• Cirrhosis


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

    Alternative Names

    Liver cirrhosis

    Causes

    Cirrhosis is caused by chronic liver disease. Common causes of chronic liver disease in the United States 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), such as primary biliary cirrhosis and primary sclerosing cholangitis
    Hepatitis B
    Medications
    Metabolic disorders of iron and copper (hemochromatosis and Wilson’s disease)
    Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH)

    Symptoms

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

    When symptoms do occur, they can include:

    Abdominal indigestion or pain
    Confusion or problems thinking
    Impotence, loss of interest in sex, and breast development (gynecomastia) in men
    Nausea and vomiting
    Nosebleeds or bleeding gums
    Pale or clay-colored stools
    Small, red spider-like blood vessels on the skin
    Swelling or fluid buildup of the legs (edema) and in the abdomen (ascites)
    Vomiting blood or blood in stools
    Weakness
    Weight loss
    Yellow color in the skin, mucus membranes, or eyes (jaundice)

    Tests & diagnosis

    During a physical examination the health care provider may find:

    An enlarged liver or spleen
    Excess breast tissue
    Expanded (distended) abdomen, as a result of too much fluid
    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)
    Clotting problems
    Liver function problems (detected on liver function tests)
    Low serum albumin

    The following tests may be used to evaluate the liver:

    Magnetic resonance imaging (MRI) of the abdomen
    Computed tomography (CT) of the abdomen
    Ultrasound of the abdomen

    A liver biopsy confirms cirrhosis.

    Some patients will be screened for liver cancer every six months. Your doctor will use a blood test to check for levels of alpha fetoprotein and will do an imaging test (ultrasound, MRI, or CT scan).

    Treatment

    All patients with cirrhosis can benefit from certain lifestyle changes, including:

    Stop drinking alcohol.
    Limit salt in the diet.
    Eat a nutritious diet.
    Get vaccinated for influenza, hepatitis A and hepatitis B, and pneumococcal pneumonia (if recommended by your doctor).
    Tell your doctor about all prescription and nonprescription medications, and any herbs and supplements you take now or are thinking of taking.

    Other treatment options are available for the complications of cirrhosis:

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

    A procedure called transjugular intrahepatic portosystemic shunt (TIPS) is sometimes necessary for bleeding varices or ascites.

    When cirrhosis progresses to end-stage liver disease, patients may be candidates for a liver transplant.

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

    Complications

    Bleeding disorders (coagulopathy)
    Buildup of fluid in the abdomen (ascites) and infection of the fluid (bacterial peritonitis)
    Enlarged veins in the esophagus, stomach, or intestines that bleed easily (esophageal varices)
    Increased pressure in the blood vessels of the liver (portal hypertension)
    Kidney failure (hepatorenal syndrome)
    Liver cancer (hepatocellular carcinoma)
    Mental confusion, change in the level of consciousness, or coma (hepatic encephalopathy)

    When to contact a doctor

    Call your health care provider if:

    You develop symptoms of cirrhosis

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

    Abdominal or chest pain
    Abdominal swelling or ascites that is new or suddenly becomes worse
    A fever (temperature greater than 101 °F)
    Diarrhea
    New confusion or a change in alertness, or it gets worse
    Rectal bleeding, vomiting blood, or blood in the urine
    Shortness of breath
    Vomiting more than once a day
    Yellowing skin or eyes (jaundice) that is new or suddenly becomes worse

    Prevention

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

    Measures for preventing the transmission of hepatitis B or C include:
    Avoid sexual contact with a person who has acute or chronic hepatitis B or C.
    Use a condom and practice safe sex.
    Avoid sharing personal items, such as razors or toothbrushes.
    Do not share drug needles or other drug paraphernalia (such as straws for snorting drugs).
    Clean blood spills with a solution containing 1 part household bleach to 10 parts water.