Cirrhosis of the liver is when the liver is permanently scarred as a result of long-term liver injury. Common causes of long-term liver injury leading to cirrhosis include chronic alcohol abuse, chronic hepatitis B, hepatitis C, and fatty liver disease. The liver is involved in many complex functions essential to life. Blood returning to the heart from the digestive system passes through the liver. The liver extracts nutrients and processes them for later use, makes bile to help absorb nutrients and vitamins, and removes medication and toxic waste products from the blood. Cirrhosis occurs when the normal structure of the liver is disrupted by bands of scar tissue. This impairs the liver's ability to perform these essential functions. In the early stages symptoms may be absent or nonspecific. Fatigue or tiredness is a common symptom of cirrhosis. Fluid retention or edema primarily in the legs may also occur in the early stages. Fluid accumulation in the belly (abdominal cavity) is called ascites. Initially this may be only detected by imaging (ultrasound or CT) if there is a small amount of fluid. However, large-volume ascites can be detected on physical examination. When this occurs the fluid may need to be by drained by inserting a small catheter into the abdominal cavity (paracentesis). If abdominal pain and/or fever develop this may indicate an infection in the fluid (peritonitis) and require hospitalization and antibiotics. Dietary salt restriction and diuretic medication ("water pills") are prescribed to control the fluid retention.
Later stages of cirrhosis include jaundice, yellow discoloration of the skin and whites of the eyes, along with dark urine. Itching over large parts of the body can also occur. Bleeding from the digestive tract from enlarged veins (varices) that can develop in the lower esophagus and stomach. The bleeding from varices is a medical emergency and requires hospitalization. Varices typically do not cause any symptoms until they rupture and bleed. Once the diagnosis of cirrhosis is made your physician may schedule an upper endoscopy to look for varices, and if present, place bands on them, which will cause them to scar and reduce the chance of bleeding.
Another complication of cirrhosis may include the development of mental slowing, sleep disturbance, and increased drowsiness. This is called hepatic encephalopathy. This occurs when the cirrhotic liver is unable to remove toxic waste products from the blood. In severe cases, patients can become unresponsive and develop a coma. Hepatic encephalopathy can be treated and prevented with medications, such as Xifaxan an oral non-absorbed antibiotic, and lactulose an oral liquid laxative. Avoiding narcotics and benzodiazepines can reduce one's chance of developing hepatic encephalopathy.
There are other causes of chronic liver disease leading to cirrhosis. Your doctor will order a series of tests, blood work, and imaging tests. A liver biopsy, insertion of a small needle through the skin into the liver to obtain a small piece of liver tissue for microscopic examination, may be performed. This can confirm cirrhosis, but also help determine the cause of cirrhosis.
Whenever possible the underlying cause of cirrhosis should be treated. Some conditions improve with medical therapy and treatment can improve or delay worsening of liver function. Those with alcoholic cirrhosis should stop all alcohol consumption. Patients with other forms of cirrhosis should also avoid alcohol. Liver function may improve with total avoidance of alcohol. Alcohol also accelerates liver damage in those with hepatitis C virus infection.
Patients with cirrhosis are at risk for developing hepatocellular carcinoma, a cancer originating in the liver. Early detection improves chances of successful treatment. These liver cancers typically do not cause symptoms when they are small. Your doctor will recommend imaging of your liver every six months with ultrasound, CT or MRI. For some patients with severe liver disease, a liver transplant may be considered. It is extremely important to keep your regular appointments to monitor for progression of your liver disease and if progression occurs, you may be referred to a liver transplant center.
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