Cirrhosis is the result of chronic liver disease that causes scarring of the liver (fibrosis - nodular regeneration) and liver dysfunction. This often has many complications, including accumulation of fluid in the abdomen (ascites), bleeding disorders (coagulopathy), increased pressure in the blood vessels (portal hypertension), and confusion or a change in the level of consciousness (hepatic encephalopathy).
Causes, incidence, and risk factors
Cirrhosis is caused by chronic liver disease. Common causes of chronic liver disease in the US include hepatitis C infection and long-term alcohol abuse. (See Alcoholic liver disease.) Hepatitis C is now the most common reason for liver transplantation in the US. Other causes of cirrhosis include hepatitis B, medications, autoimmune inflammation of the liver, disorders of the drainage system of the liver (the biliary system), and metabolic disorders of iron and copper (hemochromatosis and Wilson’s disease).
- Swelling of the legs
- Vomiting blood
- Small, red spider-like blood vessels on the skin
- Weight loss
- Nausea and vomiting
- Impotence and loss of interest in sex
- Bleeding hemorrhoids
Additional symptoms that may be associated with this disease:
- Urine output, decreased
- Swelling, overall
- Stools, pale or clay colored
- Nosebleed or bleeding gums
- Gynecomastia (breast development in males)
- Abdominal pain
- Abdominal indigestion
Symptoms may develop gradually, or there may be no symptoms.
Signs and tests
A physical examination may reveal an enlarged liver or spleen, distended abdomen, yellow eyes or skin (jaundice), red spider-like blood vessels on the skin, excess breast tissue, small testicles in men, reddened palms, contracted fingers, or dilated abdominal wall veins.
Tests can reveal liver problems including:
- Anemia (detected on a CBC)
- Coagulation abnormalities
- Elevated liver enzymes
- Elevated bilirubin
- Serum albumin low
- Enlarged liver (seen with an abdominal x-ray)
A liver biopsy confirms cirrhosis.
This disease may also alter the results of the following tests:
- Cholesterol test
- Serum magnesium - test
Treatment is directed at managing the complications of cirrhosis and preventing further liver damage.
- Offending medications and alcohol are stopped.
- Bleeding varices are treated by upper endoscopy with banding or sclerosis.
- Ascites (excess abdominal fluid) is treated with diuretics, fluid and salt restriction, and removal of fluid (paracentesis).
- Coagulopathy may be treated with blood products or vitamin K.
- Encephalopathy is treated with the medication lactulose - sometimes antibiotics are used and patients should avoid a diet high in protein.
- Infections are treated with antibiotics.
- If cirrhosis progresses and becomes life-threatening, a liver transplant should be considered.
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.
Survival depends on the severity of complications of cirrhosis and the underlying causes.
- Bleeding esophageal varices
- Portal hypertension
- Hepatic encephalopathy
- Mental confusion
- Abdominal fluid retention (ascites) and infection of the fluid (bacterial peritonitis)
- Liver cancer (hepatocellular carcinoma)
- Kidney failure (hepatorenal syndrome)
Calling your health care provider
Call your health care provider if symptoms develop that are suggestive of cirrhosis.
Call your provider, or go to the emergency room or call the local emergency number (such as 911) if vomiting blood or if rapid changes in alertness or consciousness occur.
Don’t drink heavily. If you find that your drinking is getting out of hand, seek professional help. Avoiding intravenous drug use (or only using clean needles and never sharing other equipment) will 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.
by Brenda A. Kuper, M.D.