Cirrhosis of the Liver
The liver is the largest solid organ in the body. It performs many important functions, including:
- Making blood proteins that aid in clotting, transporting oxygen, and helping the immune system
- Storing excess nutrients and returning some of the nutrients to the bloodstream
- Manufacturing bile, a substance needed to help digest food
- Helping the body store sugar (glucose) in the form of glycogen
- Ridding the body of harmful substances in the bloodstream, including drugs and alcohol
- Breaking down saturated fat and producing cholesterol
Cirrhosis is a slowly developing disease in which healthy liver tissue is replaced with scar tissue. The scar tissue blocks the flow of blood through the liver and slows the liver’s ability to process nutrients, hormones, drugs, and natural toxins. It also reduces the production of proteins and other substances made by the liver. Cirrhosis eventually keeps the liver from working properly.
What causes cirrhosis?
The most common causes of cirrhosis are chronic (long-term) viral infections of the liver (hepatitis types B and C), fatty liver associated with obesity and diabetes, and alcohol abuse. In addition, anything that damages the liver can cause cirrhosis, including the following inherited diseases:
- Cystic fibrosis
- Glycogen storage diseases, in which the body is unable to process glycogen (a form of sugar that is converted to glucose and serves as a source of energy for the body)
- Alpha-1 antitrypsin deficiency (an absence of a specific enzyme in the liver)
- Diseases caused by abnormal liver function, such as hemochromatosis (a condition in which excessive iron is absorbed and deposited into the liver and other organs), and Wilson's disease (the abnormal storage of copper in the liver)
- Blockage of the bile duct. The bile duct carries bile formed in the liver to the intestines, where it helps in the digestion of fats.
- Repeated bouts of heart failure, with fluid backing up into the liver and causing congestion (clogging)
Although less likely, other causes of cirrhosis include reactions to prescription drugs, lengthy exposure to environmental toxins, or infections by parasites.
Do people who drink a lot of alcohol always get cirrhosis?
Most people who drink large amounts of alcohol harm their livers in some way, but not all of these people get cirrhosis. In general, about 30% of people who drink 8 to 16 ounces of hard liquor or other alcoholic beverages every day for 15 years or more will get cirrhosis. Women who are heavy drinkers are at higher risk than men. People who have hepatitis B or C are more likely to suffer liver damage from alcohol.
What are the symptoms of cirrhosis?
The symptoms of cirrhosis depend on the stage of the illness. In the beginning stages, there may not be any symptoms. As the disease worsens, symptoms may include:
- Loss of appetite
- Lack of energy (fatigue)
- Weight loss or sudden weight gain
- Yellowing of skin or the whites of eyes (jaundice)
- Itchy skin
- Fluid retention (edema) and swelling in the ankles, legs, and abdomen
- A brownish or orange color to the urine
- Light-colored stools
- Confusion, disorientation, personality changes
- Blood in the stool
An early sign of cirrhosis is retaining fluid and salt. This may start as a swollen ankle or leg, but can proceed to significant fluid retention in the abdomen (ascites). By reducing salt in the diet, and using the right combination of diuretics (water pills), fluid retention can be lessened for some time. In more severe cases, a doctor may need to drain fluid from the abdomen.
Fluid in the abdomen can become infected (a condition called peritonitis), which requires quick diagnosis and treatment with antibiotics. Some people with severe fluid retention that does not respond to therapy may need a liver transplant.
What complications are associated with cirrhosis?
- Variceal bleeding. Varices are enlarged veins, usually in the esophagus and stomach. Variceal bleeding is caused by portal hypertension, which is an increase in the pressure in the portal vein (the large vessel that carries blood from the digestive organs to the liver). This increase in pressure is caused by a blockage of blood flow through the liver as a result of cirrhosis. These varices become fragile and can bleed easily, causing severe hemorrhaging (bleeding) and ascites.
- Confused thinking and other mental changes (hepatic encephalopathy). Hepatic encephalopathy most often occurs when the patient has had cirrhosis for a long time. Toxins produced in our intestines are normally removed by the liver, but once cirrhosis occurs, the liver cannot detoxify as well. Toxins get into the bloodstream and can cause confusion, changes in behavior, and even coma. A doctor who is a liver specialist can help control this problem by prescribing a combination of medications and changes in the diet.
- Other serious complications of cirrhosis. Many other problems can occur as a result of cirrhosis, including:
- Kidney failure
- Reduced oxygen in the blood
- Changes in blood counts
- Increased risk of infections
- Excessive bleeding and bruising
- Breast enlargement in men
- Premature menopause
- Loss of muscle mass
Most of these complications can be treated with medicines. Once treatment for these complications becomes ineffective, a liver transplant is considered. Almost all of the complications can be cured by transplantation. However, in many cases, careful management can reduce the harmful effects of cirrhosis and can delay or even prevent the need for a liver transplant.
How is cirrhosis diagnosed?
- Physical exam. During a physical exam, your doctor can observe how your liver feels or how large it is (a cirrhotic liver is bumpy and irregular instead of smooth).
- Blood tests. If your doctor suspects cirrhosis, you will be given blood tests to check for liver disease.
- Other tests. In some cases, other tests that take pictures of the liver are performed, such as a computerized tomography (CT) scan or an ultrasound.
- Biopsy. Your doctor may decide to confirm the diagnosis by taking a sample of tissue (biopsy) from the liver.
- Surgery. In some cases, cirrhosis is diagnosed during surgery when the doctor is able to see the entire liver. The liver also can be inspected through a laparoscope, a viewing device that is inserted through a tiny incision (cut) in the abdomen.
How is cirrhosis treated?
Although there is no cure for cirrhosis, there are treatments that can delay its progress, and in so doing, decrease the damage to liver cells and reduce complications:
- For cirrhosis caused by alcohol abuse, the person must stop drinking alcohol.
- For other patients with cirrhosis caused by autoimmune diseases, Wilson’s disease, or hemochromatosis, the doctor will recommend the proper treatments for cirrhosis as well as for the underlying disease.
- Medications may be given to control the symptoms of cirrhosis.
- Edema (fluid retention) and ascites (fluid in the abdomen) are treated by reducing salt in the diet. Diuretics (water pills) are used to remove excess fluid and to prevent edema from coming back.
- Diet and drug therapies can help improve the confused mental state that cirrhosis can cause. For instance, decreasing the amount of salt in the diet results in less fluid retention in the abdomen and legs. Laxatives such as lactulose may be given to help absorb toxins.
- Some people with severe cirrhosis may need a liver transplant.
How can I prevent cirrhosis?
- Don't abuse alcohol. If you do drink alcohol, limit how much you drink and how often. If you drink more than 2 drinks a day, you are increasing your risk. A drink is a glass of wine or a 12-ounce can of beer or a 1 1/2 ounce serving of hard liquor.
- Avoid high-risk sexual behavior such as unprotected sexual contact with multiple partners.
- Be careful around synthetic chemicals, such as cleaning products and pesticides. If you come into contact with chemicals often, wear protective clothing and a facemask.
- Get vaccinated against hepatitis B.
- Poor nutrition, usually associated with alcohol or drug abuse, may play a role in causing cirrhosis. Eat a well-balanced, low-fat diet and take vitamins.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 8/18/2014...#155572