Liver Cirrhosis

Definition

Cirrhosis is a term that refers to a group of chronic diseases of the liver in which normal liver cells are damaged and replaced by scar tissue, decreasing the amount of normal liver tissue.

The distortion of the normal liver structure by the scar tissue interferes with the flow of blood through the liver. It also handicaps the function of the liver which, through the loss of normal liver tissue, leads to failure of the liver to perform some of its critically important functions.

Description

The normal liver is soft and smooth and is connected to the small intestine by the bile duct which carries the bile formed in the liver to the intestines.

Nearly all of the blood that leaves the stomach and intestines must pass through the liver. Acting as the body's largest chemical factory, it has thousands of functions including:

• The production of clotting factors, blood proteins, bile, and more than a thousand different enzymes

• The breakdown of old red blood cells

• The metabolism of cholesterol

• The storage of energy (glycogen) to fuel muscles

• Maintenance of normal blood sugar concentration

• The regulation of several hormones

• Detoxification of drugs and poisons, including alcohol

It is no wonder that liver disease can cause widespread disruption of body function. While many liver diseases can occur, one of the most important is cirrhosis.

Causes and Risk Factors

Chronic alcoholism is the most common cause of cirrhosis of the liver in the U.S. Cirrhosis also may result from chronic viral hepatitis (types B, C, and D). Liver injury that results in cirrhosis also may be caused by a number of inherited diseases such as cystic fibrosis, alpha-1 antitrypsin deficiency, hemochromatosis, Wilson's disease, galactosemia, and glycogen storage disease.

Two inherited disorders result in the abnormal storage of metals in the liver leading to tissue damage and cirrhosis. People with Wilson's disease store too much copper in their livers, brains, kidneys, and in the corneas of their eyes.

In another disorder, known as hemochromatosis, too much iron is absorbed, and the excess iron is deposited in the liver and in other organs, such as the pancreas, skin, intestinal lining, heart, and endocrine glands.

If a person's bile duct becomes blocked, this may also cause cirrhosis. The bile ducts carry bile formed in the liver to the intestines, where the bile helps in the digestion of fat.

In babies, the most common cause of cirrhosis is due to blocked bile ducts - a disease called biliary atresia. In this case, the bile ducts are absent or injured, causing the bile to back up in the liver. These babies are jaundiced (their skin is yellowed) after the first month of life. Sometimes, they can be helped by surgery in which a new duct is formed to allow bile to drain again from the liver.

In adults, the bile ducts may become inflamed, blocked and scarred due to another liver disease, primary biliary cirrhosis. Another type of biliary cirrhosis also may occur after a patient has gallbladder surgery in which the bile ducts are injured or tied off.

Symptoms

People with cirrhosis often have few symptoms at first. The two major problems that eventually cause symptoms are loss of functioning liver cells and distortion of the liver caused by scarring. The person may experience fatigue, weakness, and exhaustion. Loss of appetite is usual, often with nausea and weight loss.

In the later stages of cirrhosis, jaundice may occur, caused by the buildup of bile pigment that is passed by the liver into the intestine. Some people with cirrhosis experience itching due to bile products that are deposited in the skin. Gallstones often form in persons with cirrhosis because not enough bile reaches the gallbladder.

Treatment

Treatment depends on the type and stage of the cirrhosis. Its aim is to stop the progress of the cirrhosis, reversing (to whatever extent possible) the damage that has already occurred, and treating complications that are disabling or life-threatening. Stopping or reversing the process requires removal of the cause, as in the following cases:

In alcoholic cirrhosis: abstinence from alcohol and intake of an adequate wholesome diet.

In cirrhosis caused by viral hepatitis: use of experimental approaches that include the use of drugs to improve immune responses to viral infection (interferon) or to help destroy the virus (anti-viral compounds).

In certain types of cirrhosis caused by chronic hepatitis: corticosteroids are indicated.

In cirrhotic patients with jaundice: use of supplemental fat soluble vitamins may be helpful.

In Wilson's disease: removal of excessive copper.

In hemochromatosis: removal of excess iron.

Questions to Ask Your Doctor

What tests need to be done to diagnose and determine the cause?

How serious is the cirrhosis?

What treatment do you recommend?

Will this treatment stop the cause and reverse the damage?

Will any medication be prescribed? What are the side effects?