Cirrhosis is characterized by progressive destruction of liver cells and the formation of fibrous scar tissue. The loss of liver cells interferes with the organ’s ability to process nutrients, hormones, and drugs and slows the production of proteins and other important substances manufactured in the liver. Eventually liver failure may result.
The scar tissue interferes with blood flow from the entire gastrointestinal tract through the liver via the portal vein. Pressure in the portal vein increases (portal hypertension), the spleen becomes enlarged, and blood is shunted around the liver through enlarged, fragile veins (varices) in the stomach and esophagus.
Toxic substances formed in the intestine, and normally cleared in the liver, bypass the liver and are carried to the brain, where they can interfere with its function (hepatic encephalopathy). People with cirrhosis may exhibit no symptoms until the damage—which is irreversible—is quite extensive. Cirrhosis is more common among men than women, and some forms of it are associated with an increased risk of liver cancer.
What Causes Cirrhosis?
- Alcoholism is the primary cause of cirrhosis, owing to a combination of the alcoholic’s poor diet and the direct toxic effects of alcohol. Many alcoholics are also infected with hepatitis C.
- Chronic viral hepatitis (types B, C, and D) or chronic autoimmune hepatitis may lead to cirrhosis.
- Some hereditary diseases, such as cystic fibrosis, hemochromatosis (iron accumulation), and Wilson’s disease (deposition of copper), may injure the liver.
- Bile ducts, through which bile is released to the intestines to aid in digestion, may become blocked, inflamed, or scarred, resulting in a type of cirrhosis called biliary cirrhosis. The common bile duct may also be injured during gallbladder surgery.
- Prolonged exposure to certain medications or to toxic chemicals like insecticides, herbicides, and cleaning solvents may harm the liver.
- Congestive heart failure (CHF) may lead to cirrhosis.
- Nonalcoholic steatohepatitis, which sometimes accompanies obesity, diabetes, or lipid disorders, may result in cirrhosis.
Symptoms of Cirrhosis
- No symptoms in early stages.
- Loss of appetite, weight loss, abdominal pain, fatigue, vomiting, nausea, diarrhea, constipation, chronic dyspepsia, black or bloody stool, vomiting blood
- Pruritus (severe itching)
- Bleeding (e.g., frequent nosebleeds, bleeding gums) and easy bruising
- Fatigue, weakness and exhaustion
- Swelling in the legs and ankles (edema) or abdomen (ascites)
- Dark urine
- Impotence, testicular atrophy, and enlarged breasts (gynecomastia) in men; cessation of menstruation (amenorrhea) in women
- Telangiectasis; small, red, veins (spider nevi); and spider angiomas on the face, arms, neck and trunk; redness and swelling of the palms (palmar erythema); skin discoloration (ecchymosis)
- Distended abdominal blood vessels, umbilical hernia
- Inability to concentrate, impaired memory, and irritability; mental confusion
- Trembling hands, clubbed fingers
Prevention of Cirrhosis
- Consume no more than two drinks a day. If you suspect that you may have a drinking problem, seek help immediately. You will need to avoid alcohol completely in order to halt the progress of cirrhosis, and a doctor or support group can help you achieve this goal.
- Eat a healthy, balanced diet.
Diagnosis of Cirrhosis
- In late stages of cirrhosis, diagnosis is very often evident from the history and findings on physical examination. Other tests mentioned are confirmatory in late stages but essential in early stages.
- Blood tests are conducted to measure the synthesis of certain proteins by the liver and any increased release of certain enzymes that indicate inflammation. Blood tests are also done to detect the presence of hepatitis B or C.
- A liver biopsy or scan may be done.
- In some cases, the liver may be examined with a viewing instrument (laparoscope) inserted through a small incision in the abdomen.
- Abdominal x-rays may be performed to determine the size of the liver and detect cysts or gas in the biliary tract or liver, fluid in the abdomen (massive ascites); and liver calcification.
- Computed tomography (CT scan) and liver scans may be performed to measure liver size, identify liver masses and obstructions and evaluate hepatic blood flow.
- Esophagogastroduodenoscopy may be done to detect bleeding esophageal varices, stomach irritation or ulceration or duodenal bleeding and irritation.
How to Treat Cirrhosis
- Stop drinking alcohol completely. Even if cirrhosis is not alcohol-induced, the liver may be further damaged by alcohol.
- Avoid any toxins or medications that cause liver injury.
- If swelling in the legs, ankles, or abdomen is present, eat a low-salt diet to reduce fluid retention. (Diuretics may be prescribed for this purpose as well.)
- Antibiotics may be prescribed if excess fluid retained in the abdomen has become infected.
- Cholestyramine may be prescribed to relieve severe itching by binding bile salts in the small intestine.
- Antihypertensive drugs such as beta-blockers may be prescribed to lower pressure within the portal vein and thus reduce the risk of bleeding from esophageal varices.
- Endoscopic procedures to close off esophageal varices may be warranted.
- Restriction of dietary protein may ease or prevent neurological changes (hepatic encephalopathy).
- Laxatives (such as lactulose) may be used to speed the passage of toxins through the intestine.
- In advanced cases of cirrhosis, a liver transplant may be recommended.
When to Call a Doctor
- Make an appointment with a doctor if you develop symptoms of cirrhosis.
- Seek help from a health professional or a support group if you are worried that you or someone close to you has a drinking problem.
- EMERGENCY If you begin to vomit blood, call an ambulance.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media