Cirrhosis of the Liver
What is Cirrhosis?
Cirrhosis is a disease in which normal liver cells are damaged and replaced with scar tissue, disrupting liver function. It may be caused by direct injury to liver cells, or by indirect injury, such as inflammation or obstruction of the ducts that drain bile from the liver.
The liver is the largest internal organ in the body. It is located mainly in the upper right side of the abdomen, situated mostly under the lower ribs. It weighs about 3 pounds and is roughly the size of a football.
Most of the blood that leaves the stomach and intestines passes through the liver. The liver performs hundreds of functions necessary for survival, including:
- Producing blood proteins that regulate blood clotting
- Producing bile and enzymes necessary for digestion
- Metabolizing cholesterol
- Storing energy to fuel muscles
- Helping to maintain glucose (blood sugar) concentration
- Helping to regulate hormones
- Removing toxins from drugs and poisons, including alcohol
How is it diagnosed?
Cirrhosis signs and symptoms
- Fatigue; weakness.
- Poor appetite; nausea; weight loss.
- Enlarged liver.
- Red palms.
- Jaundice (yellow skin and eyes).
- Dark yellow or brown urine.
- Spider blood vessels of the skin (fine vessels that spread out from a central point).
- Hair loss.
- Breast enlargement in men.
- Fluid accumulation in the abdomen and legs.
- Enlarged spleen.
- Diarrhea; stool may be black or bloody.
- Bleeding and bruising.
- Mental confusion; coma.
Cirrhosis may be diagnosed by a physician during a physical examination that includes a medical history and list of medications. A physician can sometimes identify early stages of cirrhosis by gently pressing the abdomen to determine whether the liver is enlarged and firm. During later stages of the disease the liver shrinks, causing an enlarged spleen which a physician may also identify by gently touching the abdomen.
If a patient is suspected to have cirrhosis, blood tests may be performed. These can detect changes in the body that occur as a result of cirrhosis. Tests include:
- Hematology tests. Patients with cirrhosis are often anemic and also tend to have larger-than-normal spleens, which leads to abnormally low platelet counts. The loss of functioning liver leads to less clotting protein production and abnormal coagulation labs.
- Liver function test. When a liver is damaged, it releases enzymes, which may be detected with a blood test.
- Bilirubin test. Bilirubin (substance formed from the breakdown of red blood cells that gives bile its color) is processed in the liver and excreted in urine. When the liver is damaged, it cannot process bilirubin, leading to high levels of bilirubin in the blood.
- Ultrasound. An imaging technology that uses sound waves to produce images of the shape and outline of various tissues and organs of the body.
- CAT scan (computed axial tomography). A test that allows for multiple x-rays to be taken from different angles around the patient. It creates images of organs and bones within the body.
- MRI (magnetic resonance imaging). Safe and noninvasive or minimally invasive imaging test that can help physicians diagnose diseases of numerous organs and vessels. It uses powerful magnets to produce images on a computer screen and film.
- Liver scan. A radioactive substance (radioisotope) that highlights the liver is injected into a vein. After the liver absorbs the substance, the liver is scanned and images are displayed on a computer screen.
- Laparoscopy. A laparoscope (thin, lighted tube with a tiny video camera) is inserted into the abdomen through a small incision. Images are displayed on a computer screen.
Tests may also be performed to screen for complications of cirrhosis, such as a CAT scan, upper endoscopy or capsule endoscopy for esophageal varices.
How is Cirrhosis treated?
There is no cure for cirrhosis. The liver is capable of repairing some damage, but it is limited. The focus of treatment is to prevent or delay further progression of the disease and to reduce complications. This may involve treating the underlying cause of the disease.
All patients, including those with cirrhosis caused by alcohol abuse, must stop drinking alcohol. Some patients require assistance to help them quit, which may involve a chemical dependency evaluation, intervention, counseling, support groups, outpatient treatment program or inpatient residential program. Other drugs that may be related to liver damage should also be avoided. These include acetaminophen, some other over-the-counter drugs and certain vitamin supplements.
Patients with cirrhosis, regardless of the cause of the disease, must follow a healthy diet because the liver requires nutrients to heal. In addition, patients should avoid eating raw seafood because of the potential presence of bacteria. A diet that restricts salt may also be recommended because of the potential for swelling (edema) and fluid in the abdomen (ascites).
Patients with cirrhosis caused by hepatitis may be treated with medication, such as interferon for viral hepatitis (hepatitis B or hepatitis C virus) or corticosteroids for autoimmune hepatitis.
- Portal hypertension. Medications that lower blood pressure, such as beta blockers, may be prescribed to lower pressure in the portal vein (large, short vein that carries nutrient-rich blood from the intestines and spleen to the liver).
- Bleeding blood vessels. Medications may be prescribed to reduce bleeding from blood vessels. Patients may also undergo medical procedures to stop bleeding. For example, a procedure called an endoscopic variceal band ligation is used to treat bleeding in the esophagus. During this procedure, latex bands are used to stop the blood supply to bleeding vessels.
- Fluid retention. Patients may be treated with medications called diuretics to reduce fluid buildup in the legs or abdomen. Some patients require fluid to be removed from the abdominal cavity with a needle using local anesthetic. Patients may require antibiotics to lessen the possibility of bacterial peritonitis.
- Itching. Patients may be treated with antihistamines to help stop itching.
- Hepatic encephalopathy. Patients may be treated with lactulose, a medication that helps lower blood ammonia, or antibiotics, which reduce the amount of ammonia-producing bacteria in the intestines.
Researchers are studying potential alternatives to a liver transplant, such as an experimental drug that has treated cirrhosis in mice.
- Iron supplements for anemia resulting from hemorrhage or poor nutrition.
- Diuretics to reduce fluid retention.
- Antibiotics, such as neomycin, to reduce ammonia buildup.
- Stool softeners.
Aldactone (Spironolactone), Imuran (Azathioprine), Revia (Naltrexone)
What might complicate it?
Almost all forms of cirrhosis are associated with portal hypertension, esophageal bleeding, enlarged spleen, fluid retention (ascites and edema), and coma. Other complications may include portal vein thrombosis (blood clot formation), the development of liver tumors, altered drug metabolism, spontaneous bacterial peritonitis in which fluid accumulating within the abdomen becomes infected, and hepatic encephalopathy in which the brain is poisoned by high blood levels of certain metabolic byproducts.
Differential diagnoses include other causes of liver cell injury, idiopathic portal hypertension, schistosomiasis, and congenital hepatic fibrosis.
Gastroenterologist, pathologist, and general surgeon.
- Maintain as active a life as possible.
- Elevate swollen feet and legs when resting.
- In the early stages, eat a well-balanced diet that is high in carbohydrates, high in protein and low in salt.
- Late stages may require protein reduction.
- Vitamin and mineral supplements may be necessary.
- Don't drink alcohol.
Notify your physician if
- You or a family member has symptoms of cirrhosis.
- The following occur during treatment:
- Vomiting blood or passing black stool.
- Mental confusion or coma.
- Fever or other signs of infection (redness, swelling, tenderness or pain).
Last updated 4 July 2015