LIVER CIRRHOSIS
Cirrhosis of the liver is a type of liver damage where healthy cells are replaced by scar tissue. This serious condition can be caused by many forms of liver diseases and conditions, such as hepatitis or chronic alcoholism. Each time the liver is injured, it tries to repair itself. In the process, scar tissue forms. As cirrhosis gets worse, more and more scar tissue forms, making it difficult for the liver to do its job. Advanced cirrhosis is life-threatening.
Depending on the cause, cirrhosis can develop over months or years. The liver damage caused by cirrhosis generally cannot be undone. But if diagnosed early and the underlying cause is treated, further damage can be limited. Treatment aims to halt liver damage, manage the symptoms and reduce the risk of complications.
SYMPTOMS
With early cirrhosis, there are often no symptoms. But, as scar tissue accumulates, it undermines the liver’s ability to function properly. A person may notice:
Fatigue.
Easily bleeding or bruising.
Loss of appetite.
Nausea.
Swelling in the legs, feet or ankles, called edema.
Weight loss.
Itchy skin.
Yellow discoloration in the skin and eyes, called jaundice.
Fluid accumulation in the abdomen.
Spiderlike blood vessels on the skin.
Redness in the palms of the hands.
Pale fingernails, especially the thumb and index finger.
Clubbing of the fingers, in which the fingertips spread out and become rounder than usual.
For women, absence of or loss of periods not related to menopause.
For men, loss of sex drive, testicular shrinkage or breast enlargement, known as gynecomastia.
Confusion, drowsiness or slurred speech.
CAUSES
A wide range of diseases and conditions can damage the liver and lead to cirrhosis. Some of the causes include:
Long-term alcohol abuse.
Ongoing viral hepatitis (hepatitis B, C and D).
Nonalcoholic fatty liver disease, a condition in which fat accumulates in the liver.
Hemochromatosis, a condition that causes iron buildup in the body.
Autoimmune hepatitis, which is a liver disease caused by the body's immune system.
Wilson's disease, a condition in which copper accumulates in the liver.
Cystic fibrosis.
Poorly formed bile ducts, a condition known as biliary atresia.
Inherited disorders of sugar metabolism, such as galactosemia or glycogen storage disease.
Infection, such as syphilis.
Medications, including methotrexate or isoniazid.
COMPLICATIONS
Complications of cirrhosis can include:
High blood pressure in the veins that supply the liver. This condition is known as portal hypertension. Cirrhosis slows the regular flow of blood through the liver. This increases pressure in the vein that brings blood to the liver.
Swelling in the legs and abdomen. The increased pressure in the portal vein can cause fluid to accumulate in the legs, called edema, and in the abdomen, called ascites. Edema and ascites also may happen if the liver can't make enough of certain blood proteins, such as albumin.
Enlargement of the spleen. Portal hypertension can cause the spleen to trap white blood cells and platelets. This makes the spleen swell, a condition known as splenomegaly. Fewer white blood cells and platelets in the blood can be the first sign of cirrhosis.
Infections. If you have cirrhosis, your body may have a hard time fighting infections. Ascites can lead to bacterial peritonitis, a serious infection.
Malnutrition. Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss.
Buildup of toxins in the brain. A liver damaged by cirrhosis can't clear toxins from the blood as well as a healthy liver can. These toxins can then build up in the brain and cause mental confusion and difficulty concentrating. This is known as hepatic encephalopathy. With time, hepatic encephalopathy can progress to unresponsiveness or coma.
Jaundice. Jaundice occurs when the diseased liver doesn't remove enough bilirubin, a blood waste product, from the blood. Jaundice causes yellowing of the skin and whites of the eyes and darkening of urine.
Increased risk of liver cancer. A large proportion of people who develop liver cancer have pre-existing cirrhosis.
Acute-on-chronic cirrhosis. Some people end up experiencing multiorgan failure. Researchers now believe this is a complication in some people who have cirrhosis. However, they don't fully understand what causes it.
PREVENTION
Limit alcohol intake
Adopt a healthy eating diet
Maintain a healthy weight
Reduce the risk of hepatitis
DIAGNOSTIC INVESTIGATIONS
Tests may include:
Blood tests. A panel of liver function tests can show signs of liver disease and liver failure. These measure liver products like liver enzymes, proteins and bilirubin levels in the blood.
Imaging tests. Imaging tests like an abdominal ultrasound, CT scan or MRI can show the size, shape and texture of the liver. A special type of imaging test called elastography uses ultrasound or MRI technology to measure the level of stiffness or fibrosis in the liver.
Liver biopsy. A liver biopsy is a minor procedure to take a small tissue sample from the liver to test in a lab. While not always necessary, a liver biopsy can confirm cirrhosis and may help determine the cause.
TREATMENT
Treatment for cirrhosis of the liver includes:
Treating the cause
Some medications can treat certain types of liver diseases, with varying levels of success. Other medications can reverse the effects of certain inherited diseases but may only treat the symptoms of others.
Diet and lifestyle
Even if the liver disease is from other factors, eliminating alcohol and drugs that damage the liver will help preserve the liver longer.
Treating the complications
Once a healthcare provider has diagnosed cirrhosis, they’ll also check for common side effects. Portal hypertension is the most common side effect and comes with its own set of complications, each requiring specific treatments.
Liver transplantation
Widespread scarring may be irreversible. In these cases, the person may
need a liver transplant, and this procedure is often a last resort.
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