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Wednesday, November 26, 2008

Cirrhosis of the Liver

The liver weighs about 3 pounds and is the largest solid organ in the body.  It performs many important functions, such as:

1. Manufacturing blood proteins that aid in clotting, oxygen transport, and immune system function.

2. Storing excess nutrients and returning some of the nutrients to the bloodstream.

3. Manufacturing bile, a substance needed to help digest food.

4. Helpi
ng the body store sugar (glucose) in the form of glycogen.

5. Ridding the body of harmful substances in the bloodstream
, including drugs and alcohol.

6. Breaking down saturated fat and producing cholesterol.

What is cirrhosis?  

Cirrhosis ("suh-ROH-sus") is a very serious condition. It is a slowly progressing disease in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properly.

The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins. It also slows the production of proteins and other substances made by the liver.

According to the National Institutes of Health, cirrhosis is the 12th leading cause of death by disease.

When a person has cirrhosis, scar tissue (fibrosis) replaces healthy tissue and prevents the liver from working as it should. For example, the liver may stop producing enough clotting factors, which can lead to bleeding and bruising.

Bile and poisons may build up in the blood.

Scarring can also cause high blood pressure in the vein that carries blood from the intestines through the liver (portal hypertension). This can lead to severe bleeding in the digestive tract and other serious problems.

Cirrhosis can be deadly. But early treatment can help stop damage to the liver.

What Causes Cirrhosis of the Liver?

Hepatitis C, fatty liver, and alcohol abuse are the most common causes of cirrhosis of the liver in the U.S., but anything that damages the liver can cause cirrhosis, including:

1. Fatty liver associated with obesity and diabetes.

Chronic viral infections of the liver (hepatitis types B, C, and D. Hepatitis D is extremely rare).

Blockage of the bile duct, which carries bile formed in the liver to the intestines where it helps in the digestion of fats. In babies, this can be caused by biliary atresia in which bile ducts are absent or damaged, causing bile to back up in the liver. In adults, bile ducts may become inflamed, blocked, or scarred, due to another liver disease called primary biliary cirrhosis.

4. Repeated bouts of
heart failure with fluid backing up into the liver.

5. Certain
inherited diseases such as:
  • Cystic fibrosis.
  • Glycogen storage diseases, in which the body is unable to process glycogen, a form of sugar that is converted to glucose and serves as a source of energy for the body.
  • Certain inherited diseases such as:
    • Cystic fibrosis

    • Glycogen storage diseases - in which the body is unable to process glycogen, a form of sugar that is converted to glucose and serves as a source of energy for the body.

    • Alpha 1 antitrypsin deficiency - an absence of a specific enzyme in the liver.

    • Diseases caused by abnormal liver function, such as hemochromatosis, a condition in which excessive iron is absorbed and deposited into the liver and other organs, and Wilson's disease, caused by the abnormal storage of copper in the liver.
Although less likely, other causes of cirrhosis include reactions to prescription drugs, prolonged exposure to environmental toxins, or parasitic infections. 

Cirrhosis can have many causes.  Some of the main ones include:

1. Long-term, heavy use of alcohol - This is the most common cause of cirrhosis in the United States.  Alcoholic cirrhosis can develop after 10 or more years of heavy drinking (5 or more drinks a day for a man or 3 or more drinks a day for a woman).   

[See the picture to learn what one drinks.]

2. Chronic viral hepatitis - Cirrhosis develops in ab
out 10 to 20 out of 100 people with long-term (chronic) viral hepatitis (mainly hepatitis B or C).

Often it takes up to 20 years or longer for cirrhosis to develop from hepatitis. It may happen much sooner in people with viral hepatitis who drink a lot of alcohol.

Auto-immune diseases - such as auto-immune hepatitis or primary sclerosing cholangitis (PSC).  In some people, the immune system attacks the liver, causing inflammation that leads to cirrhosis.

Non-alcoholic steatohepatitis (NASH) - NASH is liver inflammation caused by a buildup of fat in the liver. Although the cause is not known, NASH seems to be related to some other conditions, including obesity, high cholesterol and triglycerides, and diabetes.

Blocked bile ducts - A disease called primary biliary cirrhosis develops when the ducts that carry bile out of the liver become inflamed and blocked. The exact cause is unknown, but it may be related to a problem with the immune system.

Inherited diseases - such as Wilson's disease, cystic fibrosis, or hemochromatosis. Cirrhosis can also be caused by a condition called alpha 1-antitrypsin deficiency, in which a protein collects in the liver and causes damage.

Less common causes of cirrhosis include severe reactions to medicines or long-term exposure to poisons, such as arsenic.  Some people have cirrhosis without an obvious cause. 

What are the symptoms?

You may not have symptoms in the early stages of cirrhosis. As it progresses, it can cause a number of symptoms, including:

1. Extreme tiredness and weakness
2. Nosebleeds and easy bruising
3. Weight loss
4. Belly pain or discomfort
5. Yellowing of the skin (jaundice)
6. Itching
7. Fluid buildup in the legs, called edema (say "ih-DEE-muh"), and in the belly, called ascites (say "uh-SIGH-teez")
8. Bleeding in the stomach or in the esophagus, the tube that leads from the mouth to the stomach
9. Confusion

How is cirrhosis diagnosed?

The doctor will start with a physical exam and questions about your symptoms and past health. If the doctor suspects cirrhosis, you may have blood tests and imaging tests, such as an ultrasound or CT scan. These tests can help your doctor find out what is causing the liver damage and how severe it is.

To confirm that you have cirrhosis, the doctor may do a liver biopsy. This means he or she will use a needle to take a sample of liver tissue for testing.

How is it treated? 

It is important to get treated for cirrhosis as soon as possible.  Treatment cannot cure cirrhosis, but it can sometimes prevent or delay further liver damage.

Treatment may include medicines, surgery, or other options, depending on what caused your cirrhosis and what problems it is causing.

There are things you can do to help limit the damage to your liver and control the symptoms:

1. Do not drink any alcohol. If you don't stop completely, liver damage may quickly get worse.

2. Talk to your doctor before you take
any medicines. This includes both prescription and over-the-counter drugs, vitamins, supplements, and herbs. Drugs that can be dangerous include acetaminophen (such as Tylenol) and anti-inflammatory drugs such as aspirin and ibuprofen (Advil or Motrin, for example).

3. Make sure your immunizations are up-to-date. You are at higher risk for infections.

4. Follow a low-sodium diet. This can help prevent fluid buildup, a common problem in cirrhosis that can become life-threatening.

Symptoms may not appear until a problem is severe, so it is important to see your doctor for regular checkups and lab tests. You may also need testing to check for possible problems such as:

5. Enlarged veins, called varices (say "VAIR-uh-seez"), in the digestive tract. Varices can bleed.

6. Liver cancer. People with cirrhosis are at higher risk for liver cancer.

If cirrhosis becomes life-threatening, then liver transplant may be an option. But transplant is expensive, organs are hard to find, and it doesn't always work. For these reasons, doctors have to decide who would get the most benefit from a liver transplant. Ask your doctor what steps you can take now to improve your overall health so you can be a good candidate for transplant.

If your cirrhosis is getting worse, you may choose to get care that focuses on your comfort and dignity.  Palliative care can provide support and symptom relief so you can make the most of the time you have left.

You may also want to make important end-of-life decisions, such as writing a living will.  It can be comforting to know that you will get the type of care you want.

It can be hard to face having cirrhosis. If you feel very sad or hopeless, be sure to tell your doctor.  You may be able to get counseling or other types of help.

Think about joining a support group.  Talking with other people who have cirrhosis can be a big help.

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