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
	© 2008 Nucleus Medical Art, Inc.

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:
  • 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

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 (this is 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 performed 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:
  • Vaccines for flu , pneumonia , and hepatitis
  • Avoiding raw seafood

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

References:

American Academy of Family Physicians website. Available at: http://www.aafp.org/ . Accessed October 11, 2005.

American Gastroenterological Association website. Available at: http://www.gastro.org . Accessed October 11, 2005.

Cirrhosis. National Guideline Clearinghouse website. Available at: http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=7054 . Accessed October 11, 2005.

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

National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/ . Accessed October 11, 2005.

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