Cirrhosis occurs when the liver becomes scarred. As the scar tissue replaces healthy tissue, small bumps form on the organ, causing blockages, which can lead to bile backing up into the liver and the blood. Bile is a fluid that is made up of water, electrolytes, cholesterol, bilirubin and other substances needed for both digestion and ridding the body of waste products. Once the liver has been scarred, the damage cannot be reversed.
A normal liver:
- Removes toxic substances from the blood
- Keeps the blood free of germs
- Provides immune agents to ward off infections
- Produces nutrients
- Regulates blood clotting
- Absorbs fats and vitamins
A person cannot live without a functioning liver, which makes cirrhosis potentially life threatening.
In early stages, the condition rarely shows any symptoms. Often the disease advances slowly and can be controlled. However, as time goes by and more healthy tissue is replaced with scar tissue, the liver begins to fail and a person may experience:
- Nausea and vomiting
- Weakness and exhaustion
- Loss of appetite and weight loss
- Red, spidery blood vessels on the skin
- Mental confusion, such as forgetfulness, poor concentration, dullness and sleep problems
Other symptoms that can be caused by complications of cirrhosis include:
- Coma (this is sometimes called hepatic encephalopathy)
- Yellowish skin and whites of the eyes (jaundice)
- Portal hypertension (slowing of blood flow through the portal vein)
- Swelling in the legs and abdomen caused by the buildup of water
- Bruising too easily
- Bleeding in the upper stomach
- Severe itching, from bile deposits in the skin
- Less urine output
- Stools that are pale or dull red in color
- Problems with side effects of medications taken
- Red palms or curled fingers
- Small testicles in men
- Hemorrhoids that bleed
- Lack of interest in sex
- Severe kidney problems
Causes and Risk Factors
Alcohol abuse is one of the most common causes of cirrhosis in the United States. Drinking too much can prevent the liver from processing protein, fats and carbohydrates in the body. Damage to the liver can develop after a period of ten or more years of excessive drinking. The amount of daily alcoholic intake that may result in cirrhosis differs from person to person and between men and women. More than 10% of people who drink to excess will get the disease.
Other health conditions that can lead to cirrhosis include:
- Chronic hepatitis C is also a major cause of cirrhosis in the U.S. The liver becomes inflamed and slow injury occurs because of viral infections associated with hepatitis C.
- Hepatitis B causes inflammation and damage to the liver over long periods of time. This type of hepatitis-caused cirrhosis is much more common in other parts of the world.
- Immune system problems in which the body attacks the liver
- Damaged or blocked bile ducts
- Long-term exposure to certain toxins in the environment
- Inherited diseases, such as cystic fibrosis, Wilson's disease (copper buildup in organs) and hemochromatosis.
- Fat buildup in the liver, associated with diabetes, obesity and heart problems
- Reactions to prescription drugs (for example, some cholesterol-lowering drugs can cause damage to the liver)
- Complications from gallbladder surgery
After taking a medical history and conducting a physical exam, a physician may perform a CAT scan, ultrasound or other imaging test to determine the state of the liver. A laproscope may be inserted into the stomach area to produce a picture of the liver. To confirm a diagnosis of cirrhosis, a liver biopsy may be done, which involves taking a small sample of tissue to be examined under the microscope.
Since nothing can be done about scarring that has already occured, treatment is concentrated on helping patients avoid complications of the disease and blocking further damage. Treatment depends on the cause of cirrhosis and any complications that result.
- Eliminating alcohol intake (in cases of alcohol abuse) and maintaining a healthy diet
- Medications, including interferon and cortisteroids
- Endoscopy to treat enlarged blood vessels
- Diuretics or laxatives to reduce buildup of fluids
- Liver transplantation, which should be considered when cirrhosis is severe and the liver is failing to function
Cedars-Sinai has a range of comprehensive treatment options.