Cirrhosis is a disease in which the cells throughout the liver are progressively destroyed. The liver tissue is replaced by areas with normal new cells as well as scar tissue, which alters the structure of the organ. The flow of blood and lymph through the damaged liver is much less efficient, and eventually the liver fails.

Causes

Cirrhosis represents an attempt by the liver to rebuild itself and continue despite injury. The injury may be a sudden and massive infection, as in acute hepatitis, or it may occur in a less dramatic manner over a period of months or years, as in chronic active hepatitis or obstruction of the bile ducts within the liver.

The process of obstruction starts with inflammation and progresses to scarring and then closure of the ducts. A similar condition is caused by obstruction of the external bile ducts by a stone, scar, inborn defect, or tumor. The damage can also be caused, slowly and steadily, by alcohol abuse, which is by far the most common cause of cirrhosis. Other causes include the following:
  • Use of certain medications

  • Inborn errors in physical or chemical processes of the body

  • Syphilis

  • Passive liver congestion, due to inability of the heart to accept a normal flow of blood from the liver or to obstruction of one of the drainage systems of the liver

  • Long-term infection with hepatitis B or C virus
Symptoms

Frequently, because it imitates many other diseases, cirrhosis is not suspected until it is well advanced. Symptoms include general weakness, a vague feeling of being unwell, loss of appetite, loss of weight, and a loss of interest in sex. There may be a dull abdominal ache, nausea, constipation, or diarrhea. In a malnourished patient, the tongue may be inflamed.

Many symptoms of cirrhosis are the result of high blood pressure in the portal vein, which brings blood from the intestinal area to the liver. In cirrhosis, the liver cannot handle a normal flow of blood, so the pressure in the portal vein rises.

One result is that fluid from the blood is lost into the abdominal cavity, a condition called ascites. The fluid may accumulate and press against the diaphragm (the muscular wall separating the abdominal and chest cavities) and interfere with breathing. Collateral blood vessels form to carry away the excess blood into the general circulation. There may be bleeding in the esophagus or stomach when these smaller collateral vessels burst under pressure. The patient may vomit blood. Serious, life-threatening hemorrhage may occur.

The liver may be enlarged and firm or, in advanced cases, shrunken. Other symptoms include an enlarged spleen, mottled redness of the mound at the base of the thumb, "spider veins" on the skin of the upper body, loss of hair from the chest and the pubic area, diminished size of the testes, and tingling sensations in the skin of the hands and feet.

Diagnosis

A liver biopsy is used to diagnose cirrhosis of the liver. A hollow needle is inserted through the skin and into the liver itself to obtain a tissue sample for analysis. Examination of tissue from a diseased liver reveals destruction of cells and scarring. Other diagnostic procedures include nuclear medicine scanning, in which radioactive material is administered and its distribution to the liver is recorded on X-ray film. X-ray pictures are taken of the gallbladder and of bile ducts both inside the liver and leading from it. Important clues that may be found in blood and urine tests include the presence of high levels of bile pigments in the blood, a low red blood cell count (anemia), vitamin and mineral deficiencies, and low levels of protein in the blood.

Treatment

Treatment is aimed first at removing the cause of the original injury. For example, an alcoholic patient is told to stop drinking and is placed on a well-balanced diet. Often, thiamin (vitamin B1) and folate supplements are also given. If a stone is obstructing an external bile duct, it can be removed. Fluids and salt are usually restricted, to prevent fluid buildup. Liver transplantation is sometimes considered.

Good care includes getting plenty of rest and avoiding infection, which places stress on the liver. Avoidance of alcohol intake is paramount in the treatment of cirrhosis and most other liver diseases. A physician should be consulted before any medication, including over-the-counter preparations, is taken.

Prevention

Many of the various causes of cirrhosis of the liver cannot be predicted and guarded against, but the major one can be. Drinking moderately or not at all is the best way to reduce the risk of developing cirrhosis. Also, immunization against hepatitis B can prevent infection and thus the cirrhosis that the infection can cause.



This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.