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What should we do if we don&#8217;t want to have cirrhosis? 
How to know if you have cirrhosis 
How do we treat cirrhosis? 
If the liver is already damaged, can it still be treated?

The issue of “cirrhosis” is not only a problem for alcohol drinkers, but anyone can get it. Because whenever you have hepatitis B or C virus, have fat accumulation in the liver, or take medication for a long time, you are at risk of cirrhosis if not properly treated. Before this disease enters our life cycle, let&#8217;s quickly get to know it to be prepared.
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Everyone probably knows well that the “liver” is the largest organ in the body. It functions as a storage of energy, nutrients, and vitamins in the body, removes toxins from the body, creates immunity to fight infections, eliminates pathogens from the blood, produces proteins used in blood clotting, and produces bile to absorb fats and fat-soluble vitamins. We cannot live without a liver. Simply put, the liver is extremely important.
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<h4 style="color: #008080;">Cirrhosis… how is it “hard”? 
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Cirrhosis is when the liver is damaged, and scar tissue replaces normal cells, obstructing blood flow into the liver, causing the liver to not function as before. Cirrhosis causes the death of 25,000 people worldwide every year and is ranked as the 8th leading cause of death from diseases.
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<h4 style="color: #008080;">Let&#8217;s see what causes “cirrhosis”</h4>
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<li>Alcoholic hepatitis Drinking large amounts of alcohol for a long time, more than 10 years, can cause cirrhosis. The amount of alcohol that causes liver injury varies among individuals.
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<li>For women, an average of 2-3 drinks per day can cause cirrhosis.</li>
<li>For men, 3-4 drinks per day are needed to cause cirrhosis.</li>
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Because alcohol inhibits the body&#8217;s functions, including the breakdown of proteins, fats, and carbohydrates, it causes damage to the liver.
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<li>Hepatitis C virus infection Infection with hepatitis C virus causes gradual liver injury. Patients usually do not feel any symptoms until cirrhosis develops. Especially if patients with hepatitis C also drink alcohol, cirrhosis progresses faster.</li>
<li>Hepatitis B and D virus infection Hepatitis B virus infection is the most common hepatitis virus infection in most countries except the United States and Western European countries. The characteristics of hepatitis B virus are similar to hepatitis C virus, causing gradual liver inflammation leading to cirrhosis over decades. Hepatitis D virus is found in patients already infected with hepatitis B. In Thailand, hepatitis D is mostly transmitted through needle sharing among drug users.</li>
<li>Autoimmune hepatitis This is a chronic inflammation where patients may have no symptoms. It occurs when the immune system attacks liver tissue gradually.</li>
<li>Genetic diseases Deficiency of certain substances (Alpha-1 Antitrypsin deficiency), excessive iron accumulation in the liver and other organs (Hemochromatosis), inability of the liver to excrete copper (Wilson’s disease), excessive accumulation of glycogen in the liver and other organs (Glycogen storage disease). These conditions cause abnormal liver function without symptoms until cirrhosis develops.</li>
<li>Excess fat accumulation in the liver This occurs when fat infiltrates liver tissue and accumulates extensively, eventually damaging cells and causing scarring. It is associated with diabetes, protein deficiency, obesity, ischemic heart disease, and steroid use.</li>
<li>Bile duct obstruction When the bile duct is blocked, the liver cannot release bile to aid digestion, causing bile to accumulate in the liver and injure it. In newborns, this is often due to a reduced number of bile ducts. In adults, it may result from gallbladder surgery that affects the bile duct.</li>
<li>Drugs, toxins, and other infections Prolonged unnecessary drug use, exposure to toxic environments, consumption of unclean food containing parasites such as liver flukes, or frequent heart failure can cause blood congestion in the liver, eventually leading to cirrhosis.</li>
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<h4 style="color: #008080;">What symptoms indicate cirrhosis has arrived? 
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Some diseases have symptoms that can indicate which disease you have, but&#8230; you cannot just wait for symptoms to appear with cirrhosis. Many patients with cirrhosis have no symptoms in the early stages. Symptoms appear as scar tissue replaces more healthy liver tissue, worsening liver function. Eventually, patients experience easy fatigue, weakness, loss of appetite, nausea, weight loss, and if cirrhosis worsens, complications may develop.
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<h4 style="color: #008080;">This is the scary part of cirrhosis—not just the liver problem itself but the complications that are equally dangerous. Let&#8217;s look at them together.</h4>
<ul>
<li>Swollen legs and ascites When the liver loses its ability to produce proteins (such as albumin, which helps retain water in blood vessels), fluid leaks out of blood vessels and accumulates in the legs causing swelling and in the abdominal cavity causing ascites.</li>
<li>Bruising and bleeding When the liver cannot produce proteins needed for blood clotting, patients bruise easily and bleed easily with difficulty stopping the bleeding.</li>
<li>Jaundice Yellowing of the eyes and skin occurs because the body cannot excrete bilirubin, leading to excessive bilirubin in the blood causing jaundice.</li>
<li>Itching Due to bile accumulating under the skin, causing skin irritation.</li>
<li>Gallstones Cirrhosis causes bile produced by the liver to not flow properly to the gallbladder, leading to bile stasis and eventually gallstones.</li>
<li>Increased toxins in blood and brain Cirrhosis prevents the body from removing toxins from the blood, increasing toxins from food breakdown and body metabolism, affecting the brain. Patients may be unable to work, personality changes, drowsiness, and may lead to death.</li>
<li>Increased sensitivity to drug toxicity Because the liver filters drugs less effectively, medications last longer and may accumulate causing side effects.</li>
<li>Portal hypertension Normally, blood from the intestines and spleen flows into the liver via the portal vein. Cirrhosis slows blood flow into the liver, increasing pressure, causing veins in the esophagus and stomach to dilate into varices. These varices have thin walls and can rupture easily, causing bleeding in the esophagus or stomach. Patients may have black, tarry stools or vomit blood, which can be fatal.</li>
<li>Infections Patients with cirrhosis are more prone to infections and illnesses due to low immunity.</li>
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<h4 style="color: #008080;">Want to know if you have cirrhosis? Diagnosis must be clear. 
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To determine if you have cirrhosis, doctors will take a detailed medical history, perform blood tests, and additional examinations such as CT scans, ultrasound, radioisotope scans of the liver and spleen, Fibroscan, and liver biopsy to obtain liver tissue samples for laboratory analysis.
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<h4 style="color: #008080;">Can cirrhosis be treated? 
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Doctors always inform patients that cirrhosis cannot restore the liver to its original condition. The main goal of treatment is to prevent further liver damage, slow progression, and reduce complications. Treatment focuses on the cause of the disease, such as medication, endoscopic treatment, or if the liver is severely damaged or complications are uncontrollable, liver transplantation may be considered. Currently, liver transplantation has a success rate of 80-90%. 

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Besides treatment according to the doctor&#8217;s discretion, the patient is a key person to achieve treatment goals. Patients must take care of their health, avoid causes that harm health and damage the liver, and cause other complications, such as stopping alcohol consumption, stopping long-term medications that damage the liver, reducing salty food in cases of ascites, etc. 

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Looking closely at cirrhosis, the causes include uncontrollable factors and those related to lifestyle behaviors. Therefore, it is better to start loving your health, give yourself beneficial things, and avoid things that harm the liver to help reduce the risk of cirrhosis for the largest organ in our body.
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<div align="right">Dr. Wiriya Tanyawalak</div>
<div align="right">Gastrointestinal Endoscopy and Liver Disease Center 
Phyathai 3 Hospital</div>

The issue of cirrhosis, when examined closely, shows that the causes of the disease include both factors beyond our control and those resulting from lifestyle behaviors. Therefore, it would be better if we start to love our health.

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Cirrhosis is not just caused by heavy drinking; it can also be due to hepatitis viruses... long-term medication use also poses a risk!

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