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Figuring out the stages of cirrhosis?

Hey guys.  I was diagnosed with Non-Alcoholic Fatty Liver in 2014 and didn't give it the respect it deserved.  By 2017, I was in the hospital again and diagnosed with end-stage cirrhosis.  I made a radical lifestyle change on MANY levels.  If you would have asked me a year ago if I could live this type of lifestyle, I would have said absolutely not.

I've never had a biopsy (my doctor didn't want to give me one because I had bleeding esophageal varices when I was in the hospital) but I was told I was in 4th stage.  I've never been jaundiced, have ascites issues when I eat poorly but have always been able to manage it with my healthy diet now.  When I questioned my doctor about a transplant, he said I wasn't sick enough.  So am I really 4th stage?  Obviously I have varices but they only started bleeding when I was smoking.  I quit smoking immediately and have been smoke-free since October of last year.  The only thing I've been struggling with is my hair thinning.  Not sure if that is related to cirrhosis or thyroid.

When I went into the hospital with ascites in 2017, I was terribly swollen but my body was able to process it after a couple days in the hospital.  I've been no where near that ever since.  The most I ever have is because I accidentally ate something I shouldn't have and a day or two later it works itself out.  If anyone is interested in the lifestyle changes I made, I started a blog about it a few months ago at midliferevelations.com.  I'm not selling anything, just sharing my experiences and happy to help any of my fellow cirrhosis sufferers to the best of my ability.  I'm no expert, just a normal person who has done a ton of research and I'm still very much learning.

Take care!
4 Responses
683231 tn?1467323017
Hi Misty and welcome.

Are you familiar with the MELD score? The MELD score is called the Model For End Stage Liver Disease. It is used to stage patients for liver transplant. The higher the score the higher you are on the transplant list. You needs score of at least 15 to be eligible for transplant. The scale is from 6 to 40. The score is derived from several of your blood test scores. You can find an online calculator to find your score if you know your test results for Bilirubin, creatinine, INR, and sodium.

What Are the 4 Stages of Cirrhosis?

Stage 1 Cirrhosis

Stage 1 is the earliest stage of cirrhosis and is characterized by the absence of two significant complications known as varices and ascites. Varices are dilated, ballooned veins. They are most often located in the lining of the esophagus and/or stomach. Acsites refers to an accumulation of fluid in the abdominal cavity. Both varices and ascites develop primarily because of obstructed blood flow through the liver, a condition known as portal hypertension. While people with stage 1 cirrhosis have extensive liver scarring, it is not severe enough to cause substantial portal hypertension and its complications.

Stage 1 cirrhosis is considered compensated cirrhosis. This means that despite extensive damage, the liver is not yet so severely scarred that clinically apparent signs of liver failure have developed. People with stage 1 cirrhosis generally do not experience many symptoms other than perhaps lack of energy and fatigue. Stage 1 cirrhosis is potentially reversible if the underlying cause of the cirrhosis is eliminated or cured.

Stage 2 Cirrhosis

Stage 2 cirrhosis is marked by the development of esophageal varices, due to worsening portal hypertension, but without the presence of ascites. While the development of esophageal varices indicates worsening cirrhosis and an increased risk of dying in the next 12 months, stage 2 cirrhosis is still considered compensated cirrhosis. There remains the potential for at least partial reversal of liver damage if the underlying cause of cirrhosis is eliminated or cured.

Stage 3 Cirrhosis

Stage 3 cirrhosis is marked by the development of ascites, with or without the presence of varices. The volume of ascites varies from being detectable only with imaging tests, such as abdominal ultrasound, to obvious bloating of the abdomen. The development of ascites signals worsening portal hypertension due to advancing liver scarring and deterioration of liver function. Stage 3 cirrhosis signals decompensated cirrhosis, meaning the liver is failing. Once decompensated cirrhosis develops, liver scarring is irreversible and evaluation for liver transplantation is generally recommended. A variety of signs and symptoms may be present with stage 3 cirrhosis, including:
pale and/or yellowish skin
weight loss and loss of appetite
shortness of breath
extreme fatigue
persistent, widespread itchiness
swelling of the feet, ankles and lower legs
wasting of the muscles of the arms and legs
Stage 4 Cirrhosis

The defining feature of stage 4 is gastrointestinal bleeding, usually from ruptured varices in the esophagus or stomach. This type of bleeding can be immediately life threatening if not controlled. Even if bleeding stops or is medically controlled, however, individuals with stage 4 cirrhosis still face a high risk of dying within 12 months. Persons with stage 4 cirrhosis have end-stage liver disease and urgent evaluation for possible liver transplantation is necessary. Signs and symptoms that might develop include those that may occur with stage 3 cirrhosis as well as others, such as:
confusion, personality changes and/or extreme sleepiness
hand tremors
reduced urination, which may indicate kidney failure
high fever, signalling infection of the abdominal cavity.
Avatar universal
Thanks.  I go to a new liver doc on the 12th and he has all my lab work so I will ask then.  I have researched the stages of cirrhosis; however, at stage 4, I imagine people who have to have ascites drained as being stage 4.  
Avatar universal
Did your liver labs show up as abnormal?
683231 tn?1467323017
For me now being cured of hep c (which caused my cirrhosis) my labs are all normal with the exception of my platelet count which is still low because of my portal hypertension caused by cirrhosis. I have a small amount of ascities only visible on ultrasound and a small amount of edema. I had varicies that needed banding back in 2012 but they were not bleeding. They have not reoccurred since then.

Yes needing to be drained is stage 4 so is having HE (hepatic encelopathy or experiencing an esophageal bleed or SBP spontaneous bacterial peritonitis where the excess fluid in the abdomen can suddenly become infected.
Thanks.  I don't have HE and my abdomen has never been drained.  When I went into the hospital I was horribly swelled in the abdomen but after taking lactulose and not eating for a day or so, it began to process on it's own.  Here I am now, 40 pounds lighter and have maintained the weight loss since October 2017.  I haven't had any bleeds for 8 months.  That said, sometimes my belly does swell if I ate something that had a bunch of salt (usually a mistake on my part) or even eating more fat than I should, sugar, etc.  If I am on my diet, my gut swelling is pretty mild.  Sometimes I know its there (because I know what it feels like to be without it) and I tighten up on the diet to get rid of it as fast as I can.  I personally think the only reason I had the bleed is because I was a smoker.  I actually feel better than I have in YEARS right now.  I'd say I'm stage 3.  The thing I do wrestle with is swelling/edema in my feet and sometimes muscle cramps.  I don't tend to drink enough fluids.
As far as liver labs, my ultrasound came up normal.  My liver bloodwork is slightly off normal.  The only thing that's way off (and has been for years) is my platelets are considerably below minimum.
Having any amount of ascities is Stage 3 cirrhosis.

Lactulose is used to treat HE. You said they gave you lactulose are you still taking lactulose?

For patients with compensated cirrhosis but nothing currently actively and injuring their liver most lan tests including ALT and AST will be normal.

Having low platelet counts is caused by portal hypertension a symptom of advanced liver disease.

Esophageal varicies are another symptom of portal hypertension. As pressure in the portal vein builds it causes blood vessels in the esophagus to become enlarged. If they become very large these blood vessels can burst and bleed. Esophageal varicies are a dangerous symptom of advanced cirrhosis and are life threatening.

I was checked for varicies when I was first diagnosed with cirrhosis. They were grade one at that time. When checked again in two years they were grade two. So I was checked again the next year and they were now grade three so I underwent four banding procedures over the next four months to prevent a life threatening bleeding incident. I had not been smoking for about 10 years at that time.

Varicies are caused by portal hypertension of course a hard coughing episode from smoking could probably trigger a bleed so it is good you are not smoking but smoking does not cause varicies.

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