Cirrhosis

Cirrhosis is a chronic liver disease that causes degeneration of liver cells and decreased function of the liver.

What is going on in the body?

The liver filters out poisons, germs, bacteria, and wastes from the blood. It also releases vitamins, minerals, sugar, and immune agents back into the blood. The liver can replace its own diseased or damaged cells with new cells. Liver transplants are possible because of this ability.

In some cases, however, the restoration process can cause problems. As the liver tries to repair itself, the new cell growth is surrounded by scar tissue. The scar tissue may form nodules, or lumps. These nodules prevent the liver from restoring itself. The scar tissue blocks the flow of blood through the veins and arteries.

What are the causes and risks of the condition?

Cirrhosis can be caused by a number of diseases and conditions. It occurs in twice as many men as women. Most people with cirrhosis are between 40 and 60 years of age. The most common causes of cirrhosis in developed nations include:

alcoholic liver disease

hepatitis B, which may be accompanied by hepatitis D

hepatitis C, with or without alcoholic liver disease

Other causes of cirrhosis include:

autoimmune hepatitis

drug-induced liver disease from methotrexate, alpha methyl dopa, amiodarone, and other medicines

hemochromatosis, a disorder that causes excess accumulation of iron in the body

inborn errors of metabolism, such as galactosemia or alpha-1 antitrypsin deficiency

thalassemia, a group of hereditary blood disorders

tricuspid regurgitation, a heart valve disorder

various liver diseases

Wilson’s disease, a disorder that allows copper to accumulate in the liver and other organs

years of severe right-sided heart failure

What are the signs and symptoms of the condition?

Most people with cirrhosis have few symptoms in the early stages. But as the liver develops more nodules, liver function slows down. Symptoms start becoming more noticeable at this point. As liver function starts to fail, people may experience:

abdominal pain

ascites, or abdominal swelling

depression

fatigue

intermittent mild fever

loss of appetite

loss of sex drive

nausea

unexplained nosebleeds

weakness

weight loss

As cirrhosis progresses through the liver, symptoms become worse. The following problems can occur as a result:

bacterial infections

bruising and/or abnormal bleeding

continuous mild fever

hemorrhoids

itching

jaundice, or a yellowing of the skin and eyes

low blood pressure

muscle wasting

portal hypertension, or increased blood pressure in the liver

sensitivity to medicines, which build up in the body when the liver can’t break them down

spider nevi, which are small, red marks that may appear on the skin anywhere above the waist

swelling in the legs

varicose veins, or enlarged, weakened veins, on the stomach and esophagus

As cirrhosis worsens, the person may have a variety of cognitive impairments, or defects in mental functioning. As toxins build up in the brain, cognitive impairment progresses from mild loss of concentration to increasing confusion. The individual may also experience the following impairments:

drowsiness

irritability

lack of interest in people and events

personality changes

How is the condition diagnosed?

Diagnosis of cirrhosis begins with a medical history and physical exam. The healthcare provider may order tests, including:

abdominal CT scan

abdominal MRI

blood tests, such as liver function tests and a complete blood count, or CBC

radioisotope liver studies

ultrasound scanning

The only way to definitively diagnosis the presence of cirrhosis is with a liver biopsy. This involves the removal of a small piece of liver tissue that is examined under a microscope.

What can be done to prevent the condition?

The most important way to prevent cirrhosis is to avoid excessive alcoholic drinking. Progression of cirrhosis caused by drinking can be avoided if the person stops drinking.

Maintaining good personal hygiene can prevent hepatitis. This includes washing hands after going to the bathroom. Following safer sex guidelines can help protect against sexually transmitted hepatitis. Vaccines against hepatitis A and B are available.

What are the long-term effects of the condition?

Once cirrhosis sets in, it cannot be reversed. Treatment may be able to stop or delay further damage. The severe long-term effects of cirrhosis are a result of the portal hypertension. These include:

cognitive impairments that may progress to a coma

gastrointestinal bleeding, such as bleeding esophageal varices

in rare cases, liver cancer

kidney failure, or chronic renal failure

peptic ulcers

If cirrhosis is diagnosed early in a person abusing alcohol, the chance for recovery is excellent. However, the person must stop drinking alcohol permanently and follow medical advice. Problems are significant if cirrhosis progresses before it is discovered and treated.

A person who suffers from cirrhosis due to complications from hepatitis may regain a normal life after a successful liver transplant. People who are suffering from chronic alcoholism may not be good candidates for a liver transplant because of the damage done to the rest of their body.

What are the risks to others?

Cirrhosis itself is not contagious. However, it may be caused by an infectious disease, such as hepatitis, which is contagious.

What are the treatments for the condition?

Specific treatments for cirrhosis depend upon what caused the liver disease and any known complications. The first step in treating alcoholic cirrhosis is to provide the encouragement and support systems needed for the person to avoid drinking. Next, the individual can be offered suggestions for improved diet for liver disease. Medicines, blood transfusions, and other treatments may be used to treat the disorder causing the cirrhosis.

Finally, liver transplantation has become a widely accepted form of treatment. There are very specific indications for liver transplantation. The major problem with liver transplants is the limited supply of donor organs.

What are the side effects of the treatments?

Side effects depend on the treatments used. All medicines have possible side effects. For example, antibiotics may cause allergic reactions or stomach upset. Surgery carries a risk of bleeding, infection, and allergic reaction to anesthesia.

The medicines that must be taken to prevent rejection after a liver transplant have many side effects. These include allergic reactions, stomach upset, and kidney damage. Because these medicines suppress the immune system, there is also an increased risk of infection.

What happens after treatment for the condition?

Cirrhosis is usually progressive. A person who has cirrhosis due to alcohol may stop the progression of the cirrhosis when drinking stops. However, the scar tissue will remain.

How is the condition monitored?

A person with cirrhosis should have frequent physical exams by the healthcare provider. This helps the provider to monitor the activity of the disorder and determine possible complications. Frequent blood tests, including a CBC and liver function tests, may help monitor the disorder as well. Any new or worsening symptoms should be reported to the healthcare provider.