Cirrhosis

Cirrhosis is a disease in which the liver becomes permanently damaged and the normal structure of the liver is changed. Healthy liver cells are replaced by scarred tissue. The liver is not able to do its normal functions, such as detoxifying harmful substances, purifying blood, and making vital nutrients. In addition, scarring slows down the normal flow of blood through the liver, causing blood to find alternate pathways. This may result in bleeding blood vessels known as gastric or esophageal varices .

  • Causes

    Causes of cirrhosis include:


    • Excessive consumption of
      alcohol

    • Hepatitis
      C
      ,
      B
      ,
      and D
    • Autoimmune hepatitis

    • Inherited diseases, such as
      glycogen storage disease
      ,
      hemochromatosis
      , or
      cystic fibrosis
      • Galactosemia
      • Fructose intolerance
      • Tyrosinemia
      • Wilson's disease
      • Alpha1-antitrypsin deficiency

    • Nonalcoholic steatohepatitis (NASH), associated with:

      • Diabetes
      • Obesity
      • Heart disease
      • High blood triglycerides
      • Steroid use

    • Bile duct blockages, associated with:

      • Cirrhosis
      • Congenital defects
      • Scarred ducts—sometimes related to inflammatory bowel disorders
      • Gallbladder surgery
      • Pancreatitis

    • Drugs and toxins:

      • Arsenic
      • Isoniazid
      • Methotrexate
      • Excess vitamin A

    • Infections:

      • Schistosomiasis
      • Brucellosis
      • Echinococcosis

      • Advanced or congenital
        syphilis
    • Heart failure
      , causing blood to repeatedly back up into the liver

  • Definition

    Cirrhosis is a disease in which the liver becomes permanently damaged and the normal structure of the liver is changed. Healthy liver cells are replaced by scarred tissue. The liver is not able to do its normal functions, such as detoxifying harmful substances, purifying blood, and making vital nutrients.


    In addition, scarring slows down the normal flow of blood through the liver, causing blood to find alternate pathways. This may result in bleeding blood vessels known as gastric or
    esophageal varices
    .

    Cirrhosis of the Liver
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

  • Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done.

    Tests may include:

    • Blood tests
    • CT scan
      ,
      ultrasound
      , or liver/spleen scan—to identify changes in the liver

    • Liver
      biopsy
    • Laparoscopy
      —looking at the liver via a thin tube with a lighted camera

    Other tests may include:

    • Inserting a catheter into the liver vein and measuring the pressure within that vein; rarely necessary
    • Removing fluid from the abdomen and examining it
    • Other tests to determine what caused the cirrhosis and what complications may occur

  • Prevention

    To help reduce your chance of developing cirrhosis, take these steps:

    • Drink alcohol in moderation. Moderate alcohol intake is no more than two drinks per day for men and one drink per day for women.
    • Get hepatitis vaccines.

    • Practice
      safe sex
      to lower your chance of getting hepatitis B.
    • If you use IV drugs, do not share needles, which can spread hepatitis B, C, or D.
    • Maintain a healthy weight.
    • Follow your doctor's recommendations about blood tests when taking medications that may damage the liver.

  • Risk Factors

    Factors that may increase your chance of having cirrhosis include:

    • Alcohol abuse
    • Hepatitis infection
    • Liver cancer
    • Use of drugs toxic to the liver

    • Being
      overweight
      or gaining weight
    • Diabetes that is poorly controlled

    • Ingestion of
      too much iron

  • Symptoms

    Cirrhosis often does not cause symptoms early in the disease process. Symptoms start when the liver begins to fail, as scar tissue replaces healthy cells. Symptom severity depends on the extent of liver damage.

    Cirrhosis may cause:

    • Fatigue
    • Weakness
    • Poor appetite, nausea, or weight loss
    • Itching
    • Abdominal swelling, tenderness, and pain
    • Appearance of thin, purplish-red, spidery looking blood vessels on the skin
    • Menstrual problems
    • Impotence
    • Enlarged breasts in men

    As cirrhosis progresses, it may cause:

    • Jaundice
      —yellowing of the skin and whites of the eyes
    • Dark urine
    • Water retention and swelling in the legs and abdomen
    • Enlarged liver or spleen
    • Loss of body hair
    • Bleeding and bruising
    • Vomiting blood
    • Neurological problems, such as forgetfulness, confusion, agitation, or tremors
    • Inability to process medications

    Complications of cirrhosis may include:

    • Ascites
      —accumulation of fluid in the abdominal cavity
    • Arrhythmias
      —abnormal heart rhythms
    • Sleep disturbances

    • Digestive disorders, such as abdominal infections,
      ulcers
      , or
      gallstones
    • Liver cancer
    • Insulin resistance
    • Hypoglycemia
    • Coma

  • Treatment

    There is no cure for cirrhosis. The goals of treatment are to keep the condition from getting worse, including:

    • Control the cause
    • Treat underlying medical conditions
    • Prevent additional damage
    • Treat symptoms and complications
    • Liver cancer screenings

    Talk with your doctor about the best treatment plan for you. Options include: