Your Health - Cirrhosis

Cirrhosis

Pronounced: sih-ROH-sis

Definition

Cirrhosis is a disease in which the liver becomes permanently damaged and the structure of the liver is permanently altered. In cirrhosis, normal areas of liver are replaced by scarred areas.

Cirrhosis of the Liver

Causes

Cirrhosis occurs when cells in the liver are damaged and scar tissue forms. This scar tissue causes blood flow to be blocked and waste products to build up in the body.

Causes of cirrhosis include:

Excessive consumption of alcohol
Hepatitis C , B , and D
Autoimmune hepatitis
Inherited diseases:
- Glycogen storage disease
- Galactosemia
- Fructose intolerance
- Tyrosinemia
- Hemochromatosis
- Wilson's disease
- Alpha1-antitrypsin deficiency
- Cystic fibrosis
Nonalcoholic steatohepatitis (NASH), associated with:
- Diabetes
- Obesity
- Heart disease
- High blood triglycerides
- Steroid use
Bile duct blockages, associated with:
- Congenital defects
- Scarred ducts
- Gallbladder surgery
- Pancreatitis
Drugs and toxins:
Infections:
- Schistosomiasis
- Brucellosis
- Echinococcosis
- Advanced or congenital syphilis
Heart failure, causing blood to repeatedly back up into the liver

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:

Alcohol abuse
Hepatitis infection
Use of drugs toxic to the liver
Being overweight
Diabetes that is poorly controlled
Ingestion of too much iron

Symptoms

Cirrhosis often causes no 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.

Early symptoms include:

Fatigue
Poor appetite
Abdominal swelling, tenderness, and pain
Nausea
Weight loss
Weakness
Enlarged breasts in men

Later symptoms, some due to complications, include:

Yellowing of the skin or eyes ( jaundice )
Reddened palms
Loss of body hair
Shrunken testicles
Enlarged liver
Enlarged spleen
Appearance of thin, purplish-red, spidery looking blood vessels on the skin, especially around the navel
Dark urine
Water retention and swelling in the legs and abdomen
Bleeding and bruising
Vomiting blood
Itching
Menstrual problems
Abdominal infections
Impotence
Forgetfulness
Confusion
Agitation
Tremors
Coma
Inability to fully process drugs
Enlarged, twisted, thin-walled blood vessels called varices that bleed easily and sometimes catastrophically (usually located in the esophagus)
Liver cancer
Osteoporosis
Gallstones
Arrhythmias
Sleep disturbances
Ulcers
Breathing problems
Insulin resistance

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:

Blood tests—to assess how well the liver is working and determine a cause
CT scan , ultrasound , or liver/spleen scan—to identify changes in the liver
Liver biopsy —analyzing a sample of liver tissue removed via a thin needle inserted through the abdomen and into the liver
Laparoscopy —looking at the liver via a thin tube with a lighted tip inserted through a small incision near the belly button

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 has caused the cirrhosis and what complications may occur

Treatment

There is no treatment to cure cirrhosis. The goals of treatment are to:

Control the cause
Prevent additional damage
Treat symptoms and complications
Treat underlying medical conditions

Treatments include:

Medication

Doctors prescribe drugs to:

Treat hepatitis and complications that arise
Reduce the absorption of waste products and toxins in the digestive system
Reduce the risk of a blood vessel breaking
Fight infections
Shed excess fluids

Surgery

Liver transplant—may be done if:

Complications can no longer be controlled using medical therapy.
The liver stops functioning.

Endoscopy —This is used to tie off bleeding blood vessels (varices) or inject drugs to cause clotting. A thin tool with a lighted tip is inserted down the throat to help the doctor see and access the varices, which are located in the esophagus.

Self-care

Be careful not to further damage your liver.
Stop drinking alcohol.
Do not take any medications without your doctor's approval, including over-the-counter drugs.
Eat a balanced diet . You may need extra calories and a generous amount of protein to help your liver regenerate.
If your liver disease is more advanced, you may need to limit protein intake, because your weakened liver won't be able to process it properly.
You may need to limit salt in your diet because it increases water retention.
Take any vitamin supplements your doctor recommends.
Put your feet and legs up to decrease swelling.
Due to increased risk of infections, doctors recommend:
- Getting vaccines for flu , pneumonia , and hepatitis
- Avoiding raw seafood

If you are diagnosed with cirrhosis, follow your doctor's instructions .

Prevention

To decrease the risk of cirrhosis:

Drink alcohol in moderation. Moderate alcohol intake is no more than two drinks per day for men and one drink per day for women.
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.
Receive hepatitis vaccines.
Follow your doctor's recommendations about blood tests when taking medications that may damage the liver.

RESOURCES:

American College of Gastroenterology
http://www.acg.gi.org/

American Gastroenterological Association
http://www.gastro.org/

American Liver Foundation
http://www.liverfoundation.org/

CANADIAN RESOURCES:

Canadian Liver Foundation
http://www.liver.ca/

Health Canada
http://www.hc-sc.gc.ca/index_e.html/

References:

Cirrhosis. National Guideline Clearinghouse website. Available at: http://www.guideline.gov/ . Accessed July 9, 2009.

Cirrhosis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis/ . Published December 2008. Accessed July 9, 2009.

Cirrhosis and chronic liver failure: what you should know. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/20060901/781ph.html . Published September 2006. Accessed July 9, 2009.

Cirrhosis of the liver. AGA Patient Center. American Gastroenterological Association website. Available at: http://www.gastro.org/wmspage.cfm?parm1=5673 . Accessed July 9, 2009.

Dambro MR, Griffith JA. Griffith's 5-Minute Clinical Consult. Philadelphia, PA: Lippincott Williams & Wilkins; 1999.

Ferri F, ed. Ferri’s Clinical Advisor 2010. Philadelphia, PA: Mosby Elsevier; 2009.

Feldman M. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. St. Louis, MO: Mosby; 2005.

Last reviewed November 2009 by Rosalyn Carson-DeWitt, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.