Cirrhosis is a description of the extent of scarring of the liver. With cirrhosis, scarring or fibrosis has advanced to the extent that the structure of the liver is altered: the usual smooth texture of the liver starts to become nodular and lumpy. Nodules are areas of liver cells that have become cut off from the rest of the liver by circular bands of scarring with liver cells unsuccessfully trying to regenerate inside the bands. The free flow of blood throughout the liver starts to be compromised.
Compensated cirrhosis means that the liver is still able to cope with or compensate for the damage and carry out most (sometimes all) of its functions. Cirrhosis, as with fibrosis, ranges from mild (at the beginning) to moderate and severe. Severe cirrhosis can then progress to decompensated cirrhosis. The rate of progression of cirrhosis is different in different people but is not apparently 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.
Many people do not experience symptoms once they have developed compensated cirrhosis 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 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. From the studies so far it appears that on average 18% of people with compensated cirrhosis will progress to decompensated cirrhosis after 5 years and that after ten years the rate will be 29%.
In one study of 250 patients with compensated cirrhosis over eight years 33% of patients developed at least one major complication. The most common were liver cancer (hepatocellular carcinoma) (21%), ascites (20%), gastrointestinal bleeding (about 5%) and hepatic encephalopathy (about 2%). 19% of the patients died from liver disease during the follow up mainly due to hepatocellular carcinoma (a type of liver cancer). Another recent study of the mortality rates amongst people with compensated cirrhosis found that the mortality rate was 9% after five years and 21% after ten years.
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, (and this can be on top of any of the other symptoms that can be experienced with hepatitis C). It doesnt mean however that you will necessarily experience them or that if you do, that it means you have cirrhosis.
General Symptoms
- Fatigue. (This may result from insufficient nutrients being processed by the liver)
- Loss of appetite
- Weight loss
- Nausea
- Sensitivity to drugs due to reduced ability of the liver to inactivate them
Skin disorders
- Spider nevi. These are small capillaries that are seen on the surface of your skin. Branches grow from the one capillary and it can either look like a small red spider or a splat (kind of like a squashed spider. They can be found only above the waist, usually on the chest, upper arms, shoulders, face, neck and upper back.
- Palmar erythema. Blotchy redness on the palms of the hands.
Endocrine Disorders (hormonal disorders)
The liver metabolizes the sexual hormones. If it can not do this properly this may lead to:
- Loss of sexual desire.
- In men: a fall in testosterone levels, reduced testicle size, enlarged tender breasts, impotence.
- In women: menstrual irregularities, increased menstrual pain and more intense menopausal symptoms.
