What is Cirrhosis?
Cirrhosis is the severe scarring of the liver and poor liver function seen at the terminal stages of chronic liver disease.
It is a serious degenerative disease that occurs when healthy cells in the liver are damaged and replaced by scar tissue, usually as a result of alcohol abuse or chronic hepatitis. As liver cells give way to tough scar tissue, the organ loses its ability to function properly.
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
According to the National Institutes of Health (NIH), cirrhosis is the 12th leading cause of death due to disease in the United States. It’s more likely to affect men than women.
The liver is a very hardy organ and is normally able to regenerate damaged cells. Cirrhosis develops when the factors that damage the liver (such as alcohol and chronic viral infections) are present over a long period of time. When this happens, the liver becomes injured and scarred. A scarred liver can’t function properly, and ultimately this may result in cirrhosis.
Cirrhosis causes the liver to shrink and harden. This makes it difficult for nutrient-rich blood to flow into the liver from the portal vein. The portal vein carries blood from the digestive organs to the liver. The pressure in the portal vein rises when blood can’t pass into the liver. The end result is a serious condition called portal hypertension, in which the vein develops high blood pressure. The unfortunate consequence of portal hypertension is that this high-pressure system causes a backup, which leads to esophageal varices (like varicose veins), which can then burst and bleed.
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
- itchy skin
More serious symptoms include:
- confusion and difficulty thinking clearly
- abdominal swelling (ascites)
- swelling of the legs (edema)
- gynecomastia (when males start to develop breast tissue)
Diagnosis of Cirrhosis
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)
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.
Complications from Cirrhosis
If your blood is unable to pass through the liver, it creates a backup through other veins such as those in the esophagus. This backup is called esophageal varices. These veins are not built to handle high pressures, and begin to bulge from the extra blood flow.
Other complications from cirrhosis include:
- bruising (due to low platelet count and/or poor clotting)
- bleeding (due to decreased clotting proteins)
- sensitivity to medications (the liver processes medications in the body)
- kidney failure
- liver cancer
- insulin resistance and type 2 diabetes
- hepatic encephalopathy (confusion due to the effects of blood toxins on the brain)
- gallstones (interference with bile flow can cause bile to harden and form stones)
- esophageal varices
- enlarged spleen (splenomegaly)
- edema and ascites
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.
Prevention of 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.