Cirrhosis

The liver, the largest organ in the body, is essential in keeping the body functioning properly. It removes or neutralizes poisons from the blood, produces immune agents to control infection, and removes germs and bacteria from the blood. It makes proteins that regulate blood clotting and produces bile to help absorb fats and fat-soluble vitamins. You cannot live without a functioning liver.                

In cirrhosis of the liver, scar tissue replaces normal, healthy tissue, blocking the flow of blood through the organ and preventing it from working as it should. Cirrhosis is the twelfth leading cause of death by disease, killing about 26,000 people each year. Also, the cost of cirrhosis in terms of human suffering, hospital costs, and lost productivity is high.

Causes

Cirrhosis has many causes. In the United States, chronic alcoholism and hepatitis C are the most common ones.

• Alcoholic liver disease. To many people, cirrhosis of the liver is synonymous with chronic alcoholism, but in fact, alcoholism is only one of the causes. Alcoholic cirrhosis usually develops after more than a decade of heavy drinking. The amount of alcohol that can injure the liver varies greatly from person to person. In women, as few as two to three drinks per day have been linked with cirrhosis and in men, as few as three to four drinks per day. Alcohol seems to injure the liver by blocking the normal metabolism of protein, fats, and carbohydrates.

• Chronic hepatitis C. The hepatitis C virus ranks with alcohol as a major cause of chronic liver disease and cirrhosis in the United States. Infection with this virus causes inflammation of and low grade damage to the liver that over several decades can lead to cirrhosis.

• Chronic hepatitis B and D. The hepatitis B virus is probably the most common cause of cirrhosis worldwide, but it is less common in the United States and the Western world. Hepatitis B, like hepatitis C, causes liver inflammation and injury that over several decades can lead to cirrhosis. Hepatitis D is another virus that infects the liver, but only in people who already have hepatitis B.

• Autoimmune hepatitis. This disease appears to be caused by the immune system attacking the liver and causing inflammation, damage, and eventually scarring and cirrhosis.

• Inherited diseases. Alpha-1 antitrypsin deficiency, hemochromatosis, Wilson disease, galactosemia, and glycogen storage diseases are among the inherited diseases that interfere with the way the liver produces, processes, and stores enzymes, proteins, metals, and other substances the body needs to function properly.

• Nonalcoholic steatohepatitis (NASH). In NASH, fat builds up in the liver and eventually causes scar tissue. This type of hepatitis appears to be associated with diabetes, protein malnutrition, obesity, coronary artery disease, and treatment with corticosteroid medications.

• Blocked bile ducts. When the ducts that carry bile out of the liver are blocked, bile backs up and damages liver tissue. In babies, blocked bile ducts are most commonly caused by biliary atresia, a disease in which the bile ducts are absent or injured. In adults, the most common cause is primary biliary cirrhosis, a disease in which the ducts become inflamed, blocked, and scarred. Secondary biliary cirrhosis can happen after gallbladder surgery if the ducts are inadvertently tied off or injured.

• Drugs, toxins, and infections. Severe reactions to prescription drugs, prolonged exposure to environmental toxins, the parasitic infection schistosomiasis, and repeated bouts of heart failure with liver congestion can all lead to cirrhosis.

Signs and Symptoms

You may not have signs and symptoms of cirrhosis in the early stages of the disease. But as more scar tissue replaces healthy tissue and liver function declines, you may experience some of the following:

• Lack of appetite

• Weight loss

• Nausea

• Small, red spider veins under your skin or easy bruising

• Weakness

• Fatigue

• Yellowing of your skin and eyes and dark, cola-colored urine

• Bleeding from engorged veins in your esophagus or intestines

• Loss of interest in sex

• Fluid in your abdominal cavity (ascites)

• Itching on your hands and feet and eventually on your entire body

• Swelling of your legs and feet from retained fluid (edema)

•  Mental confusion, such as forgetfulness or trouble concentrating (encephalopathy)

Prevention

Although not all cases of cirrhosis are preventable, the following measures can greatly reduce your risk:

Avoid alcohol or drink in moderation. Alcohol is a toxin that must be filtered by your liver. In the process, liver cells become damaged. Unfortunately, you may not recognize that you have a problem with alcohol before serious liver damage has occurred. Knowing and recognizing a family history of alcoholism for you or others is an important step in seeking treatment. If you have cirrhosis, you should not drink alcohol.

Protect yourself from hepatitis C. Because there's no vaccine to prevent hepatitis C, the only way to protect yourself is to avoid exposure to the virus. If you aren't absolutely certain of the health status of a sexual partner, use a new condom every time you have sex. Don't use nasal cocaine and avoid sharing needles or other drug paraphernalia. Contaminated drug paraphernalia is responsible for about half of all new cases of hepatitis C. See your doctor if you have or have had hepatitis C or think you may have been exposed to the virus.

Protect yourself from hepatitis B. Getting a vaccine for hepatitis B is the best way to protect yourself and others. However, other measures also can keep you safe. Know the health status of every sexual partner. If you don't know, use a new condom every time you have sex. And if you use needles to inject drugs, be sure they're sterile and don't share them.

Talk to your doctor about getting a vaccination for Hepatitis A if you have not been exposed to this virus or vaccinated. This virus, although it does not lead to cirrhosis itself, can cause significant liver damage and be dangerous among people with cirrhosis.

Coffee also may play a role in preventing cirrhosis caused by alcohol abuse. In a 2006 study of more than 125,000 people, one cup of coffee a day reduced the risk of alcoholic cirrhosis by 20 percent. Four cups a day reduced the risk by 80 percent. It's unclear whether the caffeine or another coffee ingredient provided the protection — but avoiding alcohol remains the only proven way to prevent alcoholic cirrhosis. These study results are controversial and should not be interpreted to suggest coffee as a treatment to allow excess alcohol consumption. If alcohol is consumed, it should be done so in moderation. People with cirrhosis should not consume any alcohol.

Screening And Diagnosis

Because cirrhosis seldom causes signs and symptoms in the early stages, your doctor may discover the disease during a routine medical examination. By gently pressing your abdomen, your doctor can often tell whether your liver is enlarged and firm, a sign of liver disease. As cirrhosis progresses, however, your liver often shrinks, leading to a backflow of blood and an enlarged spleen, which also may be detected in a physical exam.

If your doctor suspects cirrhosis, you're likely to have certain tests, including:

Liver Blood Tests. A damaged liver releases certain enzymes. Measuring these enzymes may help determine whether you have liver damage.

Bilirubin Test. Bilirubin, a red-yellow pigment that results from the normal breakdown of red blood cells, is metabolized in your liver and excreted in your urine. But in advanced cirrhosis, your liver can't process bilirubin, leading to high blood levels of the pigment.

Ultrasound. This noninvasive test uses sound waves to produce a picture of internal organs, including the liver. Ultrasound is painless and usually takes less than 30 minutes. While you lie on a bed or examining table, a wand-shaped device (transducer) is placed on your body. It emits sound waves that are reflected from your liver and transformed into a computer image.

Computerized Tomography (CT) Scan. This test uses X-rays to produce cross-sectional images of your body. It can provide an accurate look at internal organs, but it generates more radiation than conventional X-rays do.

Magnetic Resonance Imaging (MRI). Instead of X-rays, MRI creates images using a magnetic field and radio waves. Sometimes a contrast dye also may be used. The test can take from 15 minutes to an hour.

Liver Biopsy. Although other tests can provide a great deal of information about the extent and type of liver damage, a biopsy is the only way to definitively diagnose cirrhosis. In this procedure, a small sample of tissue is removed from your liver and examined under a microscope. Your doctor is likely to use a thin cutting needle to obtain the sample. Needle biopsies are relatively simple procedures requiring only local anesthesia, but your doctor may choose not to do one if you have bleeding problems or severe abdominal swelling (ascites). Risks include bruising, bleeding and infection. 

Treatment

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