Liver Cirrhosis Treatment - Medical & Surgical Management

At PACE Hospitals, team of best liver specialist doctors in Hyderabad include hepatologist, liver transplant doctors are experienced in handling complex cases of liver related diseases and its complications such as cirrhosis of the liver, chronic liver disease, non-alcoholic fatty liver disease, alcoholic liver disease, liver parenchymal disease, autoimmune liver disease, cholestatic liver disease.

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Diagnosis for liver cirrhosis

Most people with compensated cirrhosis are asymptomatic, although symptomatic patients exist. Generally, the history of the patient and the physical examination are considered before taking the assistance of lab tests, imaging tests and other objective tests.

Physical examination for liver cirrhosis diagnosis

There are various points that the liver specialist doctor can look out for in case of cirrhotic liver suspicion, such as: 


Public body: 

  • Muscle wasting (disorder or non-usage of muscles leading to weakening, shrinking, and loss of muscle tissue))

Central nervous system: 

  • Asterixis (inability to maintain sustained posture associated with subsequent brief, shock-like, involuntary movements)
  • Constructional apraxia (patients cannot draw simple designs (e.g., a star of David)) 
  • Drowsiness and confusion

Head: 

  • Fetor hepaticus (characteristic breath of patients with a severe parenchymal liver disease resembling the mixture of rotten eggs and garlic)
  • Jaundice (yellowing of skin and eyes)
  • Parotid enlargement (inflammation of one or both the major parotid salivary glands located on either side of the face)
  • Scleral icterus (yellowish discolouration of the eye due to build-up of bilirubin in the blood.)
  • Spider nevi (also called spider angioma/spider telangiectasia, dilatation of end vasculature found underneath the skin surface giving a spider's web-like appearance)

Chest: 

  • Gynecomastia (enlargement of a man's chest)
  • Spider nevi (also called spider angioma/spider telangiectasia, dilatation of end vasculature found underneath the skin surface giving a spider's web-like appearance)
  • Thinning axillary hair

Abdomen: 

  • Ascites (Abdominal swelling caused by the accumulation of fluid, most often related to liver disease)
  • Caput medusae (one of the cardinal features of portal hypertension 
  • Contracted or enlarged liver
  • Haemorrhoids (swollen veins in the anal region)
  • Splenomegaly (Enlarged spleen)

Hands and nails: 

  • Clubbing (bulbous enlargement of the distals (fingers or toes))
  • Dupuytren contracture (bending of one or more fingers toward the palm - a painless condition. The affected fingers cannot be straightened completely)
  • Palmar erythema (reddening of palms, usually seen during pregnancy)
  • Terry's nails (whiteness of nail plate)

Genitourinary (male): 

  • Testicular atrophy (reduction in the size of one or both of the "testes", which could be accompanied by reduced testicular function.)

Lower extremities: 

  • Oedema
  • Distal erythema
  • Petechiae (small red/purple spots caused by bleeding into the skin)

Blood tests for diagnosing liver cirrhosis

There are several blood tests that can be used to help diagnose and monitor cirrhosis of the liver. These tests can measure liver function, as well as check for complications of cirrhosis. Some common blood tests for cirrhosis include:


Alanine transaminase (ALT) and aspartate transaminase (AST): These are liver enzymes that can be elevated in people with cirrhosis, indicating liver damage. Nevertheless, the test, at times, can still be normal, even in the case of cirrhosis. ALT was earlier called serum glutamic pyruvic transaminase (SGPT). AST was earlier called serum glutamic oxaloacetic transaminase (SGOT).


Alkaline phosphatase (ALP): This is an enzyme that can be elevated in people with cirrhosis, indicating bile duct obstruction.


Albumin test: This is a protein made by the liver that can be low in people with cirrhosis, indicating poor liver function. Most serum tests except the hyaluronic acid test are indirect markers of liver damage. Besides the non-alcoholic fatty liver disease fibrosis score for non-alcoholic steatohepatitis, biomarkers are most validated in chronic Hepatitis C.


Bilirubin Blood Test: Bilirubin build-up in the blood (jaundice) due to the impaired liver can cause yellow discolouration of the skin and eyes. Elevated bilirubin levels can indicate a problem with the liver's ability to clear this waste product, such as cirrhosis or other forms of liver disease.


Gamma-glutamyl Transferase (GGT) Test: Increased GGT levels may indicate liver impairment, bile duct damage or blockage.


Prothrombin time (PT): This test measures the time it takes for blood to clot and can be prolonged in people with cirrhosis, indicating poor liver function and a risk of bleeding.


The international normalized ratio (INR): This test is used to evaluate the time it takes for blood to clot. It can also be used to monitor the effect of blood-thinning medication on patients with cirrhosis.


Creatinine: A waste product made by the working of muscles. The kidneys usually filter it out of the blood. Increased creatinine could indicate kidney damage - a common anomaly in cirrhosis's late stages.


Sodium blood test: In case of a low level of sodium in the blood (hyponatremia), it could be cirrhosis. 


Hepatitis B&C tests: Viral hepatitis is an infectious disease resulting in cirrhosis (in case of late diagnosis) which can be caused by various viruses, of which hepatitis B virus and hepatitis C virus are deadly.   


Ceruloplasmin test: A copper-carrying protein in the blood, ceruloplasmin is synthesised in the liver. It also plays a role in the metabolism of iron. In cirrhosis, serum ceruloplasmin levels are increased. Ceruloplasmin (protein created by the liver) and urinary copper tests may be ordered to rule out Wilson's disease.


Autoimmune profile (AIP): In a few patients, liver cirrhosis occurs due to an autoimmune disease. In autoimmune liver disease, the body’s own immune system attacks the liver.  


Genetic testing: A blood test is also done to see if any inherited disorders could cause liver cirrhosis. 


Ferritin and transferrin saturation test: These are helpful in patients with decompensated liver cirrhosis and hemochromatosis (a hereditary disorder of iron salts deposition in the tissues, leading to liver damage, diabetes mellitus, and bronze skin discolouration).


Complete blood counts (CBCs): This will help to check the red and white blood cell count. Usually, normochromic anaemia (reduced number of red blood cells) is expected, but macrocytic anaemia (increased size of red blood cells) is typical of alcoholic liver cirrhosis. Leukopenia (reduced white blood cells) and thrombocytopenia (decreased platelet count) are also seen due to spleen enlargement and alcohol suppression effect on the bone marrow.


Immunoglobulins Blood Test: Immunoglobulins measure the amounts of IgA, IgG and IgM in the blood that are usually elevated due to impaired clearance by the liver, especially the gamma fraction.


Alpha-Fetoprotein (AFP) Test: It is considered a tumor marker test in non-pregnant people to detect liver cancer. Not necessarily an increase in Alpha-Fetoprotein levels is always cancer; it can also be caused by other conditions.


It is important to note that these tests are not specific to cirrhosis, but they could help diagnose it and monitor its progression. In order to get a definitive diagnosis, imaging tests might be needed.

Imaging tests for liver cirrhosis diagnosis

In order to get a definitive diagnosis, the doctor may recommend any of these imaging tests to check for scarring or other damage to the liver. Imaging tests are usually non-invasive that include:


Liver ultrasound: Ultrasonography for the liver is beneficial for identifying cirrhosis and its consequences, such as:  

  • Splenomegaly (increased spleen size)
  • Portal hypertension (blood pressure increase in the vein supplying blood to the liver)
  • Ascites (distended abdomen)
  • Hepatocellular cancer (liver cancer)

Concomitant liver illnesses can also be found through ultrasonography because of its accessibility, and absence of radiation (e.g., extrahepatic cholestasis). 


Although ultrasonography effectively detects steatosis, it usually misses fibrosis or cirrhosis. Cirrhosis is distinguished by: 

  • Hepatic nodularity
  • Coarseness
  • Echogenicity

CT scan: A non-invasive diagnostic imaging procedure, computed tomography of the liver (CT scan) utilises the effect of computerised X-rays producing horizontal or axial images of the body (often called slices). It produces much more detailed images of the body.


MRI Scan: A non-invasive diagnostic imaging procedure, MRI of the liver or (MRI scan) utilises the effect of radio waves more clear images of the body (often called slices). It also produces detailed images of the liver.


Endoscopy: UGI endoscopy is helpful in diagnosing abnormal blood vessels called esophageal varices; this can happen due to blood flow being blocked in the portal vein because of cirrhosis of the liver.


Transient elastography and Magnetic resonance elastography (MRE): Quickly replacing biopsy as the primary approach for fibrosis staging, Magnetic resonance elastography (MRE) and Transient elastography, is a newer ultrasound procedure which measures the velocity of low-frequency elastic shear waves propagating in the liver to assess liver stiffness.

 

Procedure doesn’t take much time, and the results are usually treatment oriented. Transient elastography detects cirrhosis more accurately than biomarker-based techniques.


Disadvantages:

  • Inability to detect the intermediate stages of liver disease.
  • Less reliable in patients with Obesity, Ascites (distended abdomen), Excessive alcohol intake and Extrahepatic cholestasis 

Liver biopsy for liver cirrhosis diagnosis

Despite being the gold standard for diagnosing cirrhosis, sensitivity for fibrosis staging is a bit rusty with liver biopsy. 


Due to diverse pathologic alterations and frequent sampling errors, an expert pathologist can interpret the biopsy. 

  • A biopsy is prescribed in the cases of 
  • unclear clinical, laboratory, and imaging data 
  • inappropriate transient elastography 

A liver biopsy can distinguish necroinflammation from steatohepatitis (non-alcoholic steatohepatitis).

Liver cirrhosis stages

There are two stages of liver cirrhosis –

  1. Compensated liver cirrhosis
  2. Decompensated liver cirrhosis


These are the 2 clinical dynamic and progressive stages, but there is potential reversibility from the decompensated liver cirrhosis to the compensated liver cirrhosis.

  • Compensated liver cirrhosis is the asymptomatic stage and does not present any form of Ascites, Variceal haemorrhage, Hepatic encephalopathy and Jaundice.
  • Compensated liver cirrhosis has a median survival time > 12 years.
  • Identification of compensated liver cirrhosis in subpopulations can be based on the absence or presence of (varicose veins).
  • The presence of the various forms is the critical prognostic factor for compensated liver cirrhosis patients, indicating a higher likelihood of decompensation.
  • The Model for End-Stage Liver Disease (MELD) -is the best predictor of mortality in decompensated cirrhotic patients.

  • Decompensated liver cirrhosis is characterised by the presence or development of overt complications of Ascites, Jaundice, Variceal haemorrhage and Hepatic encephalopathy.
  • Decompensated liver cirrhosis has a median survival time of nearly two years.
  • Decompensated liver cirrhosis in subpopulations depends on the type or number of decompensating events.
  • The presence of the various forms is the critical prognostic factor for compensated liver cirrhosis patients, indicating a higher likelihood of decompensation. 
  • The Model for End-Stage Liver Disease (MELD) is the best predictor of mortality in decompensated cirrhotic patients.
  • Decompensation may improve and can regress to a compensated stage if the cause of the liver disease is resolved (e.g., alcohol abstinence).

Child-Turcotte-Pugh score method

The prognostic scoring system of the Child-Turcotte-Pugh score (CTP) in cirrhosis has based on the collection of symptom points:


Points for symptom/feature

  • Ascites: none (1 point), diuretic-sensitive or mild/moderate (2 points) & diuretic-refractory or tense (3 points)
  • Encephalopathy: none (1 point), episodic or overt grade 2 (2 points) & recurrent/chronic or grade 3 to 4 (3 points)
  • Albumin in g/dL: > 3.5 (1 point), 3.4 to 2.8 (2 points) & < 2.8 (3 points)
  • Bilirubin in mg/dL: < 2 (1 point), 2 to 3 (2 points) & 3 (3 points)
  • Prothrombin time, expressed as an international normalised ratio (INR): < 1.7 (1 point), 1.7 to 2.3 (2 points) & >2.3 (3 points)


The prognostic scoring system of the Child-Turcotte-Pugh score (CTP) in cirrhosis has based on the collection of symptom points. Interpretation of the CTP scoring system:

  • CTP A patients (5-6 points): mostly patients with compensated cirrhosis
  • CTP B patients (7-9 points): mostly decompensated, but decompensation is "early."
  • CTP C patients (10-15 points): decompensated (late or "further" decompensation)

Differential Diagnosis of Liver Cirrhosis

The sign and symptoms of liver cirrhosis are common with various other chronic diseases, such as: 

  • Acute fatty liver of pregnancy [a rare but severe condition of pregnancy in which an excessive accumulation of fat (triglycerides and fatty acids) in the hepatic cells]
  • Amanita phalloides mushroom poisoning
  • Acetaminophen (paracetamol) poisoning
  • Bacillus cereus toxin
  • Fructose intolerance (a disorder in which the patient is deficient in the protein needed to break down fructose)
  • Galactosemia (inability to metabolisethe simple sugar galactose.)
  • HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome of pregnancy
  • Haemorrhage viruses (Ebola virus, Lassa virus, Marburg virus)
  • Idiopathic drug reaction
  • Neonatal iron storage diseases
  • Tyrosinemia (a rare, inherited disorder marked by high blood levels of tyrosine (amino acid))

Considerations and goals of a hepatologist / gastroenterologist in treating cirrhosis of the liver

A disease is defined as a physiological health failure, while sickness is determined by the inability to achieve critical objectives owing to physical or psychological dysfunction. Besides cirrhosis of liver, increasing physical and social losses from other chronic diseases severely influence the dignity of the afflicted individual in chronic conditions. 


From the patient's point of view, the thoughts and expectations about the illness, energy loss, and/or chronic weariness differ from a healthy person, impacting the patient's psychological well-being. The considerations of hepatologists / gastroenterologists include:


Prognosis and quality of life: Numerous symptoms are seen in cirrhosis of liver which includes fluid retention (ascites), various degrees of confusion due to hepatic encephalopathy, acute gastrointestinal bleeding from varices or bacterial infections, etc. At least 50% of patients present one or more symptoms at the time of diagnosis. The deterioration of liver disease is indirectly proportional to the person's health‐related quality of life. Unless a curative liver transplant is possible, the symptom management is palliative. 


Need for a holistic approach: This forms the basis for the holistic approach in treating a cirrhotic patient, as liver cirrhosis is a medically complex disease associated with poor health‐related quality of life, fatigue, psychological distress and abdominal symptoms. 


Abolishing health ignorance: The holistic approach to treatment is also necessary as, combined with the aforementioned issues, the patients suffering from cirrhosis of liver demonstrate an air of ignorance about the disease, thus enhancing the prognosis and preventable hospital admissions. Therefore, patient education about the disease is necessary.


Address of psychological needs: According to Maslow's hierarchy of needs, patients must first meet their needs for safety, security, and stability before attaining the health behaviours required for successful care of advanced liver disease. Psychologist consultation can help.


Empathic staff: An educated understanding healthcare team which show empathy achieve a reduction in suffering from the patients by the patient‐centred care.


Intercommunication: Multidisciplinary healthcare teams display a high degree of communication and collaboration, aiding in accomplishing shared goals and including overall integrated healthcare.


Case management techniques used by mental health practitioners include screening, evaluation, risk stratification, follow-up, and care transfer, along with continuing treatment for liver cirrhosis.


Goals of a hepatologist / gastroenterologist in treating cirrhosis of liver


The goals of clinical manifestations of liver cirrhosis are adaptable, and it is difficult to provide overall management guidelines. General approaches to therapy should include:

  • Identification and elimination: The possible causes of cirrhosis (e.g., alcohol abuse).
  • Assessment of risk for variceal bleeding: Variceal bleeding risk assessment can instigate pharmacologic prophylaxis. Reserve prophylactic endoscopic therapy for patients with contraindications or intolerance to β-adrenergic blockers. Endoscopic treatment is also appropriate for patients suffering acute bleeding episodes. Variceal obliteration with endoscopic techniques is the recommended treatment of choice in patients with acute bleeding.
  • Evaluation of ascites: The clinical signs of ascites are ascertained with pharmacologic therapy (usually diuretics and paracentesis). Careful monitoring for spontaneous bacterial peritonitis should be used in patients with ascites who undergo acute deterioration.
  • Attention for hepatic encephalopathy: A complication of cirrhosis of liver requiring clinical vigilance involved with dietary restriction, and elimination of central nervous system depressants, apart from therapy to lower ammonia levels.
  • Constant vigilance over: 
  • Hepatorenal syndrome [dysfunctional kidneys in patients with severe liver problems. Reduced urine promotes waste build-up containing nitrogen in the blood (azotaemia). Occurs in 1-10 hospitalised liver failure patients]
  • Pulmonary insufficiency (incompetent pulmonary valve during diastole, which allows the backflow of blood from the pulmonary artery to the right ventricle of the heart)
  • Endocrine dysfunction (impaired endocrine system causing wide-ranging effects on the body).

Team of the Best Doctor for Liver Cirrhosis in India

Dr Govind Verma | Best Gastro, Liver and Pancreas Specialist in Hyderabad, India

Dr. Govind Verma

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Interventional Gastroenterologist, Transplant Hepatologist, Pancreatologist & Endosonologist

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Dr Ch Madhusudhan | Best Liver Transplant Surgeon in India, Top Liver Transplant Doctor in Hyderabad
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Dr. Suresh Kumar S | Famous Surgical Gastroenterologist and Liver Transplant Surgeon in Hyderabad, India
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Dr. Padma Priya | Best Female Gastroenterologist, Hepatologist and Endoscopist in Hyderabad, India

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  • Can the liver recover from cirrhosis?

    No, the liver can't recover from cirrhosis as the damage to the liver is far more extensive and beyond repair. Nevertheless, certain reformative steps can be taken to treat the underlying cause of cirrhosis. This could delay the worsening of cirrhosis and get time for a liver transplant.  

  • What are the first signs of cirrhosis of the liver?

    The first symptoms of cirrhosis of the liver may not develop in the early stage of cirrhosis as the liver can still function despite being damaged. Only severe damage to the liver can present symptoms. The main symptoms of cirrhosis include:

    • Tiredness and weakness
    • Feeling sick and loss of appetite 
    • Red patches on palms and small, spider-like blood vessels on skin (spider angiomas) above waist level

  • How to prevent liver cirrhosis?

    Preventative tips for cirrhosis include: 

    • Abstinence from alcohol
    • Eating a healthy plant-based diet with rich fruits and vegetables.
    • Maintenance of a healthy weight and dietitian consultation for a weight-loss plan if obese 
    • Reduce the risk of hepatitis with vaccines and avoid unhealthy practices such as sharing needles and unprotected sex.

  • How long does it take fatty liver to become cirrhosis?

    According to the research, it takes about ten years for 8-30% of the patients with alcoholic fatty liver disease who indulge in alcoholism daily to develop fibrosis or cirrhosis. It must be understood that the prognosis of non-alcoholic fatty liver disease is uncertain. 


    Studies show that in predominantly non-alcoholic steatohepatitis patients with aggressive natural history, the development of cirrhosis is seen in 26% of patients.

  • Why is PACE Hospitals the best hospital for liver cirrhosis treatment in Hyderabad?

    The Institute of Liver Sciences at PACE Hospitals is backed up by the top and highly skilled liver specialist doctors, and liver transplant surgeons with wide experience in treating all kinds of liver-related diseases and cancers through medical management and surgical management with high success rates. Department is among the famous hepatologists and liver transplant surgeons in Hyderabad, awarded nationally and internationally in their respective fields of study. 


    PACE Hospitals is equipped with cutting-edge infrastructure and equipment, including world's 1st Universal Surgical Robotic System, Liver Intensive Care Unit, advanced 3D HD laparoscopic system and world-class infrastructure to provide precision treatment. The multidisciplinary team is well-versed in the latest modalities. It is highly skilled in tackling critical cases, which makes PACE Hospitals, one of the best hospitals for liver cirrhosis treatment in Hyderabad, India. 


Treatment for Liver Cirrhosis

Liver cirrhosis treatment depends on the cause and extent of your liver damage. The goals of treatment are to slow the progression of scar tissue in the liver and to prevent or treat symptoms and complications of cirrhosis. The various treatment modalities which can be administered to treat cirrhosis of liver.

Medical management of liver cirrhosis

Surgical management of liver cirrhosis

Medical management of liver cirrhosis involves a combination of treatments designed to slow the progression of the disease and manage its symptoms. Some of the main goals of medical management for liver cirrhosis include:


  • Management of the underlying cause: treating the underlying hepatitis virus infection (B or C), or blood extraction to lower iron levels in haemochromatosis etc.
  • Dietary and lifestyle changes: People with liver cirrhosis often have difficulty absorbing nutrients from food, which can lead to malnutrition. Medical management may involve dietary changes; a nutritious, low-sodium diet, low-fat, high-protein diet and exercise in their routine can help people to avoid malnutrition and get enough nutrients.
  • Immunisation for hepatitis (B or C).
  • Reducing the load on the liver: This may involve reducing the intake of alcohol and certain medications, as well as treating underlying conditions that may be contributing to liver damage, such as viral hepatitis or nonalcoholic fatty liver disease.
  • Managing complications: Liver cirrhosis can lead to a number of complications, such as ascites (fluid accumulation in the abdomen), varices (enlarged veins in the esophagus or stomach), and hepatic encephalopathy (a condition that causes confusion and difficulty thinking). 
  • Medications: Medical management of liver cirrhosis may involve medications such as Beta-blockers to reduce hypertension and risk of bleeding or diuretics to remove excess fluid, Antiviral drugs: to treat viral hepatitis, Steroids and immunosuppressive agents: to treat autoimmune hepatitis.
  • Avoiding drug-induced liver injury: certain medications that can make the symptoms worse – such as opiates, non-steroidal anti-inflammatory drugs (NSAIDs), or sedatives. Upon the doctor's advice, they must be stopped, and alternatives must be administered.
  • Regularised endoscopic procedures: Endoscopy can help in assessment of varices (enlarged veins in the esophagus or stomach) happen because of portal hypertension in cirrhosis patients. In most of severe cirrhosis cases, esophageal varices can burst and cause internal bleeding.
  • Monitoring for liver cancer: People with liver cirrhosis have an increased risk in future of developing liver cancer. Medical management may involve regular monitoring, regular medical check-ups for signs of liver cancer, such as ultrasound exams or blood tests.


It's important to note that medical management of liver cirrhosis is not a cure for the condition. The focus is on slowing the progression of the disease and managing its symptoms. In advanced cases of liver cirrhosis, a liver transplant may be the best treatment option. It's important to work closely with liver specialist doctors to determine the best treatment plan for you.

Surgical treatment for liver cirrhosis may be recommended in certain cases and may be used to treat more-severe complications of cirrhosis. Some possible surgical treatments for liver cirrhosis include:


  • Liver transplant: This is the most effective treatment for advanced liver cirrhosis. A liver transplantation involves surgically removing the damaged liver and replacing it with a healthy liver from a donor.
  • Shunt surgery: Shunt surgery may be an option for people with liver cirrhosis and portal hypertension (high blood pressure in the vein that carries blood to the liver). Shunt surgery involves creating an alternate pathway for blood to bypass the damaged liver, a small tube called a Transjugular intrahepatic portosystemic shunt (TIPS) may be placed in your vein to reduce blood pressure in your liver.
  • Liver resection (hepatectomy): In some cases, a portion of the damaged liver may be surgically removed in a procedure called a liver resection. This may be an option for people with small, isolated areas of scarring in the liver.
  • Copper chelating therapy: Copper chelating therapy is typically used to treat Wilson's disease, a rare genetic disorder that causes excessive amounts of copper to accumulate in the body. Copper chelating therapy can be effective in reducing copper levels in the body and improving symptoms of Wilson's disease
  • Iron chelation and phlebotomy: to treat hemochromatosis, an inherited condition where the body absorb too much iron from the food after eating. 


It's important to understand that surgical treatment for liver cirrhosis is not always possible, and it may not be the best option for everyone. Surgical treatment plan will depend on the severity of your liver damage, your overall health, and other factors. It's important to work closely with the liver specialist team to determine the best treatment plan for you.

Frequently asked questions:

What are the 4 stages of cirrhosis of the liver? 

Liver cirrhosis does not contain 4 stages. Actually, liver cirrhosis is one of the stage of liver disease / liver failure. Seemingly, liver failure has four stages. They are inflammation, fibrosis, cirrhosis and liver failure.

  • Stage 1: Inflammation: The early stages of liver disease. Here, swollen or hepatitis is seen as a natural response to injury. Increased toxins are one of the causative factors. 
  • Stage 2: Fibrosis: Untreated inflammation may lead to scarring of the liver, also called fibrosis which hinders the liver’s abilities, as it can restrict the blood flow. Scar tissue is usually not repairable. If detected early, the fibrotic patient can be saved.
  • Stage 3: Cirrhosis: Severe and irreversible scarring of the liver. It may take several years to manifest. Most prone to liver cancer. 
  • Stage 4: Liver Failure (the final stage): Also called as hepatic failure or advanced liver disease where functioning of the liver is stopped. The liver cannot be repaired on its own or even with treatments; a liver transplant is the only option for recovery.

What is the best treatment for liver cirrhosis?

Initial stage, hepatology doctor may manage patients with medications, diet and lifestyle modifications to treat the underlying condition which caused liver cirrhosis in the first place. Doing this avoids further liver damage, and the deterioration can be slowed.


A liver transplant is currently the best treatment for progressive cirrhosis and severe damage. This major operation involves extracting the damaged liver and replacing it with a healthy normal liver from a donor.

What are the symptoms of cirrhosis of the liver? 

The symptoms of liver cirrhosis could be non-specific, i.e., the symptoms may not denote a defective liver. In a few cases, the patient could be asymptomatic (shows no symptoms at all). Some of the common signs and symptoms of liver cirrhosis include:

  • Nausea & Fatigue 
  • Itchy skin
  • Weight loss
  • Loss of appetite
  • Swelling in your legs
  • Testicular atrophy in men
  • Breast enlargement in men
  • Easy bleeding and bruising 
  • Redness in the palms of the hands
  • Spider-like blood vessels on the skin
  • Confusion, drowsiness and slurred speech
  • Ascites (fluid accumulation in the abdomen)
  • Jaundice (yellow discolouration in the skin and eyes)

How does liver cirrhosis cause hyperglycemia (high blood sugar)?

The prevalence of type 2 diabetes mellitus (T2DM) is higher in patients with liver diseases such as non-alcoholic fatty liver disease, chronic viral hepatitis, cirrhosis etc. Various mechanisms influence the pathogenic link between the presence of T2DM and the severity of the liver injury. Some of them include the following: 

  • Gut microbiota
  • HCV infection
  • Hepatic inflammation 
  • Obesity-associated insulin resistance
  • Hepatic fat accumulation
  • Reactive oxygen species


Gut microbiota: These are the bacterial organisms living in the gut. They can produce bacterial lipopolysaccharide-binding protein, contributing to low-grade inflammation in obesity, non-alcoholic fatty liver disease, diabetes and cardiovascular disease. A higher prevalence of bacteria in small intestinal bacterial overgrowth is seen in patients with non-alcoholic steatohepatitis.


HCV infection: HCV infection can directly or indirectly alter glucose homeostasis. Intrahepatic inflammation results in insulin resistance & higher risk of developing T2DM.


Obesity-associated insulin resistance: Visceral adiposity (fat tissue) and chronic hepatic inflammation are intertwined and associated with chronic systemic inflammation in the pre-diabetic state.


Hepatic fat accumulation: Studies show that liver fat content, much more strongly than visceral fat, determines insulin sensitivity in humans and supports a direct and significant role of fatty liver in insulin resistance.


Reactive oxygen species: Oxidative stress has been long proposed as the root cause underlying the development of insulin, impaired glucose tolerance and T2DM. In both non-alcoholic steatohepatitis and experimental steatohepatitis, oxidative stress is increased, leading to T2DM.

Can cirrhosis of the liver be reversed?

No, cirrhosis of the liver cannot be reversed, but the damage to the body (and liver) may be slowed down if the steps are taken to treat the underlying disease and condition. In case of early detection, and the cause is treated, further damage can be stopped and, rarely, reversed.

What causes cirrhosis of the liver?

There are various causative factors of liver cirrhosis. the most common of them are: 

  • Alcoholism 
  • Obesity
  • Poor diet/lifestyle
  • Viral infections such as hepatitis B and C
  • Underlying autoimmune disease
  • Certain drugs, medications, and chemicals
  • Genetics factor 

Can liver function tests be normal with cirrhosis?

Yes. Liver function tests can be normal with cirrhosis and even at many stages of liver disease. This is why a usual series of tests, blood and urine tests, may be prescribed by the treating physician to detect the signs of liver impairment. Often, a liver biopsy could be the only way to confirm a diagnosis of cirrhosis.

How long can you live with cirrhosis of the liver? 

Life expectancy in people with stage 3 cirrhosis of the liver is about 10 to 12 years (compensated cirrhosis). In liver cirrhosis, the deterioration of the fibrotic liver to the cirrhotic liver could take many years. This is why early diagnosis of liver impairment is of utmost important.

Can you come back from liver damage?

Yes. You can come back from liver cirrhosis. There are cases of people recovering from liver failure with appropriate treatment and transplantation. With permanent abstinence from alcohol (if alcoholism is the causative factor), the treated people can go back to their daily activities within six months. In the case of the Non-alcoholic fatty liver disease (NAFLD) pathway, taking steps to remove fat build-up in the liver can help.

How do I know if my fatty liver is getting worse?

If the patient has been diagnosed with fatty liver disease, they must let the treating gastroenterologist know about the increasing severity and intensity of the disease symptoms. These symptoms include loss of appetite, fatigue, weight loss, weakness, fluid retention, bleeding etc.

How alcohol causes cirrhosis of the liver? 

Alcoholic liver cirrhosis is caused by frequent and heavy alcohol usage. 

  • When the liver tissue begins to scar, the liver no longer functions as effectively as it once did. 
  • Consequently, the body cannot create enough proteins or filter poisons from the blood as efficiently as it can.
  • Cirrhosis of the liver may be caused by various factors. Alcoholic liver cirrhosis, on the other hand, is directly tied to alcohol use.

Can smoking cause liver cirrhosis? 

Yes. Smoking can cause liver cirrhosis. Research from 2020 demonstrated the association between smoking cigarettes and the progression of fibrosis in chronic liver diseases (CLD), such as non-alcoholic fatty liver disease (NAFLD) and primary biliary cholangitis.

  • Developed liver cancer in patients with chronic hepatitis B or C virus infection.
  • Lung function is affected, which can preclude liver transplantation. 
  • Post liver transplantation, smoking can cause various adverse effects such as: 
  • Increased risk of liver cancer
  • Vascular complications (blood vessel problems) etc.

Is omega-3 good for liver cirrhosis?

Yes. Omega-3 fatty acids are good for liver cirrhosis. 

  • Omega-3 polyunsaturated fatty acids are the "essential fatty acids" as humans cannot synthesize them; therefore, they must be obtained through diet.
  • Research suggested that it might be beneficial in reducing liver triglyceride levels, but not in other features of steatohepatitis.

Is ginger good for liver cirrhosis?

Yes. Ginger is considered a good supplement for stalling liver cirrhosis. Reduction of liver damage, cholesterol levels, blood sugar levels, and inflammation in people with non-alcoholic liver disease can be seen with the ginger present in everyday diet. Ginger is generally considered safe. Gingerols and schools in ginger root help inhibit inflammation and protect against cellular damage.

Is curd good for liver cirrhosis? 

Yes. Curd is good for liver cirrhosis. A 2018 study demonstrated that curd consumption improved liver features in patients with non-alcoholic fatty liver disease. The various benefits include: 

  • Curd could improve hyperglycaemia condition by modifying the gut flora, increasing faecal pH, and reducing intestinal toxinsproduction.
  • Beneficial effects of curd on fatty liver could result from the reversal of dysbiosis (imbalance in the gut-microbial community associated with liver disease).

Who is the best liver specialist doctor in Hyderabad for liver cirrhosis treatment?

The liver specialist doctor at PACE Hospitals, who are among the top 10 hepatologist in Hyderabad, with vast expertise in handling severe and critical cases of liver diseases with the help of the latest treatment modalities, are among the best liver specialist doctor in Hyderabad for liver cirrhosis treatment.

How do I book an appointment for liver cirrhosis treatment in Hyderabad?

If you are looking for a liver cirrhosis doctor near me or in the vicinity of Madhapur, Kondapur, Hitec city, Gachibowli, Kukatpally, or KPHB for liver cirrhosis treatment, then opt booking appointment with the top liver specialist in Hyderabad at PACE Hospitals by filling out an appointment form online or calling directly on 04048486868. The team of multidisciplinary team for liver disease treatment has a wide-range of experience in treating liver cirrhosis with a high success rate.

How much does cirrhosis of the liver treatment cost in Hyderabad?

Liver cirrhosis treatment cost in Hyderabad depends upon the multiple factors such as the age of the patient, health conditions, extent of liver damage caused by alcohol-related liver disease, genetic or inherited liver disease, hepatitis etc.


Since cirrhosis, treatment is completely focussed on to stop the liver damage progression. The cost of treatment for liver cirrhosis can vary widely depending on the type of treatment needed. Lifestyle changes, medications, and nutritional supplements are required to follow during the course of treatment. However, the cost of treatment may depend on the severity of the condition and if the patient is considering alternative treatments such as liver transplantation, the cost may vary depending on the type of treatment they choose.

What is liver cirrhosis treatment cost in India?

Cirrhosis of the liver treatment cost in India depends upon the multiple factors such as the patient's age, stage of liver damage and scarring, complications associated. It must be understood that the damage to the liver is permanent. Nevertheless, right time and early diagnosis can help in treating the causes and further any additional liver impairment must be avoided to slow the prognosis.

Are liver cirrhosis treatment covered by insurance in India?

Yes, liver cirrhosis treatment is covered by insurance in Hyderabad, India. Person need to cross-check with their respective health insurance companies and corporates about the partial or complete cashless treatment eligibility to get the benefits.