Cirrhosis:

What is cirrhosis?

The liver is the largest organ in the body, and is essential in keeping the body functioning properly.  The liver removes or neutralizes poisons from the blood, produces immune agents in order to control infection, and removes germs and bacteria from the blood.  Proteins that regulate blood clotting and produce bile to help absorb fats and fat-soluble vitamins are also made by the liver.  In cirrhosis of the liver, scar tissue replaces normal, healthy tissue, and blocks the flow of blood through the organ, preventing it from functioning as normal.  Cirrhosis is the twelfth leading cause of death by disease, killing about 26,000 people each year. 

What causes cirrhosis?

There are many causes of cirrhosis.  Within the United States, chronic alcoholism and hepatitis C are the most common causes.  Other common causes of cirrhosis include:  

• Alcoholic liver disease:  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 causes harm to the liver by blocking the normal metabolism of protein, fats, and carbohydrates.
• Autoimmune hepatitis:  this disease occurs when the immune system attacks the liver and causes inflammation, damage, and eventually scarring and cirrhosis.
• 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. 
• Chronic hepatitis C:  the hepatitis C virus is a major cause of chronic liver disease and cirrhosis.  Infection with this virus causes inflammation of the liver and can eventually damage the liver.
• Chronic hepatitis B and D:  the hepatitis B virus is also a very common cause of cirrhosis.  Similar to hepatitis C, the hepatitis B virus 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.
• 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.
• Nonalcoholic steatohepatitis (NASH):  In NASH, fat builds up in the liver and eventually causes scar tissue.  This type of hepatitis is associated with diabetes, protein malnutrition, obesity, coronary artery disease, and treatment with corticosteroid medications.

What are the symptoms of cirrhosis?

Symptoms of cirrhosis are usually caused by the loss of functioning liver cells or swelling due to scarring of the liver.  The liver enlarges during the early stages of illness. The palms of the hands turn red and patients may experience various symptoms such as:

• Constipation 
• Diarrhea
• Dull abdominal pain
• Fatigue
• Indigestion
• Loss of appetite
• Nausea
• Vomiting
• Weakness
• Weight loss

As the disease progresses, the spleen enlarges and fluid collects in the abdomen (ascites) and legs (edema).  Spider-like blood vessels appear on the chest and shoulders, and bruising becomes very common.  Men may experience the loss of their chest hair, as well as breasts growth and the shrinkage of their testicles.  Women may have menstrual irregularities.  Cirrhosis can cause extremely dry skin and intense itching.  The whites of the eyes and the skin may turn yellow (jaundice), and urine may be dark yellow or brown.  Stools may be black or bloody.  Sometimes the patient develops persistent high blood pressure due to the scarring (portal hypertension).  This type of hypertension can be life threatening and may can cause veins to enlarge in the stomach and in the esophagus. These enlarged veins are called varices, and they can rupture and bleed massively. 

Other symptoms of cirrhosis include:

• Anemia
• Bleeding gums
• Decreased interest in sex
• Fever
• Fluid in the lungs
• Hallucinations
• Extreme fatigue
• Lightheadedness
• Muscle weakness
• Painful nerve inflammation
• Slurred speech
• Tremors
  

Treatment options:

Currently, there is no treatment for cirrhosis or the scarring in the liver that has already occurred. There is however, treatment that may be able to prevent or delay further liver damage. The main components of treatment include: 

• Treating the cause of cirrhosis, when possible, to prevent further liver damage
• Avoiding substances that may further damage the liver, especially alcohol
• Preventing and treating the symptoms and complications of cirrhosis
• Having a liver transplant if your liver damage becomes severe, provided you are a suitable candidate for liver transplantation and a liver is available.

Additional patient resources:

• Functions of the liver
• The American Liver Foundation
• Mayo Clinic
• eMedicine Health
• More patient resources

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Last Revised: 08/14/2006