✓ Bengaluru
✓ ZCCK Registered
✓ ZCCK Registered
Comprehensive management of all stages of liver cirrhosis — from early compensated disease through to decompensation, transplant evaluation, and post-transplant aftercare. Dr. Srinivas Bojanapu, HPB & Liver Transplant Surgeon, Dhaara Liver Clinic, Yelahanka, Bangalore.
Cirrhosis is the end result of chronic liver injury — healthy liver cells are progressively replaced by scar tissue (fibrosis), distorting the liver's internal architecture. The scarring disrupts blood flow through the liver, impairs the liver's ability to process nutrients and toxins, and reduces its capacity to produce proteins essential for clotting, immunity, and fluid balance.
Unlike many other conditions, cirrhosis cannot be reversed once advanced scarring is established. However, treating the underlying cause stops further progression, and the liver retains remarkable compensatory capacity — many patients with significant cirrhosis live normal lives for years with appropriate management.
The critical clinical divide is between compensated and decompensated cirrhosis. In compensated cirrhosis, the liver still manages its functions — patients may be symptom-free. In decompensated cirrhosis, complications appear (ascites, jaundice, variceal bleeding, encephalopathy) and the trajectory changes dramatically. This is the point at which transplant evaluation becomes urgent.
The scarred liver still compensates — patients may be entirely asymptomatic or have only fatigue and mild discomfort. Diagnosed incidentally on blood tests or imaging.
The liver can no longer compensate — complications emerge. This is a turning point requiring intensive management and often transplant evaluation.
MELD (Model for End-Stage Liver Disease) is a mathematical score (6–40) calculated from your bilirubin, creatinine, and INR. It predicts 90-day mortality without transplant and determines transplant priority.
Dr. Srinivas calculates your MELD score at each visit to track disease trajectory and time transplant listing appropriately.
Dr. Srinivas manages the full spectrum of cirrhosis complications at Dhaara Liver Clinic, Yelahanka and Kauvery Hospital, Bangalore
Fluid accumulation in the abdomen from portal hypertension + low albumin. Managed with salt restriction (< 2g/day), diuretics (spironolactone + furosemide). Refractory ascites may need repeated paracentesis, TIPS, or transplant evaluation.
Engorged veins in the oesophagus/stomach that rupture — life-threatening emergency (20–30% mortality per episode). Emergency endoscopic band ligation + IV terlipressin. Primary prophylaxis with non-selective beta-blockers (carvedilol) or band ligation.
Confusion, altered consciousness, and behavioural change from ammonia accumulation. Precipitants: bleeding, infection, constipation, diuretics, sedatives. Treated with lactulose + rifaximin. Recurrent encephalopathy is a strong transplant indication.
Bacterial infection of ascitic fluid — presents with fever, abdominal pain, or sudden encephalopathy. Diagnosed by ascitic tap (PMN > 250/mm³). IV cefotaxime + IV albumin. Long-term norfloxacin prophylaxis after first episode.
Acute kidney failure in the setting of advanced cirrhosis — a pre-renal failure driven by splanchnic vasodilatation. HRS-1 (acute): terlipressin + albumin. Urgent transplant evaluation. Dialysis is a bridge, not a cure — transplant is the only definitive treatment.
All cirrhotic patients have up to 30-fold increased HCC risk. 6-monthly ultrasound + AFP surveillance catches early-stage tumours when cure is possible (resection, ablation, or transplant). Milan criteria tumours qualify for transplant — excellent post-transplant outcomes.
Regular structured follow-up is the difference between stable compensated cirrhosis and avoidable crisis admissions.
Ultrasound abdomen + serum AFP. Catches early liver cancer when curative treatment is still possible.
Liver stiffness measurement to track fibrosis progression non-invasively. Available at Dhaara Liver Clinic, Yelahanka.
Calculated from bilirubin, creatinine, INR. Tracks disease trajectory and guides transplant timing.
Screens for oesophageal and gastric varices. Surveillance interval depends on varix size and beta-blocker use.
LFTs, CBC, renal function, electrolytes, coagulation — tracks liver function and detects early decompensation.
Referral to ZCCK-registered transplant programme. Living donor work-up for appropriate family donors. MELD ≥15 triggers evaluation.
Nutrition management is a core part of cirrhosis care — malnutrition worsens outcomes and accelerates decompensation. Common misconceptions can actually harm patients:
Protein restriction is outdated and harmful. Cirrhotic patients need MORE protein (1.2–1.5g/kg/day), not less. Target protein from dairy, eggs, legumes, and lean meat. Late-evening protein snack prevents overnight muscle breakdown (sarcopenia).
Limit sodium to <2g/day (5g salt). This is the single most effective dietary intervention for ascites management. Read food labels — most processed and restaurant food exceeds daily salt allowance.
Many Ayurvedic preparations, herbal supplements, and green teas contain hepatotoxic compounds. Some have caused acute liver failure in cirrhotic patients. Always disclose all supplements to Dr. Srinivas before taking.
Regular coffee consumption (2–3 cups/day) is associated with slower fibrosis progression and lower HCC risk in multiple large studies. It is one of the few lifestyle factors with proven liver-protective effects.
Ibuprofen, naproxen, and diclofenac are dangerous in cirrhosis — they impair renal prostaglandins, precipitate hepatorenal syndrome, and increase GI bleeding risk. Paracetamol (up to 2g/day) is the safe option.
Gentle aerobic exercise (walking 30 min/day) and resistance exercise prevent sarcopenia — a major predictor of decompensation and post-transplant outcomes. Exercise is safe in compensated cirrhosis.
Liver transplant is the only cure for end-stage cirrhosis. The most common mistake is waiting too long before referral. Dr. Srinivas recommends early transplant evaluation — ideally while still compensated — because:
Unlike a pure gastroenterologist, Dr. Srinivas manages liver disease medically AND performs transplant surgery — one doctor from diagnosis to transplant to aftercare. No referral gap at the critical moment.
Every visit includes formal MELD score calculation, fibroscan review, and surveillance coordination — structured, proactive monitoring rather than reactive crisis management.
Fibroscan (liver elastography) available at Dhaara Liver Clinic, Yelahanka — measures liver fibrosis non-invasively, guiding treatment decisions at each visit without hospital admission.
ZCCK-registered transplant programme at Kauvery Hospital, Electronic City. Living donor evaluation and DDLT coordination available — outcomes benchmarked to international transplant standards.
Dhaara Liver Clinic, Yelahanka serves patients from Yelahanka, Hebbal, Jakkur, Thanisandra, Sahakar Nagar, and Airport Road — avoiding long journeys for regular follow-up.
Send your LFT reports, fibroscan results, and ultrasound images directly on WhatsApp for rapid triage and guidance between clinic visits.