What Is Cirrhosis?
Cirrhosis is a chronic (ongoing, long-term) disease of the liver. It means scarring to the normal liver tissue that keeps this important organ from working as it should. If the damage is not stopped, the liver gradually loses more of its ability to carry out its normal functions. This is called liver failure, sometimes referred to as end-stage liver disease.
The liver is the largest organ in the body and one of the most essential.
- It is about the size a football and is located on the right side in front, just below the lower rib cage.
- It produces substances that help fight infections and clot blood, filters toxins and infectious agents out of the blood, helps in the digestion of certain nutrients from foods, and stores energy for later use.
- These are just some of its many functions in the body.
The liver may be injured by a single event, as in acute (new, short-term) hepatitis; by regular injury over months or years, as in biliary tract blockage or chronic hepatitis; or by continuous injury, as in daily alcohol abuse.
- The liver responds to cell damage by producing strands of scar tissue that surround islands (nodules) of healing cells, making the liver knobby.
- At first, the inflammation in the liver causes it to swell. As the disease progresses and the amount of scar tissue in the liver increases, the liver will actually shrink.
- The scar tissue presses on the many blood vessels in the liver. This interrupts flow of blood to liver cells, which then die.
- Loss of liver cells hinders the liver’s ability to perform its normal functions.
Loss of liver function affects the body in many ways. Cirrhosis, if severe enough, can cause many different complications. These can be severe, as follows:
Portal hypertension: The nodules and scar tissue can compress veins within the liver. This causes the blood pressure within the liver to be high, a condition known as portal hypertension.
- High pressures within blood vessels of the liver occur in a majority of people who have cirrhosis.
- Cirrhosis is the most common cause of portal hypertension in the United States.
- Portal hypertension may cause blood to back up in the intestines and other organs in the abdomen and cause bleeding into the intestines and fluid accumulation throughout the body.
Hepatic encephalopathy: In this condition, toxins build up in the bloodstream because the scarred liver is unable to rid them from the body.
- The toxins can cause you to behave bizarrely, to become confused, and to lose your ability to take care of yourself or others.
- Some people become very sleepy and cannot waken easily.
Gastrointestinal bleeding: Portal hypertension causes backing up of blood flow in the veins of the stomach and esophagus.
- This causes the veins to enlarge, forming “varices” (varicose veins).
- These varices can tear and bleed, and this bleeding can be life threatening.
- This usually shows up as vomiting bright red blood.
Infection: If you have cirrhosis, you are at risk for many infections because your liver cannot form the proteins needed to fight off infection.
Fluid retention (ascites): High pressures (portal hypertension) force fluid out of blood vessels in your liver, pooling it in your abdomen.
- Several liters of this fluid can pool in your abdomen, causing pain, swelling, difficulty breathing, and dehydration.
- As fluid pools in your abdomen, your kidneys will try to hold onto more water, because they think your body is dehydrated. The excess fluid collects in your lungs, legs, and abdomen.
- The fluid in your abdomen can become infected, called spontaneous bacterial peritonitis.
Hepatorenal syndrome: For unknown reasons, liver failure leads to kidney failure in some people.
- Often the progress toward liver failure is slow and gradual.
- Although cirrhosis has traditionally been linked with alcoholism, it has many causes. The most common causes in the United States are chronic alcoholism and hepatitis C.
- There is no cure for cirrhosis, but removing the cause can slow the disease. If the damage is not too severe, the liver can heal itself over time.
What are the signs and symptoms of cirrhosis?
Many people with cirrhosis have no symptoms during the early phases of the disease. Symptoms are caused by either of 2 problems:
- Gradual failure of the liver to carry out its natural functions
- Distortion of the liver’s usual shape and size because of scarring
The most common symptoms of cirrhosis are as follows:
- Tiredness (fatigue) or even exhaustion
- Weakness
- Nausea
- Loss of appetite leading to weight loss
- Loss of sex drive
Symptoms may not appear until complications of cirrhosis set in. Many people do not know they have cirrhosis until they have a complication.
- Jaundice – Yellowing of the skin and eyes from deposition of bilirubin in these tissues. Bilirubin is a product of the breakdown of old blood cells in the liver.
- Fever
- Vomiting
- Diarrhea
- Itching – From deposition in the skin of products of the breakdown of bile
- Abdominal pain – From enlargement of the liver or formation of gallstones
- Abdominal swelling or bloating – From fluid retention
- Weight gain – From fluid retention
- Swelling in ankles and legs (edema) – From fluid retention
- Difficulty breathing – From fluid retention
- Sensitivity to medications – Due to impairment of the liver’s ability to filter medications from blood
- Confusion, delirium, personality changes, or hallucinations (encephalopathy) – From buildup of drugs or toxins in the blood, which then affect the brain
- Extreme sleepiness, difficulty awakening, or coma – Other symptoms of encephalopathy
- Bleeding from gums or nose – Due to impaired production of clotting factors
- Easy bruising – Due to impaired production of clotting factors
- Blood in vomit or feces – Due to bleeding of varicose veins caused by liver congestion
- Hemorrhoids – Varicose veins in rectum due to liver congestion
- Loss of muscle mass (wasting)
- In women, abnormal menstrual periods – Due to impairment in hormone production and metabolism
- In men, enlargement of the breasts (gynecomastia), scrotal swelling, or small testes – Due to impairment in hormone production and metabolism
Causes
Common causes of cirrhosis are:
- long-term alcohol abuse
- hepatitis B and C infection
- fatty liver disease
- toxic metals
- genetic diseases
Hepatitis B and C together are said to be the leading causesTrusted Source of cirrhosis. Other causes include:
Regularly drinking too much alcohol
Toxins, including alcohol, are broken down by the liver. However, if the amount of alcohol is too high, the liver will be overworked, and liver cells can eventually become damaged.
Heavy, regular, long-term drinkers are much more likely to develop cirrhosis, compared with other, healthy people. Typically, heavy drinking needs to be sustained for at least 10 years for cirrhosis to developTrusted Source.
There are generally three stages of alcohol-induced liver disease:
- Fatty liver: This involves a build-up of fat in the liver.
- Alcoholic hepatitis: This occurs when the cells of the liver swell.
- Approximately 10 to 15 percent of heavy drinkers will subsequently develop cirrhosis.
Hepatitis
Hepatitis C, a blood-borne infection, can damage the liver and eventually lead to cirrhosis. Hepatitis C is a common cause of cirrhosis in Western Europe, North America, and many other parts of the world. Cirrhosis can also be caused by hepatitis B and D.
Non-alcoholic steatohepatitis (NASH)
NASH, in its early stages, begins with the accumulation of too much fat in the liver. The fat causes inflammation and scarring, resulting in possible cirrhosis later on.
NASH is more likely to occur in people who are obese, diabetes patients, those with high fat levels in the blood, and people with high blood pressure.
Autoimmune hepatitis
The person’s own immune system attacks healthy organs in the body as though they were foreign substances. Sometimes the liver is attacked. Eventually, the patient can develop cirrhosis.
Some genetic conditions
There are some inherited conditions that can lead to cirrhosis, including:
- Hemochromatosis: Iron accumulates in the liver and other parts of the body.
- Wilson’s disease: Copper accumulates in the liver and other parts of the body.
Blockage of the bile ducts
Some conditions and diseases, such as cancer of the bile ducts, or cancer of the pancreas, can block the bile ducts, increasing the risk of cirrhosis.
Budd-Chiari syndrome
This condition causes blood clots in the hepatic vein, the blood vessel that carries blood from the liver. This leads to liver enlargement and the development of collateral vessels.
Other diseases and conditions that can contribute to cirrhosis include:
- cystic fibrosis
- primary sclerosing cholangitis, or hardening and scarring of the bile ducts
- galactosemia, or inability to process sugars in milk.
- schistosomiasis, a parasite commonly found in some developing countries
- biliary atresia, or badly formed bile ducts in babies
- glycogen storage disease, or problems in the storage and energy release vital for cell function
How cirrhosis is diagnosed
A diagnosis of cirrhosis begins with a detailed history and physical exam. Your doctor will take a complete medical history. The history may reveal long-term alcohol abuse, exposure to hepatitis C, family history of autoimmune diseases, or other risk factors. The physical exam can show signs such as:
- pale skin
- yellow eyes (jaundice)
- reddened palms
- hand tremors
- an enlarged liver or spleen
- small testicles
- excess breast tissue (in men)
- decreased alertness
Tests can reveal how damaged the liver has become. Some of the tests used for evaluation of cirrhosis are:
- complete blood count (to reveal anemia)
- coagulation blood tests (to see how quickly blood clots)
- albumin (to test for a protein produced in the liver)
- liver function tests
- alpha fetoprotein (a liver cancer screening)
Additional tests that can evaluate the liver include:
- upper endoscopy (to see if esophageal varices are present)
- ultrasound scan of the liver
- MRI of the abdomen
- CT scan of the abdomen
- liver biopsy (the definitive test for cirrhosis)
Complications from cirrhosis
If your blood is unable to pass through the liver, it creates a backup through other veins such as those in the esophagus. This backup is called esophageal varices. These veins are not built to handle high pressures, and begin to bulge from the extra blood flow.
Other complications from cirrhosis include:
- bruising (due to low platelet count and/or poor clotting)
- bleeding (due to decreased clotting proteins)
- sensitivity to medications (the liver processes medications in the body)
- kidney failure
- liver cancer
- insulin resistance and type 2 diabetes
- hepatic encephalopathy (confusion due to the effects of blood toxins on the brain)
- gallstones (interference with bile flow can cause bile to harden and form stones)
- esophageal varices
- enlarged spleen (splenomegaly)
- edema and ascites
Stages
Cirrhosis is graded on a scale called the Childs-Pugh score as follows:
- A: Relatively mild
- B: Moderate
- C: Severe
Doctors also classify cirrhosis as either compensated or decompensated. Compensated cirrhosis means that the liver can function normally despite the damage. A liver with decompensated cirrhosis cannot perform its functions correctly and usually causes severe symptoms.
Rather than being viewed in terms of its own stages, cirrhosis is often seen as a final stage of liver disease.
Risk factors
- Drinking too much alcohol. Excessive alcohol consumption is a risk factor for cirrhosis.
- Being overweight. Being obese increases your risk of conditions that may lead to cirrhosis, such as nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.
- Having viral hepatitis. Not everyone with chronic hepatitis will develop cirrhosis, but it’s one of the world’s leading causes of liver disease.
Treatment for cirrhosis
Treatment for cirrhosis varies based on what caused it and how far the disorder has progressed. Some treatments your doctor might prescribe include:
- beta blockers or nitrates (for portal hypertension)
- quitting drinking (if the cirrhosis is caused by alcohol)
- banding procedures (used to control bleeding from esophageal varices)
- intravenous antibiotics (to treat peritonitis that can occur with ascites)
- hemodialysis (to purify the blood of those in kidney failure)
- lactulose and a low protein diet (to treat encephalopathy)
Liver transplantation is an option of last resort, when other treatments fail.
All patients must stop drinking alcohol. Medications, even over-the-counter ones, should not be taken without consulting your doctor.
Preventing cirrhosis
Practicing safe sex with condoms can reduce the risk of getting hepatitis B or C. The U.S. Centers for Disease Control and PreventionTrusted Source recommend that all infants and at-risk adults (such as healthcare providers and rescue personnel) be vaccinated against hepatitis B.
Becoming a nondrinker, eating a balanced diet, and getting adequate exercise can prevent or slow cirrhosis. The World Health Organization reports that only 20 to 30 percent of people infected with hepatitis B will develop cirrhosis or liver cancer. The National Institute of Health reports that 5 to 20 percent of people infected with hepatitis C will develop cirrhosis over a period of 20 to 30 years.
Frequently Asked Questions About Cirrhosis
How is cirrhosis diagnosed?
Doctors may diagnose cirrhosis by evaluating any symptoms you may have, ordering blood tests, evaluating your medical history, and giving you a physical exam. However, the only way to definitively diagnose this condition is by having a liver biopsy. A doctor performs this biopsy by removing a liver tissue sample and analyzing it under a microscope. This test is the only one that confirms a patient has cirrhosis.
How does alcohol affect the liver?
Some people believe the type of alcohol consumed is the most critical factor in developing liver disease. However, the biggest risk factor is the amount you drink and the length of time you’ve been drinking. In fact, any amount of consumed alcohol can damage the liver. According to The National Institute of Alcohol Abuse and Alcoholism, moderate drinking means one drink a day for women and two drinks a day for men.
Can liver damage be reversed?
The liver is the only organ in the body that can regenerate. It can replace damaged tissue with new cells. Even if the patient experiences extreme liver damage and up to 50–60 percent of the cells are killed within a three or four day period, the liver can still repair itself completely if there aren’t additional complications.
But regeneration is impeded or prevented if scar tissue continues to develop. This occurs if the agent that damages the liver such as a drug, a virus, or alcohol continues to attack it. Cirrhosis is the severe scarring of the liver and is usually part of late stage liver disease. Once the patient experiences scar tissue, it’s difficult to reverse the process.
Can cirrhosis be prevented?
The most effective way to avoid damaging the liver is to take preventative measures to avoid the underlying causes of cirrhosis. Infections with hepatitis B or C can be avoided by practicing safe sex (i.e. protected sex), getting the necessary vaccinations, not engaging in drug use involving the sharing of needles or getting tattoos and body piercings with non-sterilised tools.
Eating a balanced diet (plenty of fruits, vegetables, whole grains, lean protein and limited aggravators such as caffeine and fatty foodstuffs), getting in enough exercise (and rest), maintaining a healthy weight range (the more body fat a person has, the more strain on the liver), avoiding tobacco use, and limiting alcohol consumption (moderation) can also reduce strain on the liver and all of its essential functions.