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• Cirrhosis is a late stage of liver scarring (fibrosis) induced by a variety of liver disorders and conditions, including hepatitis and persistent drinking. When your liver is damaged, whether through illness, excessive alcohol intake, or another cause, it attempts to restore itself. Scar tissue arises as a result of the procedure.

• It causes scar tissue to grow, making it harder for the liver to function (decompensated cirrhosis) and is considered to be potentially fatal by nature. The liver damage is often irreversible. However, if detected early and the underlying cause is addressed, additional damage can be reduced and, in rare cases, reversed.

• It often has no signs or symptoms until liver damage is extensive.

• On damage the following signs/symptoms can be seen  - Fatigue , easy bleeding/bruising , Loss of appetite, Nausea, pedal/ankle odema, Weight loss, Itchy skin, Yellow coloured eyes and skin, ascites(fluid accumulation in abdomen), spiderlike blood vessels, redness of palms, absence/loss of periods (not related to menopause), libido and gynecomastia(breast growth in males)/testicular atrophy, Confusion, sleepiness, and slurred speech (hepatic encephalopathy)

• Usually, the total bilirubin test shows 1.2 mg/dL for adults and 1 mg/dL for children under the age of 18. The normal value for direct bilirubin is 0.3 mg/dL.

• Normal findings may differ somewhat between men and women, and results may be influenced by particular diets, drugs, or severe activity. Bilirubin levels that are lower than normal are typically not a cause for worry. Elevated levels might be a sign of liver injury or illness.

• Higher-than-normal amounts of direct bilirubin in your blood may suggest that your liver isn't adequately removing bilirubin. Elevated indirect bilirubin levels may signal other issues.

• Gilbert's syndrome, a lack in an enzyme that aids in the breakdown of bilirubin, is a frequent and innocuous cause of high bilirubin. Further tests may be ordered by your doctor to explore your situation. Bilirubin test results can also be used to track the evolution of specific illnesses like jaundice.

• Further laboratory investigations such as AST(aspartate aminotransferase), ALT(alanine transaminase), ALP(alkaline phosphatase) and GGT(gamma-glutamyl transpeptidase); Total Albumin, Lactic Dehydrogenase, Alpha protein, 5’nucleotide, mitochondrial antibody and PTT levels need to be determined and procedures such as CT scan, MRI (for liver tissue damage) and biopsy (in case of chance of any cancerous growth) need to be performed.

• Fatty liver disease is a condition caused by fat buildup in the liver (i.e., when fat percentage exceeds 5 - 10% of your liver's weight), which can be caused by alcohol intake and/or a high fat diet. Individuals who are obese/overweight, have poor glycemic control/insulin resistance, have metabolic syndrome, and are taking specific drugs such as amiodarone, diltiazem, tamoxifen, or steroids are at risk of developing fatty liver.

• In some situations, it is thought to be symptomless, but in others, it can cause substantial liver damage. The good news is that it is frequently avoidable or reversible with lifestyle modifications.

• It progresses through 3 stages which include Steatohepatitis (swelling and damage of liver tissue), Fibrosis (scar tissue formation where your liver is damaged) and Cirrhosis (extensive scar tissue replacement with healthy tissue). Cirrhosis can lead to liver failure or cancer.

• Laboratory investigations consists of Liver functions tests such as AST, ALT, ALP and GGT; Total Albumin and Bilirubin, CBC, Test for viral infection, Fasting Blood Glucose, HbA1c and Lipid profile.

• Imaging procedures such as Ultrasound, CT /MRI, Elastography (for measuring stiffness of liver) and Magnetic resonance elastography and Biopsy (for ruling out any cancerous growth and for signs or any inflammation and scarring).

• If a patient has a fatty liver, he or she should be checked for the entire metabolic syndrome, which includes diabetes, hypertension, cholesterol, and thyroid issues.

• The best way to treat fatty liver is with making some lifestyle changes which can significantly improve your health which includes – Avoiding alcohol and High fat diet, Losing weight, taking medications for controlling glucose and fat(Triglyceride and Cholesterol) levels and Vitamin E with Thiazolidinediones in specific instances.

• Currently, no drug treatment is approved for management of fatty liver disease.

In order to prevent further progression of disease one can:

 Maintain a healthy weight by consuming food less/minimal in in its fat percentage.

 Follow a Mediterranean diet which is high in vegetables, fruits and good fats.

 Exercise regularly for 45 minutes where in you can include combination of cycling with walking, cardio, CrossFit and yoga with meditation.

 Restrict alcohol consumption

Based on the complaints and elevated bilirubin levels you seem to be suffering from a type of liver disorder, a condition wherein excess accumulation of bilirubin (a brown yellow coloured compound formed in breaking down of red blood cells) occurs. With loss of appetite, vomiting, stomach tightness and bloating; fever, extreme fatigue and abdominal pain can also be seen in liver diseases.

• There are multiple causes for development of liver dysfunction such as infection, autoimmune liver diseases like cholangitis, Wilson’s disease, cancer, alcoholic liver (due to alcohol abuse) and non-alcoholic (due to excessive consumption of fats) and drug induced.

• When using a medicine that is known to have the potential to cause liver damage, your doctor may recommend you to have blood tests done on a routine basis after starting the medication so that any signs of liver damage may be recognised before symptoms develop.

• Common medications that can cause damage to the liver include Paracetamol, Statins – drugs for lowering cholesterol levels and certain herbs.

• Other liver function parameters such as AST(aspartate aminotransferase), ALT(alanine transaminase), ALP(alkaline phosphatase) and GGT(gamma-glutamyl transpeptidase) bilirubin are required to be evaluated and additional to this for determining the exact cause of dysfunction especially to confirm presence of jaundice; urinalysis, CT (for distinguishing between biliary obstruction and liver disease including cancer) and liver biopsy (for ruling out concern about possible liver cancer) needs to performed.

• The treatment is based on the underlying cause and damage levels and can range from dietary changes, medications such as antibiotics, sedatives, etc to liver transplants.