Cirrhosis is a description of the extent of scarring of the liver. With cirrhosis, the scarring or fibrosis has advanced to the point where the structure of the liver has become altered. The Liver’s smooth texture starts to become nodular and lumpy.
Nodules are areas of liver cells which have become cut off from the rest of the liver by circular bands of scarring. Inside these bands liver cells have unsuccessfully tried to regenerate. The free flow of blood throughout the liver then starts to be compromised.
Compensated cirrhosis means that the liver is still able to cope with or compensate for the damage and continues to carry out most (sometimes all) of its functions. Like fibrosis, cirrhosis ranges from mild (at the beginning) and moderate to severe. Severe cirrhosis can then progress to decompensated cirrhosis.
The rate of progression of cirrhosis is different in different people but does not appear to be related to genotype. Progression is effected by similar factors to fibrosis, but at this stage the effect of alcohol on liver damage is even greater.
Once they have developed compensated cirrhosis many people do not experience symptoms that differ from those they may have had during the chronic phase of the disease. Many people experience no symptoms at all. In general, people with well-compensated cirrhosis have normal liver function for serum albumin, clotting factors and bilirubin and even sometimes normal liver enzymes.
There is also no evidence of portal hypertension. But over time and without treatment compensated cirrhosis does seem to progress inevitably to decompensated cirrhosis. For some people this may take many years and they may well die from other unrelated causes before that time. Studies have suggested that the annual rate of decompensation among people with hepatitis C with cirrhosis is about 4%.
From studies carried out it appears that on average 18% of people with compensated cirrhosis will progress to decompensated cirrhosis after 5 years. After ten years the rate rises to 30%.
As with the chronic stage of hepatitis C peoples’ experiences and symptoms during compensated cirrhosis will vary significantly.
The following is a list of symptoms that are more specifically associated with compensated cirrhosis (these can be included with of any of the other symptoms experienced with hepatitis C). It doesn't mean that you will necessarily experience them or if you do, that it means you necessarily have cirrhosis.
- Tiredness and weakness (possibly resulting from insufficient nutrients being processed by the liver)
- Loss of appetite
- Nausea and vomiting
- A build-up of fluid in the legs and abdomen
- Weight loss
- The tendency to bruise easily
- Jaundice (yellowing of the skin and the white of the eyes)
- Sensitivity to drugs due to the reduced ability of the liver to inactivate them
- Spider nevi. These are small capillaries visible on the surface of your skin. Branches grow out from the one capillary making it look like a small red spider or a splat (they can be found only above the waist, usually on the chest, upper arms, shoulders, face, neck and upper back)