Post-Necrotic Cirrhosis: Symptoms, Causes, and Treatment.

Post-necrotic cirrhosis is also called macronodular cirrhosis. It involves areas of scarring in your liver, called nodules, that are greater than 3 millimeters (mm) across.

Experts estimate that about 1 in 400 adults in the United States have cirrhosis. Cirrhosis is an irreversible scarring of your liver that can lead to liver failure.

In developed countries such as the United States, the most common causes are:

• hepatitis C
• alcoholic-related liver disease
• nonalcoholic fatty liver disease

Read on to learn more about post-necrotic cirrhosis, including its symptoms, causes, and how it differs from other subtypes of cirrhosis.

What are the symptoms of post-necrotic cirrhosis?

Cirrhosis is an irreversible condition that involves the buildup of scar tissue in your liver. You often may not notice any symptoms in the early stages. Symptoms tend to get progressively worse as the scarring progresses.

Potential symptoms include:

• fatigue
• weakness
• nausea
• loss of appetite
• weight loss
• red patches on your palms
• spider-like blood vessels (spider nervus)
• itchy skin

Later symptoms can include:

• yellowing of your skin and the whites of your eyes (jaundice)
• loss of sex drive
• abdominal swelling (ascites)
• swelling in your legs (edema)
• bleeding or bruising easily
• dark urine
• dark, tarry stool

What causes post-necrotic cirrhosis?

Cirrhosis is classified into three types, depending on how areas of scarring look under a microscope. Knowing which type of cirrhosis you have is less useful than knowing the underlying cause.

The three types of cirrhosis are:

What are the possible complications of having post-necrotic cirrhosis?

Cirrhosis can lead to complications, such as:

• portal hypertension
• swelling in your abdomen (ascites) and legs
• changes in your brain function (hepatic encephalopathy)
• internal bleeding
• enlarged spleen
• jaundice
• hepatic hydrothorax, the buildup of fluid in your lungs
• liver cancer
• lung problems (hepatopulmonary syndrome)
• kidney problems (hepatorenal syndrome)

End-stage cirrhosis is known as liver failure. Liver failure is when your liver can no longer perform its usual functions properly. Liver failure can lead to the failure of other essential organs and eventually death.

When to contact a doctor

It’s essential to speak with a doctor as soon as you develop symptoms of cirrhosis. It’s also important to maintain regular contact with your doctor if you’ve previously received a diagnosis of cirrhosis so you can alert them of any new or worsening symptoms.

Some of the early symptoms of cirrhosis to look out for include unexplained:

• weakness
• tiredness
• itchiness
• nausea and vomiting

Medical emergency

You should call 911 or go to the nearest emergency room if you develop symptoms like:

• chest pain
• fever over 101°F (38.3°C)
• persistent diarrhea
• periods of confusion
• jaundice
• shortness of breath
• tarry, black stools

How is post-necrotic cirrhosis diagnosed?

Tests that doctors can use to diagnose cirrhosis include:

• a review of your personal and medical history
• a physical exam, where they:
  • look for signs of jaundice
  • look for rashes or leg swelling
  • listen to your heart and lungs with a stethoscope.
  • feel your abdomen for signs of an enlarged liver or spleen
• blood tests, including:
  • liver enzyme test
  • complete blood count
  • hepatitis tests
  • tests for autoimmune liver disease
• imaging, including:
  • ultrasound
  • MRI scan
  • CT scan
  • elastography
• liver biopsy, if other tests give uncertain results

How is post-necrotic cirrhosis treated?

Post-necrotic cirrhosis is a progressive condition that doesn’t have a cure. Treating the underlying cause may help slow liver damage.

Here’s a look at how doctors treat some of the most common underlying causes:

• Chronic hepatitis B or C: Doctors usually prescribe antiviral drugs to help your body fight off hepatitis viruses or prevent them from causing more liver damage.
• Nonalcoholic fatty liver disease: Your doctor may recommend:
  • weight loss
  • exercise
  • a nutritious, balanced meal plan
• Alcohol-associated liver disease: Your doctor may recommend quitting drinking if they believe alcohol consumption caused your cirrhosis. If you drink, this may be difficult, but a doctor can help you create a cessation plan that works for you.
• Long-term medication use: If your cirrhosis is caused by a medication, your doctor may recommend that you stop taking this medication.
• Autoimmune hepatitis: Your doctor may recommend medications that decrease the activity of your immune system.

Your doctor may recommend a liver transplant if you have liver failure.

What is the long-term outlook for post-necrotic cirrhosis?

Cirrhosis is irreversible and doesn’t have a cure. Many people can live for years without needing a liver transplant if they adopt healthy lifestyle habits and treat the underlying cause.

The 10-year survival rate for cirrhosis is about 47%, according to 2022 research. This drops to 16% once your liver can’t meet your body’s demands.

The 1- and 5-year survival rates for people who receive a liver transplant are about 85% and 72%, respectively, per the 2022 research.

Can you prevent post-necrotic cirrhosis?

Post-necrotic cirrhosis is most commonly associated with hepatitis infection. You can prevent hepatitis B and C by:

• getting vaccinated for hepatitis B
• avoiding injecting illegal drugs and never sharing needles, syringes, or other injection equipment
• avoiding sharing items that can have blood on them, such as razors or toothbrushes
• using a latex or polyurethane condom when having oral, anal, or vaginal sex

Learn about preventing hepatitis.

Takeaway

Post-necrotic cirrhosis, also called macronodular cirrhosis, is characterized by areas of scarring in your liver greater than 3 mm across. It’s most associated with viral hepatitis infection.

You can reduce your chances of developing viral hepatitis by getting a hepatitis B vaccine, avoiding sharing injection equipment, and using a condom during sex.

It’s important to see your doctor if you develop potential signs of cirrhosis to rule out other conditions and treat the underlying cause.