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Cirrhosis

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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:

Risk Factors

Factors that may increase your chance of having cirrhosis include:

  • Alcohol abuse
  • 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
  • Impotence
  • Enlarged breasts in men

As cirrhosis progresses, it may cause:

  • Yellowing of the skin and whites of the eyes
  • 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:

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:

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

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:

Medication

Medication may be advised to:

  • Treat hepatitis and complications that arise
  • Reduce the absorption of waste products and toxins in the digestive system
  • Reduce the risk of a broken blood vessel
  • Fight infections
  • Shed excess fluids

Surgery

Liver transplant —may be done if:

  • Complications can no longer be controlled using medical therapy
  • The liver stops functioning

Endoscopy may be used to tie off bleeding blood vessels or to inject drugs to cause clotting. A thin tool with a lighted tip is inserted down the throat to help the doctor see and access the blood vessels, which are located in the esophagus.

Self-care

  • Stop drinking alcohol completely.
  • Do not take any medications without your doctor's approval, including over-the-counter drugs.
  • Eat a balanced diet . Choose a variety of fruits and vegetables, as well as lean proteins, like beans and poultry.
  • If your liver disease is more advanced, you may need to limit protein intake. Your weakened liver will not be able to process it properly.
  • You may need to limit salt in your diet, because it increases water retention.
  • Take any vitamin supplements your doctor recommends.
  • Put your feet and legs up to decrease swelling.
  • Due to increased risk of infections, take these steps:
    • Get vaccines for flu , pneumonia , and hepatitis .
    • Avoid raw seafood.
    • Avoid people who are sick with communicable diseases, like the flu or common cold.
    • Wash your hands often.

Prevention

To help reduce your chance of developing cirrhosis, take these steps:

  • 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.

Revision Information

  • American Gastroenterological Association

    http://www.gastro.org

  • American Liver Foundation

    http://www.liverfoundation.org

  • Canadian Liver Foundation

    http://www.liver.ca

  • Health Canada

    http://www.hc-sc.gc.ca

  • American Academy of Family Physicians. Information from your family doctor. Cirrhosis and chronic liver failure: what you should know. Am Fam Physician. 2006;75(5):781.

  • Cirrhosis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis. Updated April 23, 2014. Accessed September 12, 2014.

  • Cirrhosis of the liver. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 13, 2014. Accessed September 12, 2014.

  • Hirschfield GM, Gershwin ME. Primary biliary cirrhosis: one disease with many faces. Isr Med Assoc J. 2011;13(1):55-59.

  • Molodecky NA, Kareemi H, Parab R, Barkema HW, Quan H, Myers RP, Kaplan GG. Incidence of primary sclerosing cholangitis: a systematic review and meta-analysis. Hepatology. 2011;53(5):1590-1599.

  • Understanding cirrhosis of the liver. American Gastroenterological Association website. Available at: http://www.gastro.org/patient-center/digestive-conditions/cirrhosis-of-the-liver. Accessed September 12, 2014.

  • 2/12/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Chang Y, Ryu S, Sung E, et al. Weight gain within the normal weight range predicts ultrasonographically detected fatty liver in healthy Korean men. Gut. 2009;58(10):1419-1425.