DEFINITION
Cirrhosis is scarring of the liver caused by prolonged exposure to viruses, toxins or, less-commonly, by autoimmune inherited metabolic disease of the liver. As cirrhosis advances, liver function worsens and may progress to liver failure and death.
Alternate name: liver cirrhosis
CAUSES
The main causes of cirrhosis are the same causes of chronic liver disease and may include:
- Hepatitis C
- Hepatitis B
- Alcoholic liver disease
Other causes of cirrhosis are:
- Autoimmune hepatitis
- Metabolic disorders of iron and copper (hemochromatosis and Wilson's disease)
- Disorders of the drainage system of the liver (the biliary system)
- Primay biliary cirrhosis
- Primary sclerosing cholangitis
- Non-alcoholic steatohepatitis
SYMPTOMS
- Abdominal pain or tenderness, particularly in the right-upper quadrant
- Enlarged abdomen
- Easy bruising or bleeding
- Jaundice (a yellow discoloration of the skin and eyes)
- Ascites
- Swelling of the leg
- Vomiting blood
- Confusion
- Jaundice
- Small, red spider-like blood vessels on the skin
- Weakness
- Weight loss
Other symptoms that may occur with this disease:
- Abdominal indegestion
- Breast development in males (gynecomastia)
- Decreased urine output
- Fevers
- Nosebleeds or bleeding gums
- Overall swelling
- Pale or clay-colored stools
The above symptoms may gradually develop. Some patients with cirrhosis may have no symptoms until a relatively advanced stage of the disease.
DIAGNOSIS
During a physical examination, the physician may find:
- An enlarged liver
- An enlarged spleen
- Excessive fluid in the abdomen (ascites) causing an expanded abdomen
- Reddened palms
- Red spider-like blood vessels on the skin
- Yellow eyes (jaundice)
- Confusion (encephalopathy)
BLOOD TESTS
- Low red blood cells (anemia)
- Low white blood cells
- Low platelet counts
- Elevated AST and ALT
- Elevated bilirubin
- Evidence of hepatitis C (anti-HCV positive)
- Evidence of hepatitis B (HB'sAg, positive)
- Poor tests for blood cogulation (prothrobin time)
- Elevated alfafetoprotein test
TREATMENT
- Stop offending medications
- Stop alcohol intake
- Treat for hepatitis B
- Treat for hepatitis C -- only if the liver disease is stable, and under the strict supervision of a liver specialist
TREATMENT OF COMPLICATIONS
- Bleeding esophageal varices (i.e. GI bleeding) - upper endoscopy with banding and sclerosis
- Ascites (excessive abdominal fluid) - diruetics (water pills), restricted-salt diet, removal of fluid (paracentesis)
- Encephalopathy (confusion) - lactulose medications, antibiotics, low-protein diet
- Any bacteria in the body - antibiotics
- Blood coagulation abnormalities - Vitamin K or blood products
Cirrhosis will progress to liver failure or development of primary liver cancer. Treatment for liver failure is liver transplantation.
