and bleeding. Sleeping pills, some cough syrups and sedatives may cause confusion. Some antibiotics and anti-tuberculosis drugs may require dose adjustment or additional monitoring. Herbal, ayurvedic and traditional preparations can be harmful to the liver and many of their contents are unknown. Bring every product you take to your consultation. Always tell any doctor or dentist treating you that you have cirrhosis before new drugs are prescribed.

Staging Tools and Outlook

Patients are classified as Child-Pugh class A, B or C, from least to most severe, based on bilirubin, albumin, INR, ascites and encephalopathy. The MELD score, based on bilirubin, INR and creatinine, with sodium added in MELD-Na, estimates short-term risk and ranks patients for transplant: These scores are planning tools and the course for an individual depends on whether the cause is controlled, how well complications are managed and whether alcohol or other injuries stop. Often a patient who eliminates the cause and is seen regularly for review does far better than the numbers alone suggest.

Why Dr. Kriti Bansal Oza?

Dr. Kriti Bansal Oza provides routine clinic follow up with endoscopic care so that varices, ascites and nutritional issues are taken care of under one co-ordinated plan and not by several different doctors.
She discusses prognosis, warning signs and when to consider transplant evaluation with patients and their families in an open-ended manner so they can plan ahead with confidence. Her plans include practical diet charts, medicine schedules and clear instructions for emergencies….
People searching for a cirrhosis doctor in Indore receive disease staging, liver cancer and varices screening schedule, and ongoing support through all stages of the disease.

Book a Consultation in Indore

Phone: +91-7610102710
Email: drkritigastro@gmail.com