Cirrhosis of the Liver
What is cirrhosis of the liver?
Cirrhosis is a late-stage liver disease in which healthy liver tissue is replaced with scar tissue and the liver is permanently damaged. Scar tissue keeps your liver from working properly.
Many types of liver diseases and conditions injure healthy liver cells, causing cell death and inflammation. This is followed by cell repair and finally tissue scarring as a result of the repair process.
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 (poisons). It also reduces the production of proteins and other substances made by the liver. Cirrhosis eventually keeps the liver from working properly. Late-stage cirrhosis is life-threatening.
How common is cirrhosis?
Scientists estimate that cirrhosis of the liver affects about one in 400 adults in the U.S. It affects about 1 in 200 adults age 45 to 54, the age group most commonly affected by cirrhosis. Cirrhosis causes about 26,000 deaths each year in the U.S. and is the seventh leading cause of death in the U.S. among adults 25 to 64 years of age.
Who gets cirrhosis, who is most at risk?
You are more likely to get cirrhosis of the liver if you:
- Abuse alcohol for many years.
- Have viral hepatitis.
- Have diabetes.
- Are obese.
- Inject drugs using shared needles.
- Have a history of liver disease.
- Have unprotected sex.
Is cirrhosis cancer?
No, cirrhosis of the liver isn’t cancer. However, most people who have liver cancer have cirrhosis. If you have cirrhosis, you have an increased risk of liver cancer. If you have hepatitis B or hepatitis C, you have an increased risk of liver cancer because these diseases often lead to cirrhosis. Any cause of liver disease can lead to cirrhosis, which increases your chance of liver cancer. (Even if you have hepatitis B or fatty liver disease without cirrhosis, you are at increased risk of liver cancer.)
Is cirrhosis a hereditary disease?
Cirrhosis itself is not an inherited (passed from parent to child) disease. However, some of the diseases that can cause liver damage that lead to cirrhosis are inherited diseases.
Can cirrhosis be reversed?
Generally no. If you have been told you have cirrhosis, you have a late-stage liver disease and the damage that is already done is permanent. There are many liver diseases and complications of liver diseases that can lead to cirrhosis. If your liver disease or complication is caught early and successfully managed, it may be possible to slow or stop the progression of disease.
Is cirrhosis fatal?
Having a diagnosis of cirrhosis of the liver doesn’t mean you have an immediately fatal condition. However, as cirrhosis continues, more scarring occurs and liver function continues to decline. Eventually, your failing liver may become a life-threatening condition. Yet there’s still hope. You and your medical team will discuss if you are a candidate for a liver transplant. If so, you will begin the process of being placed on a national liver transplant recipient list.
What are the symptoms of cirrhosis?
The symptoms of cirrhosis depend on the stage of your disease. In the beginning stages, you may not have any symptoms. If you do have symptoms, some are general and could easily be mistaken for symptoms of many other diseases and illnesses.
Early symptoms and signs of cirrhosis include:
As liver function gets worse, other more commonly recognized symptoms of cirrhosis appear including:
- Easy bruising and bleeding.
- Yellow tint to your skin or the whites of your eyes (jaundice).
- Itchy skin.
- Swelling (edema) in your legs, feet and ankles.
- Fluid buildup in your belly/abdomen (ascites).
- Brownish or orange color to your urine.
- Light-colored stools.
- Confusion, difficulty thinking, memory loss, personality changes.
- Blood in your stool.
- Redness in the palms of your hands.
- Spider-like blood vessels that surround small, red spots on your skin (telangiectasias).
- In men: loss of sex drive, enlarged breasts (gynecomastia), shrunken testicles.
- In women: premature menopause (no longer having your menstrual period).
Is cirrhosis painful?
Yes, cirrhosis can be painful, especially as the disease worsens. Pain is reported by up to 82% of people who have cirrhosis and more than half of these individuals say their pain is long-lasting (chronic).
Most people with liver disease report abdominal pain. Pain in your liver itself can feel like a dull throbbing pain or a stabbing sensation in your right upper abdomen just under your ribs. General abdominal pain and discomfort can also be related to swelling from fluid retention and enlargement of your spleen and liver caused by cirrhosis.
Pain can come both from the diseases that lead to cirrhosis and/or cirrhosis can make the pain from existing diseases worse. For instance, if you have non-alcoholic fatty liver disease and are obese, you may also have osteoarthritis and cirrhosis makes your bone and joint pain worse. Cirrhosis also causes an inflammatory state in your entire body. Inflammation and your body’s reaction to inflammation can cause general pain.
What causes cirrhosis?
The most common causes of cirrhosis of the liver are:
- Alcohol abuse (alcohol-related liver disease caused by long-term [chronic] use of alcohol).
- Chronic viral infections of the liver (hepatitis B and hepatitis C).
- Fatty liver associated with obesity and diabetes and not alcohol. This condition is called non-alcoholic steatohepatitis.
Anything that damages the liver can lead to cirrhosis. Other causes include:
- Inherited diseases:
- Alpha-1 antitrypsin deficiency (build-up of an abnormal protein in the liver)
- Hemochromatosis (excess iron stored in the liver).
- Wilson disease (excess copper stored in the liver).
- Cystic fibrosis (sticky, thick mucus builds up in the liver).
- Glycogen storage diseases (liver can’t store or break down glycogen, a form of sugar).
- Alagille syndrome (born with fewer than normal number of bile ducts; affects bile flow and causes jaundice).
- Autoimmune hepatitis (your body’s own immune system attacks healthy liver tissue causing damage).
- Diseases that damage or block bile ducts in the liver (tubes that carry bile from the liver to other parts of digestive system; bile helps digest fats):
- Primary biliary cholangitis (bile ducts become injured, then inflamed, then permanently damaged).
- Primary sclerosing cholangitis (inflammation of the bile ducts leads to scarring and narrowing of the ducts and buildup of bile in the liver).
- Blocked bile duct (can cause infections, backup of products in the liver).
- Biliary atresia (infants are born with poorly formed or blocked bile ducts, causing damage, scarring, loss of liver tissue and cirrhosis).
- Chronic heart failure (causes fluid to back up in your liver, swelling in other areas of your body and other symptoms).
- Rare diseases, such as amyloidosis, in which abnormal deposits in the liver of an abnormal protein called amyloid disrupts normal liver function.
Changes from liver diseases that lead to cirrhosis are gradual. Liver cells are injured and if injury – from whatever cause – continues, liver cells start to die. Over time, scar tissue replaces the damaged liver cells and the liver can’t function properly.
What are the complications of cirrhosis?
There are many complications of cirrhosis of the liver. Because cirrhosis develops over many years, some of these complications may be your first noticeable signs and symptoms of the disease.
Portal hypertension: This is the most common serious complication. Portal hypertension is an increase in the pressure in your portal vein (the large blood vessel that carries blood from the digestive organs to the liver). This increase in pressure is caused by a blockage of blood flow through your liver as a result of cirrhosis. When blood flow through veins is partially blocked, veins in your esophagus, stomach or intestines can become enlarged (a condition called varices). As the pressure in these veins builds, the veins can bleed or even burst, causing severe internal bleeding.
Additional complications of portal hypertension include:
- Swelling (edema) in your legs, ankles or feet.
- Buildup of fluids in your abdomen (called ascites).
- Swelling/enlargement of your spleen (splenomegaly).
- Formation and dilation (expansion) of blood vessels in the lungs (hepatopulmonary syndrome), leading to low levels of oxygen in the blood and body and shortness of breath.
- Failure of kidney function as a result of having portal hypertension as a complication of cirrhosis (hepatorenal syndrome). This is a type of kidney failure.
- Confusion, difficulty thinking, changes in your behavior, even coma. This occur when toxins from your intestines aren’t removed by your damaged liver and circulate in the bloodstream and buildup in your brain (a condition called hepatic encephalopathy).
Hypersplenism: Hypersplenism is an overactive spleen. This condition causes quick and premature destruction of blood cells.
Infections: Cirrhosis increases your risk of getting and fighting serious infections, such as bacterial peritonitis (infection of the tissue that lines the inner wall of your abdomen).
Malnutrition: Your liver processes nutrients. A damaged liver makes this more difficult and leads to weight loss and general weakness.
Liver cancer: Most people who develop liver cancer have cirrhosis of the liver.
Liver failure: Many diseases and conditions cause liver failure including cirrhosis of the liver. As its name implies, liver failure occurs when your liver isn’t working well enough to perform its many functions.