Cirrhosis is severe scarring of the liver and poor liver function seen at the end of chronic liver disease. The scarring is most often caused by long-term exposure to toxins such as alcohol or viral infections. The liver, located in the upper right side of the abdomen below the ribs, has many essential body functions, such as:
- production of bile, which helps to absorb dietary fats, cholesterol, and fat soluble vitamins A, D, E, and K
- stores sugar and vitamins for later use by the body
- purifying blood (removes toxins such as alcohol and bacteria)
- creation of blood clotting proteins
Incidence of Cirrhosis
According to the National Institutes of Health (NIH) cirrhosis is the 12th leading cause of death due to disease in America. It is more likely to affect men than women.
How Cirrhosis Develops
The liver is a very hearty organ and is normally able to regenerate damaged cells. Cirrhosis develops when the factors that damage the liver (such as alcohol and chronic infections) are present over a long period of time. When this happens, the liver becomes injured and scarred. A scarred liver cannot function properly and cirrhosis results.
Cirrhosis produces changes to the liver, causing it to shrink and harden. This makes it difficult for nutrient rich blood to flow into the liver from the portal vein, a vein that carries blood from the digestive organs to the liver. When blood cannot pass into the liver, the pressure in the portal vein rises. The end result is a serious condition called portal hypertension, in which the vein develops high blood pressure.
Common Causes of Cirrhosis
The most common causes of cirrhosis in the United States are long-term hepatitis C infection, and chronic alcohol abuse. Obesity is also a cause of cirrhosis. Obesity can be a risk factor by itself, or in combination with alcoholism and hepatitis C.
The National Digestive Diseases Information Clearinghouse (NDDIC) reports that cirrhosis can develop in women who have two to three alcoholic drinks per day (includes beer and wine). For men, the amount of alcohol that puts them at risk for cirrhosis is three to four drinks daily.
Hepatitis C can be contracted through sexual intercourse, or exposure to infected blood (through intravenous drug abuse and needle sharing or transfusions). Hepatitis C is rarely transmitted by transfusion in the U.S. due to blood bank screening.
Other causes of cirrhosis are:
The World Health Organization (WHO) reports that over two billion people are infected with hepatitis B virus world-wide. Hepatitis B can cause liver inflammation and damage that can lead to cirrhosis.
This type of hepatitis can also cause cirrhosis. It is often seen in people who already have hepatitis B.
Inflammation Caused by Autoimmune Disease
Autoimmune hepatitis may have a genetic cause. Seventy percent of people with autoimmune hepatitis are women.
Disorders of the system that drains bile (primary biliary cirrhosis).
Disorders that affect the body’s ability to handle iron and copper (hemochromatosis and Wilson’s disease).
Medications, including prescription and over-the-counter drugs like acetaminophen, some antibiotics, and some antidepressants, can lead to cirrhosis.
Symptoms of Cirrhosis
The symptoms of cirrhosis occur because the liver is unable to purify the blood, break down toxins, produce clotting proteins and help with absorption of fats and fat-soluble vitamins. Often there are no symptoms until the disease has progressed. Some of the symptoms include:
- decreased appetite
- nose bleeds
- small spider-shaped arteries underneath the skin
- weight loss
More serious symptoms include:
- confusion and difficulty thinking clearly
- yellow skin color (jaundice caused by buildup of bilirubin in the blood)
- abdominal swelling (ascites)
- swelling of the legs (edema)
- males can start to develop breast tissue (gynecomastia)
How Cirrhosis Is Diagnosed
A diagnosis of cirrhosis begins with a physical exam. A complete medical history is taken. The history may reveal long-term alcohol abuse, exposure to hepatitis C, family history of autoimmune diseases, or other risk factors. The physical exam can show signs like:
- pale skin
- yellow eyes (jaundice)
- reddened palms
- hand tremors
- an enlarged liver or spleen
- small testicles
- excess breast tissue (in men)
- decreased alertness
Tests can reveal how damaged the liver has become. Some of the tests used for evaluation of cirrhosis are:
- CBC (complete blood count can reveal anemia)
- coagulation blood tests (to see how quickly blood clots)
- albumin (a protein produced in the liver)
- liver function tests
- alpha fetoprotein (a liver cancer screening)
Additional tests that can evaluate the liver are:
- upper endoscopy (to see if esophageal varices are present)
- ultrasound of the abdomen
- MRI (magnetic resonance imaging) of the abdomen
- CT scan (computed tomography of the abdomen)
- liver biopsy (the definitive test for cirrhosis)
Complications from Cirrhosis
If your blood is unable to pass through the liver, it creates a backup through other veins such as those in the esophagus. This is called esophageal varices. These veins are not used to high pressures, and begin to bulge from the extra blood flow.
Cirrhosis is a known risk factor for cancer of the liver.
End stage liver disease can also lead to kidney failure.
Other complications from cirrhosis include:
- bruising (due to low platelet count and/or poor clotting)
- bleeding (due to decreased clotting proteins)
- sensitivity to medications (the liver processes medications in the body)
- kidney failure
- liver cancer
- insulin resistance and type 2 diabetes
- hepatic encephalopathy (confusion due to the effects of blood toxins on the brain)
- gallstones (interference with bile flow can cause bile to harden and form stones)
- esophageal varices
- enlarged spleen (splenomegaly)
- edema and ascites
Treatment for Cirrhosis
Treatment for cirrhosis varies based on its cause.
Patients must stop drinking alcohol.
Medications (even over-the-counter ones) should not be taken without consulting your doctor. Beta-blockers or nitrates may be prescribed for portal hypertension.
Banding procedures are used to control bleeding from esophageal varices.
Intravenous antibiotics are used to treat peritonitis that can occur with ascites.
Hemodialysis can purify the blood of those in kidney failure.
Lactulose and a low protein diet are used to treat encephalopathy.
Liver transplantation is an option when other treatments fail.
Becoming a non-drinker, eating a balanced diet, and getting adequate exercise can prevent or slow cirrhosis.
You should use latex or vinyl gloves to avoid exposure to contaminated blood and body fluids to avoid getting hepatitis. Avoiding sexual promiscuity and using of condoms can reduce the risk of getting hepatitis C. In the U.S. it is recommended that all infants and at-risk adults (such as health care providers and rescue personnel) be vaccinated against hepatitis B.