Cirrhosis

What is cirrhosis?

Cirrhosis is a liver disease caused by scarring of the liver over a long period of time (months to years).

The liver is a very important part of the body. It helps the body get rid of toxic substances, including alcohol, nicotine, and other poisons. It is important in food digestion, fat metabolism, blood clotting, and other functions.

Scarring of the liver causes permanent damage and makes it hard for the liver to do its job.

How does it occur?

In the US, cirrhosis most often results from alcohol abuse. There are many other causes of cirrhosis, such as chronic hepatitis, inherited diseases, long-term exposure to toxic chemicals, certain medicines, and intestinal bypass surgery.

The liver changes that lead to cirrhosis are gradual. At first liver cells become injured. If the cause of the injury continues (for example, illness or alcohol abuse), the liver cells begin to die. Eventually the normal liver cells are replaced by scar tissue. This scar tissue cannot perform the many functions of the liver.

What are the symptoms?

The symptoms of early liver damage depend on the cause of the damage. At first there may not be any symptoms, or the symptoms may be very mild.

The symptoms of cirrhosis may include:

• being tired
• easy bruising
• loss of appetite
• fever
• nausea or vomiting
• jaundice (yellow skin)
• itching
• abdominal pain
• swelling of the abdomen or ankles
• bleeding from the stomach and esophagus
• weight loss.

How is it diagnosed?

Both a medical history and physical exam are very important in the diagnosis of cirrhosis. The medical history helps your health care provider determine possible causes of liver damage. The physical exam helps your provider know the extent of damage to the liver.

Blood tests give information on how well the liver is working. They also may help find the cause of the cirrhosis; for example, hepatitis B infection.

You may need to have a liver biopsy to determine the extent of damage to the liver. You can have a liver biopsy as an outpatient. (You do not have to stay in a hospital overnight.) If you have a biopsy, your skin will be numbed before a special needle is used to go through your skin and into your liver. The needle is used to get a small piece of liver tissue for tests.

How is it treated?

Liver damage from cirrhosis cannot be reversed, but treatment can stop or delay a worsening of the damage and reduce complications. The first important step is to remove what is causing the damage, if possible. For example, if your cirrhosis is caused by alcohol abuse, you must stop drinking any alcohol. Treatment for hepatitis-related cirrhosis involves medicines used to treat the different types of hepatitis, such as interferon for viral hepatitis. If an intestinal bypass is the cause, the bypass needs to be surgically reversed.

In all cases, regardless of the cause, following a healthy diet is essential because the body needs all the recommended nutrients to keep the tissues healthy. Because your liver is not working properly, you may need vitamin supplements and may have to change your diet. Alcohol must be avoided to prevent further damage to a liver already damaged by whatever cause.

Cirrhosis can cause problems in other parts of your body and these will need to be treated. For example, fluid may build up in your abdomen. Or you may have bleeding from the esophagus, causing bloody vomit, or bleeding in the stomach, causing bloody or tarlike bowel movements. Medicine can help control the buildup of fluid in the abdomen. Surgery may be needed to treat sites of bleeding in the stomach and esophagus.

A liver transplant is the ultimate treatment for cirrhosis. If the cause of the cirrhosis, such as alcohol abuse, can be removed or controlled and if you are healthy enough, a transplant is an option. But liver transplants are very expensive. Not all insurers will pay for liver transplants for all conditions. Also, the wait for a liver to transplant may be too long.

How long will the effects last?

If the liver continues to be injured, the cirrhosis will get worse and more liver cells will stop doing their jobs. This can lead to death.

If there is no further injury, the cirrhosis may not get worse and the remaining unscarred cells will continue to do the important work of the liver.

How can I take care of myself?

• Follow your health care provider's recommendations.
• Eat the correct diet.
• Do not drink alcohol.
• Follow your provider's advice about avoiding medicines, including nonprescription drugs, that may further damage the liver.

What can be done to help prevent cirrhosis?

• Limit your use of alcohol: no more than 1 drink a day for women and no more than 2 drinks a day for men.
• Ask your health care provider how you can help prevent hepatitis B and C.