Cirrhosis


The liver weighs about 3 pounds and is one of the largest organs in the body. It is located in the upper right side of the abdomen, below the ribs. When the liver is injured, it heals by forming scar tissue.

In cirrhosis, the scar tissue that forms harms the structure of the liver and impairs the flow of blood through the organ. The loss of normal liver tissue slows the processing of nutrients, hormones, drugs, and toxins. Also slowed is production of proteins and other substances.

What Is The Impact Of Cirrhosis?

Cirrhosis is the seventh leading cause of death by disease. About 25,000 people die from cirrhosis each year. There also is a great toll in terms of human suffering, hospital costs, and the loss of work.

What Are The Major Causes Of Cirrhosis?

Cirrhosis has many causes. In the United States, alcohol is the most common cause. Cirrhosis may result from chronic viral hepatitis (types B, C, and D). Liver injury that results in cirrhosis may be caused by a number of inherited diseases such as cystic fibrosis, alpha-1 antitrypsin deficiency, hemochromatosis, Wilson's disease, galactosemia, and glycogen storage disease.

Two inherited disorders that result in the abnormal storage of metals in the liver leading to tissue damage and cirrhosis are Wilson's disease and hemochromatosis. People with Wilson's disease store too much copper in the liver, brain, kidney, and in the corneas of their eyes.

People with hemochromatosis, have too much iron absorbed, and the excess iron is deposited in the liver and in other organs, such as the pancreas, skin, intestinal lining, heart, and endocrine glands.

If a person's bile duct becomes blocked, this also may cause cirrhosis. The bile ducts carry bile from the liver to the intestines, where bile helps the digestion of fat. In babies, cirrhosis due to the blocked ducts is a disease called biliary atresia. In this case, the bile ducts are absent or injured, causing the bile to back up in the liver. These babies are jaundiced (their skin is yellowed) after their first month of life. Sometimes they can be helped by surgery in which a new duct is created to allow bile to drain from the liver.

In adults, the bile ducts may become inflamed, blocked, and scarred due to another liver disease, primary biliary cirrhosis. Another type of biliary cirrhosis also may occur after a patient has gallbladder surgery in which the bile ducts are injured or tied off.

Other, less common, causes of cirrhosis are reactions to prescribed drugs, prolonged exposure to environmental toxins, and repeated bouts of heart failure with liver congestion.

What Are The Symptoms Of Cirrhosis?

People with cirrhosis often have few symptoms during the early stage of the disease. The two major problems that eventually cause symptoms are loss of functioning liver cells and distortion of the liver caused by scarring. The person may experience fatigue, weakness and exhaustion. Loss of appetite is usual, often with nausea and weight loss.

As liver function declines, less protein is made by the organ. For example, less albumin is made, which results in water accumulating in the legs (edema) or abdomen (ascites). A decrease in proteins needed for blood clotting makes it easy for the person to bruise or to bleed from a wound.

In the later stages or cirrhosis, jaundice (yellow skin) may occur. This is caused by the buildup of bile pigment that is normally passed by the liver into the intestines. Some people with cirrhosis experience intense itching due to bile products that are deposited in the skin. Gallstones often form in persons with cirrhosis because not enough bile reaches the gallbladder.

The liver of a person with cirrhosis also has trouble removing toxins which may build up in the blood. These toxins can dull mental function and lead to personality changes and even coma (encephalopathy). Early signs of toxin accumulation in the brain may include neglect of personal appearance, unresponsiveness, forgetfulness, trouble concentrating, or changes in sleeping habits.

Drugs are filtered from the blood by the liver, and this cleansing process also is slowed down by cirrhosis. The liver does not remove the drugs from the blood at the usual rate, so the drugs act longer than expected, building up in the body. People with cirrhosis often are very sensitive to medications and their side effects.

A serious problem for people with cirrhosis is pressure on blood vessels that flow through the liver. Normally, blood from the intestines and spleen flows to the liver through the portal vein. In cirrhosis this normal flow of blood is restricted, building pressure in the portal vein (portal hypertension). This blocks the flow of blood, causing the spleen to enlarge. Blood from the intestines tries to find a way around the liver through new vessels.

Some of these new blood vessels become quite large and are called "varices". These vessels may form in the stomach and esophagus (the tube that connects the mouth with the stomach). They have thin walls and carry high pressure. There is great danger that they may break, causing a serious bleeding problem in the upper stomach or esophagus. If this happens, the patient's life is in danger, and the doctor must act quickly to stop the bleeding.

How Is Cirrhosis Diagnosed?

The doctor can often diagnose cirrhosis from the patient's symptoms and from laboratory tests. During a physical exam, for instance, the doctor could notice a change in the consistency of the how the liver feels or it's size. If the doctor suspects cirrhosis, you will be given blood tests. The purpose of these tests is to find out what kind of liver disease is present. In some cases tests that take pictures of the liver are performed such as the computerized axial tomography (CAT) scan, ultrasound, or the liver/spleen scan.

The doctor may decide to confirm the diagnosis by putting a needle through the skin to take a sample of tissue from the liver. In some cases, cirrhosis is diagnosed during surgery when the doctor examines the entire liver. The liver also can be inspected through a laparoscope, a viewing device that is inserted through a tiny incision in the abdomen.

What Are The Treatments For Cirrhosis?

Treatment for cirrhosis is aimed at stopping or delaying its progress, minimizing the damage to liver cells, and reducing complications. In alcoholic cirrhosis, for instance, the person must stop drinking alcohol to halt progression of the disease. If a person has viral hepatitis, the doctor may administer Inteferon or other antiviral drugs to reduce liver cell injury.

Medications may be given to control the symptoms of cirrhosis, such as itching. Edema and ascites (fluid retention) are treated by reducing salt in the diet. Drugs called "diuretics" are used to remove excess fluid and to prevent edema from recurring. Diet and drug therapies can help to improve the altered mental function that cirrhosis can cause. For instance, reducing dietary protein results in less toxin formation in the digestive tract. Laxatives such as lactulose may be given to speed their removal from the intestines.

The major problems in cirrhosis are liver failure, when liver cells just stop working, and the bleeding caused by portal hypertension. The doctor may prescribe blood pressure medication, such as a beta blocker, to treat the portal hypertension. If the patient bleeds from the varices of the stomach or esophagus, the doctor can inject these veins with a sclerosing agent or put bands around the varices. In critical cases, the patient may be given a liver transplant or another surgery (such as a shunt) that is used to relieve the pressure in the portal vein and varices.

A newer procedure called TIPS may be available in the treatment of portal hypertension. In this procedure a radiologist may place a shunt (small tube) across the liver to decrease the portal hypertension.

Patients with cirrhosis often live healthy lives for many years. Even when complications develop, they can be treated. Many patients with cirrhosis have undergone successful liver transplantation.

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