What is 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 (poisons). 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);
- Autoimmune diseases of the liver (chronic conditions in which the body’s own immune system attacks the liver or bile duct cells), including: autoimmune hepatitis; primary biliary cholangitis and primary sclerosing cholangitis; and overlap syndromes;
- Blockage of the bile duct. The bile duct carries bile that is 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.
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 gets worse, 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 (holding onto) fluid and salt. This may start as a swollen ankle or leg, but can move on 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 improve with treatment may need a liver transplant.
How is cirrhosis of the liver 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.
What complications are associated with cirrhosis?
- Variceal bleeding: Varices are enlarged veins, usually in the esophagus (the tube through which food passes to the stomach) and the 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).
- Hepatic encephalopathy (confused thinking and other mental changes): 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
Some of these complications can be treated with medicines. Once treatment for these complications becomes ineffective, a liver transplant is considered. Almost all of these 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.
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