Liver Cirrhosis

Overview

Cirrhosis is the severe scarring of the liver and poor liver function seen at the terminal stages of chronic liver disease. The scarring is most often caused by long-term exposure to toxins such as alcohol or viral infections. The liver is located in the upper right side of the abdomen below the ribs. It has many essential body functions. These include:

producing bile, which helps your body absorb dietary fats, cholesterol, and vitamins A, D, E, and K
storing sugar and vitamins for later use by the body
purifying blood by removing toxins such as alcohol and bacteria from your system
creating blood clotting proteins

Common causes of cirrhosis

The most common causes of cirrhosis in the United States are long-term viral hepatitis C infection and chronic alcohol abuse. Obesity is also a cause of cirrhosis, although it is not as prevalent as alcoholism or hepatitis C. Obesity can be a risk factor by itself, or in combination with alcoholism and hepatitis C.

According to the NIH, cirrhosis can develop in women who drink more than two alcoholic drinks per day (including beer and wine) for many years. For men, drinking more than three drinks a day for years can put them at risk for cirrhosis. However, the amount is different for every person, and this doesn’t mean that everyone who has ever drunk more than a few drinks will develop cirrhosis. Cirrhosis caused by alcohol is usually the result of regularly drinking more than these amounts over the course of 10 or 12 years.

Hepatitis C can be contracted through sexual intercourse or exposure to infected blood or blood products. It’s possible to be exposed to infected blood through contaminated needles of any source, including tattooing, piercing, intravenous drug abuse, and needle sharing. Hepatitis C is rarely transmitted by blood transfusion in the United States due to rigorous standards of blood bank screening.

Other causes of cirrhosis include:

Hepatitis B: Hepatitis B can cause liver inflammation and damage that can lead to cirrhosis.
Hepatitis D: This type of hepatitis can also cause cirrhosis. It’s often seen in people who already have hepatitis B.
Inflammation caused by autoimmune disease: Autoimmune hepatitis may have a genetic cause. According to the American Liver Foundation, about 70 percent of people with autoimmune hepatitis are women.

Damage to the bile ducts, which function to drain bile: One example of such a condition is primary biliary cirrhosis.
Disorders that affect the body’s ability to handle iron and copper: Two examples are hemochromatosis and Wilson’s disease.
Medications: 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 disorder has progressed. Some of the symptoms include:

  • decreased appetite
  • nose bleeds
  • jaundice (yellow discoloration)
  • small spider-shaped arteries underneath the skin
  • weight loss
  • anorexia
  • itchy skin
  • weakness

More serious symptoms include:

  • confusion and difficulty thinking clearly
  • abdominal swelling (ascites)
  • swelling of the legs (edema)
  • impotence
  • gynecomastia (when males start to develop breast tissue)

How cirrhosis is diagnosed

A diagnosis of cirrhosis begins with a detailed history and physical exam. Your doctor will take a complete medical history. 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 such as:

  • 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:

complete blood count (to reveal anemia)
coagulation blood tests (to see how quickly blood clots)
albumin (to test for a protein produced in the liver)
liver function tests
alpha fetoprotein (a liver cancer screening)

Additional tests that can evaluate the liver include:

upper endoscopy (to see if esophageal varices are present)
ultrasound scan of the liver
MRI of the abdomen
CT scan of the abdomen
liver biopsy (the definitive test for cirrhosis)

 

Treatment for cirrhosis

Treatment for cirrhosis varies based on what caused it and how far the disorder has progressed. Some treatments your doctor might prescribe include:

  • beta blockers or nitrates (for portal hypertension)
  • quitting drinking (if the cirrhosis is caused by alcohol)
  • banding procedures (used to control bleeding from esophageal varices)
  • intravenous antibiotics (to treat peritonitis that can occur with ascites)
  • hemodialysis (to purify the blood of those in kidney failure)
  • lactulose and a low protein diet (to treat encephalopathy)
  • Liver transplantation is an option of last resort, when other treatments fail.

All patients must stop drinking alcohol. Medications, even over-the-counter ones, should not be taken without consulting your doctor.

Preventing cirrhosis

Practicing safe sex with condoms can reduce the risk of getting hepatitis B or C. The U.S. Centers for Disease Control and Prevention recommend that all infants and at-risk adults (such as healthcare providers and rescue personnel) be vaccinated against hepatitis B.

Becoming a nondrinker, eating a balanced diet, and getting adequate exercise can prevent or slow cirrhosis. The World Health Organization reports that only 20 to 30 percent of people infected with hepatitis B will develop cirrhosis or liver cancer. The National Institute of Health reports that 5 to 20 percent of people infected with hepatitis C will develop cirrhosis over a period of 20 to 30 years.

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