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 eighth leading cause of death by disease in the United States, killing about 25,000 people each year.
Cirrhosis can be caused by most of the risk factors for liver damage, with alcohol abuse and chronic hepatitis C being the most common causes in the United States. Severe reactions to prescription drugs, prolonged exposure to environmental toxins, and various infections can each lead to cirrhosis. Cirrhosis is a progressive condition that normally develops after years or even decades of abuse to the liver, at which point the liver's regenerative capacity has been diminished if not exhausted.
The early stages of the disease often produce no symptoms, but as the amount of healthy liver tissue decreases and liver function starts to fail a cirrhosis sufferer may experience exhaustion and fatigue, weakness, loss of appetite, nausea, and/or weight loss.
Sometimes cirrhosis is not detected until it has progressed to the point where any of the following complications have developed:
Edema and ascites, the accumulation of fluid in the legs and abdomen, respectively. Fluid in the abdomen may become infected with bacteria normally present in the intestines.
Bruising and bleeding due to impaired production of proteins necessary for blood clotting. Also, sometimes spider-like veins appear in the skin.
Redness of the palms (palmar erythema) and/or curling up of the fingers (Dupuytren's contracture of the palms).
Jaundice, or the yellowing of the skin and eyes caused by the restriction of bile flow.
Itching caused by bile products deposited in the skin.
Gallstones, when bile is prevented from reaching the gallbladder.
Toxins in the blood or brain, which can dull mental functioning and cause personality changes, coma, and even death. Signs of the buildup of toxins in the brain include neglect of personal appearance, unresponsiveness, forgetfulness, trouble concentrating, or changes in sleep habits.
Sensitivity to medication. As the liver fails to adequately filter medications from the blood, they can accumulate in the body.
Portal hypertension, or increased pressure in the portal vein, which flows into the liver.
Vomiting or coughing up blood. Varices, or enlarged blood vessels in the stomach and esophagus, can result from the backup in blood flow. The resulting strain on these vessels can cause them to burst and create a serious bleeding problem in the upper stomach or esophagus.
Feminization in men, including breast enlargement and shrinking of the testes.
Immune system dysfunction, leading to infection.
Abnormal nerve function
Kidney dysfunction and failure
A doctor may diagnose cirrhosis on the basis of any combination of the above symptoms, laboratory tests, the patient's medical history, and a physical examination. An ultrasound can confirm that a liver that feels harder or larger than usual is in fact enlarged. A blood test may indicate the presence of liver damage (although false negatives are not uncommon). A CAT scan or radioisotope scan may also be performed to identify areas of scarring. More intrusive diagnostic tests may include the use of a laparoscope (inserted through the abdomen to relay pictures back to a computer screen) and finally a liver biopsy, where a needle is used to extract a small sample of tissue from the liver for examination. The results of a biopsy are normally conclusive.
Prognosis and Treatment
As with most progressive conditions, the prognosis with cirrhosis worsens with the advancement of the disease and the development of serious complications (such as vomiting of blood or abnormal brain functioning). Liver cancer is always a concern for people with cirrhosis of any origin, although it is more common when the cirrhosis was caused by chronic hepatitis B or hepatitis C infection, iron overload (hemochromatosis), or long-standing glycogen storage disease.
There is no cure for cirrhosis. Scarring, once it has occurred, cannot be reversed. Treatment begins with the withdrawal of the cause of damage whenever possible in order to arrest the process of scarring. For example, a patient with alcoholic cirrhosis must stop drinking. Beyond this treatment will normally involve proper nutrition, including supplemental vitamins, and treating complications as they arise.
With advanced cirrhosis, a liver transplant may be required. Although the recurrence of cirrhosis in a transplanted liver is rare, it can happen in those cases where the underlying cause of damage cannot be removed (such as hepatitis B or C infection or continued exposure to toxins).
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