Does fatty liver occur in the early stages of cirrhosis?

Written by Wu Hai Wu
Gastroenterology
Updated on March 17, 2025
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Cirrhosis in its early stage does not necessarily involve fatty liver, as there are multiple causes for cirrhosis. Besides fatty liver causing steatohepatitis, which can lead to cirrhosis, other causes include viral hepatitis, drug-induced hepatitis, and autoimmune hepatitis, which can also lead to cirrhosis. Cirrhosis resulting from the above conditions will not involve fatty liver. However, if cirrhosis is caused by steatohepatitis, it is possible that fatty liver occurred in its early stage. Once fatty liver develops, proactive interventions are necessary, such as weight loss and medication, which might reverse fatty liver.

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Can liver cirrhosis be detected by an ultrasound B-scan?

Liver cirrhosis can be diagnosed with an ultrasound. In the early stages of cirrhosis, there are no specific changes in the sonographic pattern visible on ultrasound. Typically, cirrhosis manifests as a decrease in liver volume, with imbalanced proportions of the liver lobes; both the left and right lobes may shrink, with compensatory hypertrophy observed in some cases in the left lobe. The liver capsule appears serrated, and the echoes from the liver area are coarser and stronger, with uneven distribution. It's possible to observe nodules with low or high echoes. The liver vessels vary in thickness, the hepatic veins may narrow, and the portal vein can widen. An enlarged portal vein can lead to symptoms like splenomegaly and ascites.

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Is late-stage liver cirrhosis with liver failure easy to control?

In the late stages of cirrhosis, when the condition has progressed to liver failure, it becomes very difficult to manage. At this stage, due to liver failure, the first issue to arise is abnormal coagulation function, such as easy bleeding in patients. This will lead to severe hypoalbuminemia, causing swelling throughout the body. Additionally, bilirubin levels are very high, leading to various metabolic diseases, such as metabolic encephalopathy, which affects other organs as well. In the late stages of cirrhosis, there is also a large amount of ascites. At this time, portal hypertension is common, leading to complications such as gastric and esophageal varices rupture, bleeding, and hepatic encephalopathy, making the condition very difficult to control. If the cirrhosis is a benign lesion, at this time, adjusting liver function through methods such as artificial livers or plasma exchange can improve the condition to a manageable extent. It is critical to act quickly to perform a liver transplant, as there are no other effective treatments besides transplant, and the condition is very difficult to control.

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What are the gastrointestinal symptoms of cirrhosis?

In the early stages of cirrhosis, many patients do not exhibit any symptoms, but some may experience fatigue, nausea, vomiting, poor appetite, and indigestion. Some patients might also suffer from portal hypertensive gastropathy due to cirrhosis, leading to symptoms such as pain and bloating in the upper abdomen, acid reflux, and belching. If the disease progresses to the decompensated stage of cirrhosis, portal hypertension can cause varices in the esophagus and stomach, which may lead to severe upper gastrointestinal bleeding if hard food is consumed. Symptoms can include vomiting dark red blood or fresh blood, dizziness, fatigue, and cold sweats. In such cases, it is advised to seek immediate medical attention for emergency treatment.

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Is it okay not to remove the spleen for cirrhosis with splenomegaly?

Once cirrhosis patients are found to have splenic hyperfunction, in order to reduce the splenic hyperfunction and its phagocytic destruction of red blood cells, white blood cells, and platelets, the spleen must be dealt with. Traditionally, the treatment plan could involve surgically removing the spleen, also known as splenectomy. However, current treatment plans generally involve interventional methods. After multiple interventional embolizations, the spleen undergoes aseptic necrosis and is absorbed, thus improving the condition of splenic hyperfunction. Therefore, now in cases of cirrhosis with splenic hyperfunction, it is possible to treat without removing the spleen, using interventional methods instead.

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Is early-stage cirrhosis treatable?

Whether early symptoms of cirrhosis can be treated depends on the cause of the cirrhosis. If the cause of the cirrhosis is clear and can be effectively suppressed, then the early symptoms of cirrhosis can be effectively treated. For example, if the cirrhosis is caused by chronic hepatitis B virus infection, then the use of antiviral drugs such as entecavir, tenofovir, and adefovir can effectively control the further development of cirrhosis. However, if the cirrhosis is caused by autoimmune liver diseases or cholestatic liver cirrhosis, the treatment might not be as effective, because there are no specifically effective treatments available for these diseases. (Medication should be used under the guidance of a physician)