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Cirrhosis

What is cirrhosis of the liver?
What are the signs of cirrhosis of the liver?
What causes cirrhosis of the liver?
How does my doctor tell if I have cirrhosis of the liver?
How are patients with cirrhosis of the liver treated?

What is cirrhosis of the liver?

Cirrhosis (nodules surrounded by scar tissue or fibrosis) is the result of limited regeneration (regrowth) of the damaged liver accompanied by scars (fibrous bands). The scars and growths from cirrhosis make it difficult for blood to flow through the liver. Cirrhosis may lead to liver failure, and many other health problems.

What are the signs of cirrhosis of the liver?

Cirrhosis may cause no symptoms at first. As the scarring continues, the following signs and symptoms may appear:

  • Early, vague symptoms, such as fatigue and weight loss.
  • Symptoms typical of advanced (decompensating) liver disease:
    • Fluid retention in the abdomen (ascites), or in the skin and legs (edema)
    • Abnormal blood vessels/circulation due to impaired blood flow through the liver. Normal routes are bypassed and blood vessels in the stomach wall and esophagus swell (varices). Varices may cause severe bleeding.
    • Jaundice (yellowing of the skin/eyes), often accompanied by itching
    • Weight loss/ loss of appetite
    • Nausea and vomiting
    • Loss of interest in sex, and impotence
    • Pain in the right upper abdomen
    • Mental dysfunction
      • Sleep disturbance (awake at night, sleepy during the day)
      • Confusion
      • Coma

These symptoms are due to accumulation of toxic substances (ammonia and others) in the blood and often made worse by sleeping medication, dehydration or infection.

People with cirrhosis have a greater chance of getting diabetes, kidney problems, ulcers, severe infections, and liver cancer.

What causes cirrhosis of the liver?

Cirrhosis is the consequence of injury to the liver due to:

  • Excessive alcohol consumption
  • Hepatitis B and hepatitis C
  • NASH
  • Bile duct obstruction
  • Genetic disorders, such as
    • Hemochromatosis (too much iron in the liver and other organs)
    • Wilson's disease (too much copper in the liver and other organs)
    • Alpha-1-antitrypsin deficiency (often also affecting the lungs)
    • Autoimmune diseases, such as autoimmune hepatitis and primary biliary cirrhosis

How does my doctor tell if I have cirrhosis of the liver?

The doctor may suspect cirrhosis from your symptoms, medical history, and a physical exam. To be sure you have cirrhosis, your doctor may perform any of these tests:

  • Blood tests to check liver function
  • An ultrasound, which uses sound waves to create images of the inside of your body (jelly on your abdominal wall, no pain, usually no injections)
  • A computerized axial tomography (CT) scan or an MRI (magnetic resonance imaging), which are imaging devices that provide images of the inside of your abdomen, showing your liver, spleen, fluid, etc. You often will get contrast fluids injected through a vein in your arm.
  • Liver biopsy, a procedure where the doctor uses a special needle to remove a tiny sample of your liver. The sample is then checked at a laboratory for signs of liver damage or disease. The procedure is done through the skin, and only takes about 20 minutes. It may cause some discomfort, and you will need to take it easy for a few days after the surgery. Occasionally, complications such as bleeding may occur.

How are patients with cirrhosis of the liver treated?

Many things can be done to limit the effects of cirrhosis of the liver, including:

  • Reduce the damaging effect of toxins (Stop alcohol and certain medications)
  • Treat viral infections, such as Hepatitis B and C, in an attempt to eradicate them
  • Treat fluid overload (diet, diuretics)
  • Treat bleeding varices (endoscopy)
  • Vaccinate against infection
  • Educate the patient about the effects of other potentially damaging drugs, vitamins and herbs.
    The damage cirrhosis does to the liver is usually permanent. Damage can, to a significant degree, be undone by taking away the cause.
    • If an alcoholic with cirrhosis stops drinking immediately, the liver may improve to a considerable degree.
    • Removing excessive iron from the blood of a person with Hemochromatosis can reverse many symptoms
    • Treating infections such as viral Hepatitis B and C may prevent the need for transplantation.

In advanced cases of cirrhosis, the only option for treatment is a liver transplant. Alcoholics and drug abusers must complete a detoxification and rehabilitation program to be considered for a transplant.

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