Cirrhosis is a condition of the liver. It is marked by scarring of liver tissues that results in blocked blood flow and impaired liver function. Cirrhosis is one of the leading causes of death by disease. Sadly, it kills more than 25,000 people per year.
The liver has several critical jobs, including the removal or neutralization of poisons in the body. This vital organ is also responsible for producing immune agents critical for controlling infection and removing bacteria and germs from the blood. The liver also produces proteins necessary for the regulation of blood clotting and makes bile for the absorption of fat and certain vitamins. A person cannot live without a functioning liver.
There are many causes of cirrhosis. Disease, drug use, infection, heavy alcoholic drinking, exposure to certain toxins, and blocked bile ducts can cause damage to the liver and lead to cirrhosis. Among the known causes of this condition, chronic alcoholism and Hepatitis C are the most common in the United States.
A person can have cirrhosis without immediately exhibiting symptoms of the condition. Over time, however, healthy cells are replaced with scar tissue and liver function is reduced. As liver function begins to fail, symptoms of exhaustion, loss of appetite, nausea, and weight loss may become evident. The affected individual may also experience weakness, abdominal pain, and spider-like blood vessels on the skin.
As cirrhosis progresses, complications may develop. These complications may include edema, ascites, bruising, bleeding, jaundice, itching, and gallstones. Other complications can include toxins in the blood or brain, medication sensitivity, portal hypertension, varices, insulin resistance, type 2 diabetes, and liver cancer. Additionally, a person with cirrhosis may develop problems with other organs.
Cirrhosis can be caused by a number of conditions, including long-standing inflammation, poisons, infections, and heart disease, as well as chronic alcoholism and chronic hepatitis, the most common causes. For 30-50 percent of cirrhosis cases, however, no cause can be found.
Chronic alcoholism: Alcohol can poison all living cells, causing liver cells to become inflamed and die. The death of liver cells leads your body to form scar tissue around veins of your liver. Healing liver cells form nodules, which also press on the liver veins. This scarring process occurs in 10-20 percent of alcoholics and is the most common form of cirrhosis in the United States. The severity of the process depends on how much you drink and how long you have been abusing alcohol. The amount of alcohol needed to injure the liver varies widely from individual to individual. Some families are more susceptible to cirrhosis than others.
Hepatitis: Hepatitis means inflammation of the liver from any cause, but it usually refers to a viral infection of the liver. Over many years the inflammation damages liver cells and leads to scarring.
Hepatitis B, hepatitis C, and hepatitis D all can cause cirrhosis. Worldwide, hepatitis B is the most common cause of cirrhosis, but in the United States hepatitis C is a more common cause.
Biliary cirrhosis: Bile is a substance produced by the liver to help the body digest fats. Bile is carried from the liver to the gallbladder and eventually into the intestines by small tubes called bile ducts. If these ducts become blocked, the bile backs up and can damage the liver. The liver becomes inflamed, starting the long process of cell damage that leads to cirrhosis. In adults, gallstones are a common cause of bile duct blockage. Surgery to remove the gallbladder also blocks the bile ducts. Children may be born with a condition that blocks the bile ducts called biliary atresia. This disease usually affects women aged 35-60 years.
Autoimmune cirrhosis: The body's immune system defends against "invaders" such as bacteria, viruses, or allergens. Autoimmune diseases occur when the immune system instead begins to fight healthy body tissues and organs. In autoimmune hepatitis, the body's immune system attacks the liver, causing cell damage that leads to cirrhosis.
Nonalcoholic fatty liver: This is a condition in which fat builds up in the liver, eventually causing scar tissue to form. This kind of cirrhosis is linked to diabetes, obesity, coronary artery disease, protein malnutrition, and treatment with corticosteroids such as prednisone. It is sometimes called "steatohepatitis."
Cirrhosis often has no signs or symptoms until liver damage is extensive. When signs and symptoms do occur, they may include:
Fatigue
Bleeding easily
Easy bruising
Fluid accumulation in your abdomen
Loss of appetite
Nausea
Swelling in your legs
Weight loss
Make an appointment with your doctor if you have any signs or symptoms that worry you.
The way cirrhosis is treated depends on the underlying cause. Cirrhosis can't be cured, but treatment aims to manage the symptoms and any complications, as well as stopping the condition from getting worse.
It's usually not possible to reverse any liver damage that's already occurred.
Ways to stop the cirrhosis from getting worse include:
taking medication to treat an underlying disease that has caused liver damage. For example, if you have viral hepatitis you may be prescribed interferon. If you have autoimmune hepatitis you may be given steroid-based medication, such as prednisolone or an immunosuppressant such as azathioprine.
making lifestyle changes – you may be advised to cut down on your alcohol intake or to lose weight if you're overweight or obese. Read more about living with cirrhosis.
A number of treatments can ease the symptoms of cirrhosis. They include:
a low-sodium (salt) diet or water tablets to reduce the amount of fluid in your body
tablets to reduce high blood pressure in your portal vein (the main vein from the liver) and prevent or treat any infection
creams to reduce itching
With advanced cirrhosis, it's only possible to treat the end-stage complications. It's not possible to treat jaundice (yellowing of the skin and the whites of the eyes) because it's simply a sign that your liver isn't working properly.
If you vomit blood or pass blood in your faeces, you probably have swollen veins in your oesophagus (food pipe). These are known as oesophageal varices. You'll need urgent medical attention, which means seeing your GP or going to the accident and emergency (A&E) department of your nearest hospital immediately.
Certain procedures can help stop the bleeding and reduce the risk of it happening again. Any of the techniques described below may be used to correct the cause of your bleeding.
Banding – an endoscopy is carried out (a thin, flexible tube is passed down your throat; it has a light and a camera on the end) and a small band is placed around the base of the varices to help control the bleeding.
Injection sclerotherapy – following an endoscopy, a substance will be injected into the varices to make the blood clot and scar tissue to form, which helps to stop the bleeding.
A Sengstaken tube with a balloon on the end – this is another option if bleeding can't be stopped using an endoscopy. The tube is passed down your throat into your stomach and the balloon is inflated, putting pressure on the varices and stopping the bleeding.
A transjugular intrahepatic portosystemic stent shunt (TIPSS) – this procedure may be used if bleeding can't be controlled using the above methods. A metal tube called a stent is passed across your liver to join two large veins (the portal vein and hepatic vein). This creates a new route for your blood to flow through, therefore relieving the pressure that causes the varices.
Ascites (a build-up of fluid around your stomach area) and peripheral oedema (fluid around your legs and ankles) are common complications of advanced cirrhosis. They'll need to be addressed as soon as possible.
You may have 20 to 30 litres of free water in your stomach area (abdomen), which can make it difficult for you to eat and breathe properly. The fluid may also become infected. The main treatments are restricting sodium (salt) in your diet and taking diuretic tablets, such as spironolactone or furosemide.
In severe cases of ascites, tubes may be used to drain the fluid from your abdomen. This will usually be repeated every few weeks. TIPSS can also be used to treat ascites (see above).
People with cirrhosis can sometimes develop problems with their brain function (encephalopathy). This occurs because the liver isn't clearing toxins properly.
The brain’s functioning ability can be impaired, causing confusion and drowsiness and, at a later stage, a coma. Treatment may include taking antibiotics and clearing out the bowel with laxatives or enemas.
Cirrhosis can affect the liver's ability to make the blood clot (thicken), leaving you at risk of severe bleeding if you cut yourself. Vitamin K and plasma can be given in medical emergencies to treat episodes of bleeding. You'll need to apply pressure to any cuts that bleed.
Your liver may stop functioning if it's severely damaged by scarring. In this situation, a liver transplant is the only option. This is a major procedure that involves removing your diseased liver and replacing it with a healthy donor liver. However, there are more people waiting for a transplant than there are donors.