What is cirrhosis of the liver?

Cirrhosis is a condition that results from permanent damage or scarring of the liver. This leads to a blockage of blood flow through the liver and prevents normal metabolic and regulatory processes.

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What are the major causes of cirrhosis?

The major causes of cirrhosis are as follows:

  • chronic alcoholism
  • viral infections caused by chronic viral hepatitis (types B, C and D)
  • metabolic diseases such as alpha-1-antitrypsin deficiency, galactosemia and glycogen storage disorders
  • inherited diseases such as Wilson disease and hemochromatosis
  • biliary cirrhosis resulting from diseases such as primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC)
  • toxic hepatitis caused by severe reactions to prescribed drugs or prolonged exposure to environmental toxins
  • repeated bouts of heart failure with liver congestion

How do babies develop cirrhosis? Can they be treated?

Biliary atresia, a condition caused by absent or injured bile ducts, is the most common cause of cirrhosis in babies. These babies are jaundiced after their first month of life due to a build-up of bile in the liver. New ducts can be surgically formed in some cases restoring normal bile secretion. Transplantation is required in other cases.

What are some early symptoms of cirrhosis?

People in the early stages of cirrhosis have few symptoms. Some symptoms an individual may notice include:

  • loss of appetite
  • nausea
  • weight loss
  • fatigue
  • weakness
  • exhaustion

What happens as liver function decreases?

As liver function decreases, fewer proteins such as albumin are produced resulting in fluid accumulation in the legs (edema) or abdomen (ascites). Individuals with cirrhosis may bleed and bruise easily due to a decrease in proteins required for blood clotting. Some people may even experience intense itching due to products that are deposited in the skin.

What problems are associated with the later stages of cirrhosis?

In the later stages of cirrhosis, jaundice occurs and gallstones are more common because insufficient levels of bile reach the gallbladder. A cirrhotic liver no longer removes toxins effectively leading to toxin accumulation in the blood, which in turn can impair mental function and lead to personality changes and possibly coma. Early signs of toxin accumulation in the brain may include neglect of personal appearance, unresponsiveness, forgetfulness, concentration problems or changes in sleeping habits. Because the normal cleansing process is impaired by cirrhosis, drugs are not properly filtered resulting in an increased sensitivity to drugs and their side-effects.

Normally, blood from the intestines and spleen is pumped to the liver through the portal vein. However, cirrhosis blocks the normal flow of blood through the liver. This can lead to swelling of the liver and potentially the spleen. Blood from the intestines, is then forced to find a new way around the liver through new vessels. Some of these new blood vessels called "varices" which form primarily in the stomach and esophagus become quite large. These varices may rupture due to high blood pressure (portal hypertension) and thin vessel walls, causing bleeding in the upper stomach or esophagus.

How is cirrhosis diagnosed?

Cirrhosis is often diagnosed by medical analysis of the following:

  • identifiable symptoms
  • physical examination
  • CAT scan (computerized axial tomography)
  • ultrasound
  • radioisotope liver/spleen scan
  • liver biopsy

Once it is determined that liver disease is present, immediate treatment is recommended.

What treatments are used to fight liver cirrhosis?

Treatments of cirrhosis are aimed at stopping or delaying the disease progression, minimizing liver cell damage and reducing complications. When cirrhosis is caused by alcohol, the patient must stop drinking to halt progression of the disease. For most other causes of cirrhosis, cessation of alcohol is also generally recommended.  Cirrhosis caused by viral hepatitis may be treated with antiviral drugs to reduce liver cell injury. Medications can also be given to control the symptoms of cirrhosis.  For example, drugs called "diuretics" are used to remove excess fluid and to prevent edema and ascites from recurring. However, a low salt diet is also essential to treat those with ascites.  Drug therapy can improve altered mental function associated with cirrhosis. Laxatives, such as lactulose, may be given to help absorb toxins and speed their removal from the intestines.  A serious consequence of cirrhosis may be bleeding as a result of portal hypertension.  Medications, such as beta blockers, may be prescribed to reduce portal hypertension.   Even when complications develop, they can usually be treated. If the patient bleeds from the varices of the stomach or esophagus, the doctor can place rubber bands around these veins through a flexible tube (endoscope) that is inserted through the mouth and esophagus. Occasionally these veins are injected with a sclerosing (hardening) agent to stop bleeding.  In critical cases, a portacaval shunt (which relieves the pressure in the portal vein and varices) or a liver transplant may be necessary.

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