Liver Cirrhosis
Cirrhosis is a late-stage result of liver disease and its complications. You may not have symptoms in the beginning stages of the disease. Common causes include alcohol abuse, hepatitis and nonalcoholic fatty liver disease. Treatment depends on the cause of cirrhosis and how much damage exists. Liver transplantation may be an option if your liver is failing.
Causes
The most common causes of cirrhosis of the liver are
Alcohol abuse (alcohol-related liver disease caused by long-term use of alcohol).
Chronic viral infections of the liver (hepatitis B and hepatitis C).
Fatty liver associated with obesity and diabetes and not alcohol. This condition is called non-alcoholic steatohepatitis.
Anything that damages the liver can lead to cirrhosis. Other causes include:
Inherited diseases
Alpha-1 antitrypsin deficiency (build-up of an abnormal protein in the liver)
Hemochromatosis (excess iron stored in the liver).
Wilson disease (excess copper stored in the liver).
Cystic fibrosis (sticky, thick mucus builds up in the liver).
Glycogen storage diseases (liver can’t store or break down glycogen, a form of sugar).
Alagille syndrome (born with fewer than normal number of bile ducts; affects bile flow and causes jaundice).
Autoimmune hepatitis (your body’s own immune system attacks healthy liver tissue causing damage).
Diseases that damage or block bile ducts in the liver (tubes that carry bile from the liver to other parts of digestive system; bile helps digest fats):
Primary biliary cholangitis (bile ducts become injured, then inflamed, then permanently damaged).
Primary sclerosing cholangitis (inflammation of the bile ducts leads to scarring and narrowing of the ducts and buildup of bile in the liver).
Blocked bile duct (can cause infections, backup of products in the liver).
Biliary atresia (infants are born with poorly formed or blocked bile ducts, causing damage, scarring, loss of liver tissue and cirrhosis).
Chronic heart failure (causes fluid to back up in your liver, swelling in other areas of your body and other symptoms).
Rare diseases, such as amyloidosis, in which abnormal deposits in the liver of an abnormal protein called amyloid disrupts normal liver function.
Changes from liver diseases that lead to cirrhosis are gradual. Liver cells are injured and if injury from whatever cause continues, liver cells start to die. Over time, scar tissue replaces the damaged liver cells and the liver can’t function properly.
Risk factors
Abuse alcohol for many years.'
Have viral hepatitis.
Have diabetes.
Have obesty.
Inject drugs using shared needles.
Have a history of liver disease.
Have unprotected sex.
Symptoms
Early symptoms and signs of cirrhosis include:
Loss of appetite.
Feeling weak or tired.
Nausea.
Fever.
Unexpected weight loss.
As liver function gets worse, other more commonly recognized symptoms of cirrhosis appear including:
Easy bruising and bleeding.
Yellow tint to your skin or the whites of your eyes (jaundice).
Itchy skin.
Swelling (edema) in your legs, feet and ankles.
Fluid buildup in your belly/abdomen (ascites).
Brownish or orange color to your urine.
Light-colored stools.
Confusion, difficulty thinking, memory loss, personality changes.
Blood in your stool.
Redness in the palms of your hands.
Spider-like blood vessels that surround small, red spots on your skin (telangiectasias).
In men: loss of sex drive, enlarged breasts (gynecomastia), shrunken testicles.
In women: premature menopause (no longer having your menstrual period).
Diagnosis
Physical exam
- Your doctor will examine you, looking for the signs and symptoms of cirrhosis including: the red, spider-like blood vessels on your skin; yellowing of your skin or whites of your eyes; bruises on your skin; redness on your palms; swelling, tenderness or pain in your abdomen; enlarged firmer-feeling, bumpy texture to the lower edge of your liver (the part of your liver below the rib cage that can be felt).
Blood tests
If your doctor suspects cirrhosis, your blood will be checked for signs of liver disease. Signs of liver damage include:
Lower than normal levels of albumin and blood clotting factors (lower levels means your liver has lost its ability to make these proteins).
Raised levels of liver enzymes (suggests inflammation).
Higher level of iron (may indicate hemochromatosis).
Presence of autoantibodies (may indicate autoimmune hepatitis or primary biliary cirrhosis).
Raised bilirubin level (suggests liver isn’t working properly to remove bilirubin from the blood).
High white blood cell count (indicates an infection).
High creatinine level (a sign of kidney disease that suggests late-stage cirrhosis).
Lower levels of sodium (is an indicator of cirrhosis).
Raised level of alpha-fetoprotein (indicates presence of liver cancer).
Treatment
Treatments for the causes of cirrhosis are as follows:
Alcohol-related liver disease: If you’ve developed cirrhosis from alcohol abuse, stop drinking alcohol. If you need help, ask your healthcare provider for recommendations for alcohol addiction treatment programs.
Hepatitis B or C: Several approved antiviral medications are available to treat hepatitis types B and C.
Nonalcoholic fatty liver disease: Management of nonalcoholic fatty liver disease includes losing weight, following a healthy diet, getting physical exercise and following your provider’s instructions for managing your diabetes.
Inherited liver diseases: Treatment depends on the specific inherited disease. Treatments are aimed at treating symptoms and managing complications. Treatment of alpha-1 antitrypsin deficiency may include medicine to reduce swelling in your abdomen and legs, antibiotics to treat infections and other medicines for complications.
Autoimmune hepatitis: Treatment includes medications to suppress your immune system.
Diseases that damage or block bile ducts in the liver: Treatments include medications such as ursodiol (Actigall®) or surgery to open narrowed or blocked bile ducts.
Heart failure: Treatment depends on the cause and stage of your heart failure. Medications include drugs to treat high blood pressure, reduce cholesterol, remove excess fluids (edema) from your body and improve heart pumping function. Other treatments include implantation of devices to help pump blood or monitor heart rhythm, surgeries to unblock arteries or replace or repair heart valves and transplant surgery to replace your heart.
Medications that may be contributing to cirrhosis: Your provider will review all of your medications to determine if any are causing problems for your liver and if so, stop the drug, lower the dosage or change to a different drug if possible.