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Cirrhosis

Cirrhosis

Definition

Cirrhosis is a disease in which the liver becomes permanently damaged and the normal structure of the liver is changed. Healthy liver cells are replaced by scarred tissue. The liver is not able to do its normal functions such as detoxifying harmful substances, purifying blood, and making vital nutrients.

In addition, scarring slows down the normal flow of blood through the liver, causing blood to find alternate pathways. This may result in bleeding blood vessels known as gastric or esophageal varices.

Cirrhosis of the Liver
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Causes

Causes of cirrhosis include:

  • Excessive consumption of alcohol
  • Hepatitis C, B, and D
  • Autoimmune hepatitis
  • Inherited diseases, such as glycogen storage disease, hemochromatosis, or cystic fibrosis
  • Genetic conditions such as:
    • Galactosemia
    • Fructose intolerance
    • Tyrosinemia
    • Wilson disease
    • Alpha1-antitrypsin deficiency
  • (NAFLD), associated with:
    • Diabetes
    • Obesity
    • Coronary artery disease
    • High blood triglycerides
    • Steroid use
  • Bile duct blockages, associated with:
    • Congenital defects
    • Scarred ducts—sometimes related to inflammatory bowel disorders
    • Gallbladder surgery
    • Pancreatitis
  • Drugs and toxins:
    • Arsenic
    • Isoniazid
    • Methotrexate
    • Excess vitamin A
  • Infections:
    • Schistosomiasis
    • Brucellosis
    • Echinococcosis
    • Advanced or congenital syphilis
  • Heart failure, causing blood to repeatedly back up into the liver

Risk Factors

Factors that may increase your chance of having cirrhosis include:

  • Alcohol use disorder
  • Hepatitis infection
  • Liver cancer
  • Use of drugs that are toxic to the liver
  • Being overweight or gaining weight
  • Diabetes that is poorly controlled
  • Ingestion of too much iron

Symptoms

Cirrhosis often does not cause symptoms early in the disease process. Symptoms start when the liver begins to fail, as scar tissue replaces healthy cells. Symptom severity depends on the extent of liver damage.

Cirrhosis may cause:

  • Fatigue
  • Weakness
  • Poor appetite, nausea, or weight loss
  • Itching
  • Abdominal swelling, tenderness, and pain
  • Appearance of thin, purplish-red, spidery looking blood vessels on the skin
  • Menstrual problems
  • Erectile dysfunction
  • Enlarged breasts in men—gynecomastia

As cirrhosis progresses, it may cause:

  • Yellowing of the skin and whites of the eyes—jaundice
  • Dark urine
  • Swelling in the legs and abdomen
  • Loss of body hair
  • Bleeding and bruising
  • Vomiting blood
  • Neurological problems, such as forgetfulness, confusion, agitation, or tremors

Complications of cirrhosis may include:

  • Fluid build-up in the abdomen—ascites
  • Abnormal heart rhythms—arrhythmias
  • Sleep disturbances
  • Digestive disorders, such as abdominal infections, ulcers, or gallstones
  • Liver cancer
  • Insulin resistance
  • Hypoglycemia
  • Coma

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

Your bodily fluids may be tested. This can be done with:

  • Blood tests
  • Liver biopsy

Images may be taken of your bodily structures. This can be done with:

  • CT scan
  • Ultrasound
  • Laparoscopy

Other tests may include:

  • Removing fluid from the abdomen and examining it
  • Inserting a catheter into the liver vein and measuring the pressure within that vein—rarely necessary
  • Other tests to determine what caused the cirrhosis and what complications may occur

Treatment

There is no cure for cirrhosis. The goals of treatment are to keep the condition from getting worse, including:

  • Controlling the cause
  • Treating underlying medical conditions
  • Preventing additional damage
  • Treating symptoms and complications
  • Having liver cancer screenings

Talk with your doctor about the best treatment plan for you. Options include:

Prevention

To help reduce your chances of cirrhosis:

  • Drink alcohol in moderation. Moderate alcohol intake is no more than two drinks per day for men and one drink per day for women.
  • Get hepatitis vaccines.
  • Practice safe sex to lower your chance of getting hepatitis B.
  • If you use IV drugs, do not share needles. Needles can spread hepatitis B, C, or D.
  • Maintain a healthy weight.
  • Follow your doctor’s recommendations about blood tests when taking medications that may damage the liver.
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