Cirrhosis

The liver filters out poisons, germs, bacteria, and wastes from the blood. It also produces proteins (for nutrition and clotting, for instance), vitamins, minerals, sugar, and immune agents back into the blood. The liver can, to some extent, repair its own diseased or damaged cells with new cells. Liver transplants are possible because of this ability.

In some cases of ongoing injury, scar tissue replaces some of the normal cells during the restoration process. The scar tissue may form nodules (lumps). These nodules cause the liver to become hard (cirrhotic). The scar tissue blocks the flow of blood through the veins and arteries.

Most people with cirrhosis have few symptoms in the early stages. But as the liver develops more nodules and more liver cells are replaced with scar tissue, 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
• a peculiar breath odor
• 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 suffer a variety of impairments, in mental functioning. As toxins build up in the brain, these defects progress 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

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
• viral hepatitis B, which may be accompanied by hepatitis D
• viral hepatitis C, with or without alcoholic liver disease
• fatty liver disease, associated with obesity, diabetes, or abnormal lipids (cholesterol)

Other causes of cirrhosis include:

• autoimmune hepatitis
• drug-induced liver disease from methotrexate, alpha methyl dopa, amiodarone, and other medicines
• hemochromatosis, a common genetic 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 genetic disorder that allows copper to accumulate in the liver and other organs
• years of severe right-sided heart failure

The most important ways to prevent cirrhosis are to avoid excessive drinking of alcohol and to avoid multiple sexual partnerships, unprofessional tattoos or piercings, and intravenous or nasal drugs.

Progression of cirrhosis caused by drinking can be avoided if the person stops drinking. Good diet and exercise are also helpful. Following safer sex guidelines can help protect against sexually transmitted hepatitis.

Vaccines against hepatitis A and B are available and are now recommended for all people.

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 usually involves using a needle to removal of thin piece of liver tissue that is examined under a microscope.

Once cirrhosis sets in, it cannot be significantly reversed. Treatment may be able to stop or delay further damage. The severe long-term effects of cirrhosis are a result of high blood pressure in the veins leading to the liver and loss of adequate, healthy liver tissue.

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 viral hepatitis may regain a normal life after treatment with medications to eradicate the virus, or 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.

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

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.

Side effects depend on the treatments used. All medicines have possible side effects. For example, antibiotics may cause allergic reactions or stomach upset. Surgery can be complicated by bleeding, infection, or an allergic reaction to the anesthetic.

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.

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.

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 complete blood counts and liver function tests, may help monitor the disorder as well. Any new or worsening symptoms should be reported to the healthcare provider.