Cirrhosis

Definition

Cirrhosis is scarring of the liver and poor liver function as a result of chronic liver disease.

Causes, incidence, and risk factors

Cirrhosis is caused by chronic liver disease. Common causes of chronic liver disease in the U.S. include:

• Hepatitis C infection
• Long-term alcohol abuse (see alcoholic liver disease)

Other causes of cirrhosis include:

• Autoimmune inflammation of the liver
• Disorders of the drainage system of the liver (the biliary system)
• Hepatitis B
• Medications
• Metabolic disorders of iron and copper (hemochromatosis and Wilson's disease)

Symptoms

• Bleeding hemorrhoids
• Confusion
• Impotence and loss of interest in sex
• Jaundice
• Nausea and vomiting
• Small, red spider-like blood vessels on the skin
• Swelling of the legs
• Vomiting blood
• Weakness
• Weight loss

Other symptoms that may occur with this disease:

• Abdominal indigestion
• Abdominal pain
• Breast development in males (gynecomastia)
• Decreased urine output
• Fevers
• Nosebleed or bleeding gums
• Overall swelling
• Pale or clay colored stools

Symptoms may develop gradually, or there may be no symptoms.

Signs and tests

During a physical examination the health care provider may find:

• An enlarged liver or spleen
• Excess breast tissue
• Excess fluid in the tissues lining the abdomen (ascites)
• Expanded (distended) abdomen
• Reddened palms
• Red spider-like blood vessels on the skin
• Smaller (contracted) fingers
• Small testicles in men
• Widened (dilated) veins in the abdomen wall
• Yellow eyes or skin (jaundice)

Tests can reveal liver problems including:

• Anemia (detected on a CBC)
• Coagulation abnormalities
• Elevated liver enzymes
• Elevated bilirubin
• Low serum albumin
• Enlarged liver (seen with an abdominal x-ray)

A liver biopsy confirms cirrhosis.

This disease may also affect the results of the following tests:

• Alpha-fetoprotein
• Cholesterol test
• Complement
• Renin
• Serum magnesium - test

Treatment

Treatment attempts to manage the complications of cirrhosis and prevent further liver damage. It may include stopping certain medications and alcohol that caused the problem.

Other treatment options are available for the complications of cirrhosis:

• Bleeding varices -- upper endoscopy with banding and sclerosis
• Excess abdominal fluid (ascites) -- diuretics, restrict fluid and salt, and remove fluid (paracentesis)
• Coagulopathy -- blood products or vitamin K
• Encephalopathy -- lactulose medication and antibiotics
• Infections -- antibiotics

If cirrhosis progresses and becomes life-threatening, a liver transplant should be considered.

Support Groups

The stress of illness can often be eased by joining a support group whose members share common experiences and problems. See liver disease - support group.

Expectations (prognosis)

Cirrhosis is caused by irreversible scarring of the liver. Once cirrhosis develops, it is not possible to heal the liver or return its function to normal. It is a serious condition that can lead to many complications.

A liver specialist (hepatologist) should help evaluate and manage complications. Cirrhosis may result in the need for a liver transplant.

Complications

• Bleeding disorders (coagulopathy)
• Bleeding esophageal varices
• Build-up of fluid in the abdomen (ascites) and infection of the fluid (bacterial peritonitis)
• Coma
• Hepatic encephalopathy
• Increased pressure in the blood vessels of the liver (portal hypertension)
• Kidney failure (hepatorenal syndrome)
• Liver cancer (hepatocellular carcinoma)
• Mental confusion or change in the level of consciousness (hepatic encephalopathy)
• Sepsis

A procedure called TIPS (transjugular intrahepatic portosystemic shunt) is sometimes necessary as a result of many of these complications.

Calling your health care provider

Call your health care provider if:

• You develop symptoms of cirrhosis

Call your provider, or go to the emergency room or call the local emergency number (such as 911) if:

• You have rapid changes in alertness or consciousness
• You vomit blood

Prevention

Don't drink alcohol heavily. If you find that your drinking is getting out of hand, seek professional help.

Avoid intravenous drug use (or only use clean needles and never share other equipment) to reduce the risk of hepatitis B and C.

Some research indicates that hepatitis C may be spread via shared use of straws or items used to snort cocaine or other drugs. Avoid snorting drugs or sharing any related paraphernalia. If you have a problem with illicit drugs, seek help.

References

Carithers RL, McClain C. Alcoholic Liver Disease. In: Feldman M, Friedman LS, Brandt LJ. Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2006:chap 81.