Everything you need to know about cirrhosis

Liver cirrhosis describes a condition in which scar tissue is progressively replacing healthy liver cells.

It is a progressive illness that develops slowly over many years. If allowed to continue, scar tissue build-up may eventually stop liver function.

To acquire cirrhosis, there must be long-term, ongoing damage to the liver. The condition becomes severe when healthy liver tissue is damaged and replaced by scar tissue, as it can start blocking blood flow through the liver.

This article of the Nccmed Knowledge Center describes the symptoms, causes , and treatments of liver cirrhosis, including complications information.

Symptoms

Blood test at lab
One of the primary methods of diagnosis is through a blood test.

Symptoms during the early stages of cirrhosis are uncommon.

However the ability of the liver to function properly is undermined as scar tissue accumulates. There may be the following signs and symptoms:

  • blood capillaries become visible on the skin on the upper abdomen.
  • fatigue
  • insomnia
  • itchy skin
  • loss of appetite
  • loss of bodyweight
  • nausea
  • pain or tenderness in the area where the liver is located
  • red or blotchy palms
  • weakness

The following signs and symptoms may appear as liver cirrhosis progresses:

  • accelerated heartbeat
  • personality changes
  • bleeding gums
  • lost mass in the body and upper arms
  • difficulties processing drugs and alcohol
  • confusion
  • dizziness
  • fluid buildup on ankles, feet, and legs, known as edema
  • hair loss
  • higher susceptibility to bruising
  • jaundice, or yellowing of the skin, whites of the eyes, and tongue
  • loss of sex drive
  • memory problems
  • more frequent fevers and increased risk of infection
  • muscle cramps
  • nosebleeds
  • pain in the right shoulder
  • breathlessness
  • stools become black and tarry, or very pale.
  • urine becomes darker.
  • vomiting blood
  • problems with walking and mobility

The liver tissue is replaced by fibrous scar tissue. It can also form regenerative nodules. These are lumps that show up as the liver tries to heal the damage.

Treatment

If a diagnosis of cirrhosis is made early enough, damage can be minimized by treating the underlying cause or the different complications that arise.

Treatment for alcohol addiction: It is necessary for the patient to stop drinking if the long-term, daily heavy alcohol intake has triggered their cirrhosis. For certain cases the doctor would prescribe an alcohol dependency treatment plan.

Medications: Drugs may be prescribed to the patient to control damage to the liver cells caused by hepatitis B or C.

Pressure control in portal vein: Blood can “back up” in portal vein, which supplies blood to the liver, causing high blood pressure in portal vein. Drugs are normally prescribed in certain blood vessels to regulate the increasing pressure. The aim is to avoid serious bleeding. An endoscopy can detect signs of bleeding.

If the patient vomits blood or passes bloody stools, they probably have esophageal varices. Requires urgent medical attention. Might assist with the following procedures:

Banding: A small band is placed around the base of the varices to control bleeding.

Injection sclerotherapy: After endoscopy, dye is injected into varicose veins, triggering blood clots and scar tissue to form. This helps to stem the bleeding.

A Sengstaken-Blakemore tube with a balloon: A balloon is placed at the end of the tube. If endoscopy does not stop the bleeding, tube down the patient’s throat and into their stomachs. The balloon is inflated. This places pressure on the varices and stop the bleeding.

Transjugular intrahepatic portosystemic stent shunt (TIPSS): If the therapies mentioned above did not stem the bleeding, the metal tube is passed in the liver to join the portal vein and liver, create a new route for blood to flow through. This reduces the pressure that causes varicose veins.

Other complications are treated in different ways:

Infections: The patient will be given antibiotics for infections that occur.

Liver cancer screening: the cirrhosis patients have a much higher risk of developing liver cancer. The doctor may recommend regular blood tests and imaging scans.

hepatic encephalopathy, or high levels of blood toxin: Medication can help treat excessive levels of toxins from blood.

In some cases, the damage caused by cirrhosis covers most of the liver and can not be reversed. In these cases, the person may need a new liver transplanted. It may take time to find a suitable donor, and this procedure is often recommended as a last resort.

Outlook

An individual with liver cirrhosis has a survival rate which depends on the extent of the scarring.

A 15-year follow-up study of 100 people with severe alcoholic cirrhosis in Norway showed that 71 percent of the study’s people had died within 5 years of diagnosis. The mortality rate was 90 per cent 15 years after diagnosis.

In people with cirrhosis, continued alcohol consumption and advanced age were linked to a higher mortality rate.

This is a limited study but it shows that cirrhosis is a severe condition that severely reduces life expectancy and impairs living quality.

Cirrhosis is responsible for 12 deaths in every 100,000 members of the population in the United States.

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 being either compensate or decompensated. Compensated cirrhosis means that despite the damage, the liver can still function normally. A liver with decompensated cirrhosis can not adequately conduct its functions and mostly causes severe symptoms.

Cirrhosis is often used as a final stage of liver disease rather than as being treated in terms of its own stages.

Causes

Frequent heavy drinking is a cause of cirrhosis
Frequent heavy drinking is a cause of cirrhosis

Common causes of cirrhosis are:

  • long-term alcohol abuse
  • hepatitis B and C infection
  • fatty liver disease
  • toxic metals
  • genetic diseases

Together, hepatitis B and C are said to be major causes of cirrhosis. Other causes are:

Regularly drinking too much alcohol

Toxins are broken down by the liver like alcohol. But, if the amount of alcohol is too high, the liver can get overworked and eventually the liver cells will get weakened.

Compared with other healthy people, heavy, frequent, long term drinkers are much more likely to develop cirrhosis. For cirrhosis to develop, heavy drinking typically needs to be sustained for at least 10 years.

Alcohol-induced liver disease typically has three stages:

  1. Fatty liver: This involves a build-up of fat in the liver.
  2. Alcoholic hepatitis: This occurs when the cells of the liver swell.
  3. Approximately 10 to 15 percent of heavy drinkers will subsequently develop cirrhosis.

Hepatitis

Blood-borne infection , hepatitis C will damage the liver and eventually lead to cirrhosis. In Western Europe , North America and many other parts of the world, hepatitis C is a common cause of cirrhosis. The hepatitis B and D may also cause cirrhosis.

Non-alcoholic steatohepatitis (NASH)

NASH starts with the accumulation of so much fat in the liver, in its early stages. The fat causes inflammation and scarring which eventually leads to possible cirrhosis.

NASH is more likely to occur in obese people, patients with diabetes, those with high blood fat levels and people with high blood pressure.

Autoimmune hepatitis

The person’s own immune system attacks healthy organs inside the body as if they were foreign substances. The liver often gets attacked. Cirrhosis will eventually develop in the patient.

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 bile duct cancer, or pancreatic cancer, may obstruct the bile ducts and raise the risk of cirrhosis.

Budd-Chiari syndrome

This condition triggers blood clots, the blood vessel that carries blood from the liver, in the hepatic vein. This leads to liver enlargement, and collateral vessel growth.

Other disorders and illnesses that may lead 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

Diagnosis

Since the disease has unusual early signs, cirrhosis is often diagnosed while the patient is being checked for some other disorder or illness.

Anyone with the following signs will see their doctor right away:

  • fever with shivering
  • shortness of breath
  • vomiting blood
  • dark or tarry stools
  • episodes of drowsiness or confusion

A doctor will examine the patient, and will feel around the area of the liver to decide whether it is enlarged. The patient will be asked about their history of medication and lifestyle like smoking.

The following tests may also be ordered:

  • Blood test: These measure how well the liver is functioning. If levels of alanine transaminase (ALT) and aspartate transaminase (AST) are high, the patient may have hepatitis.
  • Imaging tests: Ultrasound, CT, or MRI scans can be used to see whether the liver is enlarged and detect any scarring or nodules.
  • Biopsy: A small sample of liver cells is extracted and examined under a microscope. The biopsy can confirm cirrhosis and its cause.
  • Endoscopy: The doctor inserts a long, thin tube with a light and video camera at the end goes through the esophagus and into the stomach. The doctor looks out for swollen blood vessels called varices than can be a sign of cirrhosis.

Complications

Cirrhosis can lead to several other conditions, some of which are life threatening. These include:

Ascites or edema: Ascites is an accumulation of fluid in the abdomen, and edema is an accumulation of fluid in the legs. They can be treated with a diet low in salt and diuretics. In severe cases, fluid may have to be drained repeatedly. Sometimes surgery is needed.

Varices and portal hypertension: These are large swollen and esophagus and stomach veins. They can increase blood pressure in a vessel called the portal vein of that carries blood from the spleen and intestine to the liver. Varices can rupture, causing severe blood loss and blood clots.

Hepatic encephalopathy: This refers to high levels of toxins in the blood where the liver is filtering and not all of them successfully.

Hepatocellular carcinoma: This is the most common type of liver cancer. It is the third leading cause of cancer death worldwide.

hepatopulmonary syndrome (HPS): HPS Medical defined as a combination of liver disease, dilated blood vessels in the lungs, and abnormalities in gas exchange. It is linked to an increase in the mortality rate of people waiting for a liver transplant.

coagulation disorders: Cirrhosis can cause problems with blood clotting, resulting in potentially fatal bleeding and clotting.

Prevention

To stop cirrhosis, it is strongly recommended that you remain within acceptable regular and weekly alcohol limits. Please review the following useful information on drinking in moderation from the Centers for Disease Control and Prevention ( CDC).

Individuals suffering from cirrhosis should avoid alcohol altogether. Alcohol speed the disease progression up.

Be sure to take the following steps to prevent contracting hepatitis B and C:

  • Use a condom when having sex.
  • Do not share needles when injecting drugs.
  • People at risk of becoming infected with hepatitis B, such as healthcare workers, social care workers, and police personnel, can be vaccinated

Since cirrhosis can not be reversed or remedied once it reaches a certain stage, the best form of treatment is often considered to be prevention.

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