Cirrhosis

Cirrhosis 

Cirrhosis is a condition (not a disease) 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.


Causes

An illustration of a normal liver compared to liver cirrhosis. Image used with permission by Mayo Clinic
Used with permission from Mayo Clinic. All rights reserved

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

 

Cirrhosis in Babies

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.

 

Early Symptoms

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 functions 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?

An illustration showing what the liver looks like with cirrhosis, including varices where variceal bleeding occurs. Image used with permission from Mayo Clinic
Used with permission from Mayo Clinic. All rights reserved

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 (Hepatic Encephalopathy) 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.

 

Diagnosis

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.

 

Treatment

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.

Support

National Help Line:
This support resource gives you and your loved one somewhere to turn for answers after diagnosis, helps you understand your disease, and provides you with the resources you need.  You can call 1 (800) 563-5483 Monday to Friday from 9 AM to 5 PM EST.

The Peer Support Network:
This is a national network of people living with liver disease that have offered to share their experiences with others. It was developed by the Canadian Liver Foundation as a means to link Canadians like you who have a family member who has liver disease, who care for someone who suffers from liver disease, or who have been diagnosed with a liver disease, to talk about your concerns with a peer in a similar situation.

If you would like to be connected with a peer supporter in your area, or would like to join the peer support network, please call the National Help Line at 1 (800) 563-5483 or email Billie Potkonjak.

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