Cirrhosis

  • 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:
  • Risk Factors

    Factors that may increase your chance of having cirrhosis include:
    • Alcohol abuse
    • Hepatitis infection
    • Liver cancer
    • Use of drugs 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:
    • Jaundice —yellowing of the skin and whites of the eyes
    • Dark urine
    • Water retention and swelling in the legs and abdomen
    • Enlarged liver or spleen
    • Loss of body hair
    • Bleeding and bruising
    • Vomiting blood
    • Neurological problems, such as forgetfulness, confusion, agitation, or tremors
    • Inability to process medications
    Complications of cirrhosis may include:
  • Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done.
    Tests may include:
    • Blood tests
    • CT scan , ultrasound , or liver/spleen scan—to identify changes in the liver
    • Liver biopsy
    • Laparoscopy —looking at the liver via a thin tube with a lighted camera
    Other tests may include:
    • Inserting a catheter into the liver vein and measuring the pressure within that vein; rarely necessary
    • Removing fluid from the abdomen and examining it
    • 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:
    • Control the cause
    • Treat underlying medical conditions
    • Prevent additional damage
    • Treat symptoms and complications
    • Liver cancer screenings
    Talk with your doctor about the best treatment plan for you. Options 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 done 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 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 varices, 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, because 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:
      • Getting vaccines for flu , pneumonia , and hepatitis
      • Avoiding raw seafood
      • Avoiding people who are sick with communicable diseases, like the flu or common cold
      • Washing your hands often
    If you are diagnosed with cirrhosis, follow your doctor's instructions .
  • 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, which 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.
  • RESOURCES

    American Gastroenterological Association http://www.gastro.org

    American Liver Foundation http://www.liverfoundation.org

    CANADIAN RESOURCES

    Canadian Liver Foundation http://www.liver.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    American Academy of Family Physicians. Information from your family doctor. Cirrhosis and chronic liver failure: what you should know. Am Fam Physician. 2006;75(5):781.

    Cirrhosis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis . Updated February 21, 2012. Accessed August 28, 2013.

    Cirrhosis of the liver. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us . Updated July 19, 2013. Accessed August 28, 2013.

    Hirschfield GM, Gershwin ME. Primary biliary cirrhosis: one disease with many faces. Isr Med Assoc J. 2011;13(1):55-59.

    Molodecky NA, Kareemi H, Parab R, Barkema HW, Quan H, Myers RP, Kaplan GG. Incidence of primary sclerosing cholangitis: a systematic review and meta-analysis. Hepatology. 2011;53(5):1590-1599.

    Understanding cirrhosis of the liver. American Gastroenterological Association website. Available at: http://www.gastro.org/patient-center/digestive-conditions/cirrhosis-of-the-liver . Accessed August 28, 2013.

    2/12/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Chang Y, Ryu S, Sung E, et al. Weight gain within the normal weight range predicts ultrasonographically detected fatty liver in healthy Korean men. Gut . 2009;58(10):1419-1425.

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