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

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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
  • Genetic conditions such as:     
  • 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
  • Risk Factors

    Factors that may increase your chance of having cirrhosis include:

        
  • Alcohol abuse
  • Hepatitis infection
  • Liver cancer
  • Use of drugs that are 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:

        
  • Yellowing of the skin and whites of the eyes
  • Dark urine
  • Swelling in the legs and abdomen
  • Loss of body hair
  • Bleeding and bruising
  • Vomiting blood
  • Neurological problems, such as forgetfulness, confusion, agitation, or tremors
  • Complications of cirrhosis may include:

        
  • Ascites —build up 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
  • Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done.

    Your bodily fluids may be tested. This can be done with:

        
  • Blood tests
  • Liver biopsy
  • Images may be taken of your bodily structures. This can be done with:

        
  • CT scan
  • Ultrasound
  • Laparoscopy
  • Other tests may include:

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

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

        
  • Controlling the cause
  • Treating underlying medical conditions
  • Preventing additional damage
  • Treating symptoms and complications
  • Having liver cancer screenings
  • Talk with your doctor about the best treatment plan for you. Options include:

    Medication

    Medication may be advised to:

        
  • Treat hepatitis and complications that arise
  • Reduce the absorption of waste products and toxins in the digestive system
  • Reduce the risk of a broken blood vessel
  • 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 may be used to tie off bleeding blood vessels or to 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 blood vessels, which are located in the esophagus.

    Self-care

        
  • Stop drinking alcohol completely.
  • Do not take any medications without your doctor's approval, including over-the-counter drugs.
  • Eat a balanced diet . Choose a variety of fruits and vegetables, as well as lean proteins, like beans and poultry.
  • If your liver disease is more advanced, you may need to limit protein intake. Your weakened liver will not 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, take these steps:     
  • Get vaccines for flu , pneumonia , and hepatitis .
  • Avoid raw seafood.
  • Avoid people who are sick with communicable diseases, like the flu or common cold.
  • Wash your hands often.
  • 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. Needles 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.