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Cirrhosis

Pronounced: sih-ROH-sis

by Debra Wood, RN

En Espaol (Spanish Version)More InDepth Information on This Condition

Definition

Cirrhosis is a disease in which the liver becomes permanently damaged and the normal structure of the liver ischanged. Healthy liver cells are replaced by scarred tissue. The liver is not able to do its normal functions, such asdetoxifying harmful substances, purifying blood, and making vital nutrients. In addition, scarring slows down thenormal flow of blood through the liver, causing blood to find alternate pathways. This may result in gastric oresophageal varices.

Cirrhosis of the Liver

2011 Nucleus Medical Media, Inc.

Causes

Causes of cirrhosis include:

Excessive consumption of alcoholHepatitis C, B, and DAutoimmune hepatitisInherited diseases:

Glycogen storage diseaseGalactosemiaFructose intoleranceTyrosinemiaHemochromatosisWilson's diseaseAlpha1-antitrypsin deficiency

Cystic fibrosis

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Nonalcoholic steatohepatitis (NASH), associated with:DiabetesObesityHeart diseaseHigh blood triglyceridesSteroid use

Bile duct blockages, associated with:CirrhosisCongenital defectsScarred ductssometimes related to inflammatory bowel disorders

Gallbladder surgeryPancreatitis

Drugs and toxins:ArsenicIsoniazidMethotrexateExcess vitamin A

Infections:

SchistosomiasisBrucellosisEchinococcosis

Advanced or congenital syphilisHeart failure, causing blood to repeatedly back up into the liver

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:

Alcohol abuseHepatitis infectionUse of drugs toxic to the liver

Being overweight or gaining weightDiabetes that is poorly controlledIngestion 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.

Early symptoms include:

FatiguePoor appetiteAbdominal swelling, tenderness, and painNauseaWeight lossWeaknessEnlarged breasts in men

Later symptoms, some due to complications, include:

Yellowing of the skin or eyes ( jaundice)


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Reddened palmsLoss of body hairShrunken testiclesEnlarged liverEnlarged spleenAppearance of thin, purplish-red, spidery looking blood vessels on the skin, especially around the navelDark urineWater retention and swelling in the legs and abdomenBleeding and bruisingVomiting blood

ItchingMenstrual problemsAbdominal infectionsImpotenceForgetfulnessConfusionAgitationTremors

ComaInability to fully process drugsEnlarged, twisted, thin-walled blood vessels called varices that bleed easily and sometimes catastrophically

(usually located in the esophagus)Liver cancerOsteoporosisGallstonesArrhythmiasSleep disturbancesUlcersBreathing problemsInsulin resistance

Diagnosis

The doctor will ask about your symptoms and medical history and perform a physical exam.

Tests may include:

Blood teststo assess how well the liver is working and determine a causeCT scan, ultrasound, or liver/spleen scanto identify changes in the liverLiver biopsy analyzing a sample of liver tissue removed via a thin needle inserted through the abdomenand into the liverLaparoscopy looking at the liver via a thin tube with a lighted tip inserted through a small incision near the

belly button

Other tests may include:

Inserting a catheter into the liver vein and measuring the pressure within that vein; rarely necessaryRemoving fluid from the abdomen and examining itOther 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:


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Control the causeTreat underlying medical conditionsPrevent additional damageTreat symptoms and complicationsLiver cancer screenings

Treatments include:

Medication

Doctors prescribe drugs to:

Treat hepatitis and complications that ariseReduce the absorption of waste products and toxins in the digestive systemReduce the risk of a blood vessel breakingFight 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 This is used to tie off bleeding blood vessels (varices) or to inject drugs to cause clotting. A thin toolwith a lighted tip is inserted down the throat to help the doctor see and access the varices, which are located in theesophagus.

Self-care

Stop drinking alcohol completely.

Do not take any medicines 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, because your weakened liverwill 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, doctors recommend:

Getting vaccines for flu, pneumonia, and hepatitis

Avoiding raw seafoodAvoiding people who sick with communicable diseases, like the flu or coldWashing your hands often

If you are diagnosed with cirrhosis, follow your doctor's instructions.

Prevention

To decrease the risk of cirrhosis:

Drink alcohol in moderation. Moderate alcohol intake is no more than two drinks per day for men and one

drink per day for women.


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Get hepatitis vaccines.Practice safe sex to lower your chance of getting hepatitis B.If you use IV drugs, do not share needles, which 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.

RESOURCES:

American College of Gastroenterologyhttp://www.acg.gi.org/

American Gastroenterological Associationhttp://www.gastro.org/

American Liver Foundationhttp://www.liverfoundation.org/

CANADIAN RESOURCES:

Canadian Liver Foundationhttp://www.liver.ca/

Health Canadahttp://www.hc-sc.gc.ca/index_e.html/

REFERENCES:

Cirrhosis. National Guideline Clearinghouse website. Available at: http://www.guideli... . Accessed July 9, 2009.

Cirrhosis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at:http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis/ . Published December 2008. Accessed July 9, 2009.

Cirrhosis and chronic liver failure: what you should know. American Academy of Family Physicians website.

Available at: http://www.aafp.org/afp/20060901/781ph.html . Published September 2006. Accessed July 9, 2009.

Cirrhosis of the liver. AGA Patient Center. American Gastroenterological Association website. Available at:http://www.gastro.org/wmspage.cfm?parm1=5673 . Accessed July 9, 2009.

Dambro MR, Griffith JA. Griffith's 5-Minute Clinical Consult.Philadelphia, PA: Lippincott Williams & Wilkins;1999.

Ferri F, ed. Ferris Clinical Advisor 2010.Philadelphia, PA: Mosby Elsevier; 2009.

Feldman M. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. St. Louis, MO: Mosby; 2005.

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 primarysclerosing cholangitis: a systematic review and meta-analysis. Hepatology. 2011;53(5):1590-1599.

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


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Last reviewed September 2011 by Lawrence Frisch, MD, MPHLast Updated: 9/20/2011


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