Cirrhosis of Liver: Causes, Symptoms, Diagnosis

1. What is Cirrhosis of the Liver?

Cirrhosis is a complication of many liver diseases that is characterized by abnormal structure and function of the liver. The diseases that lead to cirrhosis do so because they injure and kill liver cells, and the inflammation and repair that is associated with the dying liver cells causes scar tissue to form. The liver cells that do not die multiply in an attempt to replace the cells that have died. This results in clusters of newly-formed liver cells (regenerative nodules) within the scar tissue. There are many causes of cirrhosis; they include chemicals (such as alcohol, fat, and certain medications), viruses, toxic metals (such as iron and copper that accumulate in the liver as a result of genetic diseases), and autoimmune liver disease in which the body’s immune system attacks the liver.

2. What cause cirrhosis of liver?

Cirrhosis has many causes. Chronic alcoholism and hepatitis C are the most common causes.

Alcoholic Liver Disease.
To many people, cirrhosis of the liver is synonymous with chronic alcoholism, but in fact, alcoholism is only one of the causes. Alcoholic cirrhosis usually develops after more than a decade of heavy drinking. The amount of alcohol that can injure the liver varies greatly from person to person. In women, as few as two to three drinks per day have been linked with cirrhosis and in men, as few as three to four drinks per day. Alcohol seems to injure the liver by blocking the normal metabolism of protein, fats, and carbohydrates.

Chronic Hepatitis C.
The hepatitis C virus ranks with alcohol as the major cause of chronic liver disease and cirrhosis in the United States. Infection with this virus causes inflammation of and low grade damage to the liver that over several decades can lead to cirrhosis.

Chronic Hepatitis B and D.
The hepatitis B virus is probably the most common cause of cirrhosis worldwide, but in the United States and Western world it is less common. Hepatitis B, like hepatitis C, causes liver inflammation and injury that over several decades can lead to cirrhosis. The hepatitis D virus is another virus that infects the liver, but only in people who already have hepatitis B.

Autoimmune Hepatitis.
This type of hepatitis is caused by a problem with the immune system.

Inherited Diseases.
Alpha-1 antitrypsin deficiency, hemochromatosis, Wilson’s disease, galactosemia, and glycogen storage diseases are among the inherited diseases that interfere with the way the liver produces, processes, and stores enzymes, proteins, metals, and other substances the body needs to function properly.

Nonalcoholic Steatohepatitis (NASH).
In NASH, fat builds up in the liver and eventually causes scar tissue. This type of hepatitis appears to be associated with diabetes, protein malnutrition, obesity, coronary artery disease, and corticosteroid treatment.

Blocked Bile Ducts.
When the ducts that carry bile out of the liver are blocked, bile backs up and damages liver tissue. In babies, blocked bile ducts are most commonly caused by biliary atresia, a disease in which the bile ducts are absent or injured. In adults, the most common cause is primary biliary cirrhosis, a disease in which the ducts become inflamed, blocked, and scarred. Secondary biliary cirrhosis can happen after gallbladder surgery, if the ducts are inadvertently tied off or injured.

Drugs, Toxins, and Infections.
Severe reactions to prescription drugs, prolonged exposure to environmental toxins, the parasitic infection schistosomiasis, and repeated bouts of heart failure with liver congestion can each lead to cirrhosis.

3. Cirrhosis of the Liver Symptoms

The symptoms of cirrhosis vary according to the different stages of cirrhosis. In the initial stage of cirrhosis, the patient may suffer from:

• Fatigue
• Dry Mouth
• Jaundice
• Enlarged liver
• Tenderness of the upper right abdomen
• Loss of appetite
• Itchy skin
• Edema and swelling in the ankles, legs and abdomen
• Light colored stools and brownish or orange tint urine
• Confusion, disorientation
• Blood in stools
• Fever

After the first cirrhosis stage, the liver disease progresses to the second stage. In the second stage of cirrhosis of liver the abnormal tissue form stiff bands of connective tissue called fibrosis. This fibrosis and inflammation spreads to the portal areas and periportal areas of the liver. In the stage three of cirrhosis, the areas of fibrosis merge together that causes enlargement in the liver. There is liver degradation that leads to reduced functioning of the liver. Thus, there is less absorbency of fat soluble vitamins and fats. The final liver cirrhosis stage is stage four. There are very less chances of survival at this stage. Only a liver transplant can save the patient. Thus, the life expectancy is less than 10 years for people in last stage of cirrhosis, also known as symptomatic stage of cirrhosis.

normal liver and liver with cirrhosis

4. How is cirrhosis diagnosed?

Testing is performed to confirm the diagnosis of cirrhosis, determine the underlying cause, determine the severity of cirrhosis, and monitor for complications.

Liver biopsy — The best way to confirm the diagnosis of cirrhosis is a liver biopsy. This procedure is discussed in depth in a separate article.

Imaging tests — Imaging tests, such as ultrasound, may be recommended to evaluate the condition of the liver or determine if there are cirrhosis-related complications. However, imaging tests are not usually performed to diagnose cirrhosis.

Blood tests — Blood tests may be performed to help determine the underlying cause of cirrhosis and to monitor the liver function over time

5. How is cirrhosis treated?

Treatment for cirrhosis cannot reverse liver damage, but it can stop or slow progression of the disease and reduce complications. Treatment depends on what is causing the cirrhosis and which particular complications, if any, have appeared.

In early cirrhosis, it may be possible to minimize damage to the liver by treating the underlying cause. For example:
Treatment for alcohol dependency.

People with cirrhosis caused by alcohol use need to stop drinking. If stopping alcohol use is difficult, your doctor may recommend a treatment program for alcohol addiction. Medications to control hepatitis. Medications may control damage to liver cells caused by hepatitis B or C.

Treatments for complications of cirrhosis. Your health care team will work to treat any complications of cirrhosis, such as:

Excess fluid in your body.
Fluid that accumulates in your abdomen (ascites) or your legs (edema) may be managed with a low-sodium diet and water pills. More severe fluid buildup may require procedures to drain the fluid or surgery to relieve pressure.

Increased pressure in the portal vein and surrounding small veins.
Blood pressure medications may control increasing pressure in the veins around your liver. This may prevent severe bleeding. Surgery to place a stent to hold open the portal vein also may be necessary. If you’ve been diagnosed with cirrhosis, you’ll likely undergo periodic endoscopy procedures to examine the veins in your esophagus and stomach for signs of bleeding.

Infections.
You may receive antibiotics or other treatments for infections.
Liver cancer screening. Your doctor may recommend periodic blood tests and ultrasound exams to look for signs of liver cancer.

High levels of toxins in the blood (hepatic encephalopathy)
Your doctor may instruct you to watch for signs and symptoms of hepatic encephalopathy, which can range from confusion and mild changes in your thinking to coma. Medications can help treat hepatic encephalopathy.

Liver transplant surgery
People with advanced cirrhosis may require liver transplants if their livers are no longer functioning (liver failure). A liver transplant is a procedure to remove your liver and replace it with a whole liver from a deceased donor or with part of a liver from a living donor.

6. Prevention of cirrhosis

Alcohol – do not exceed the recommended daily/weekly alcohol limit.

Men: maximum of 21 units per week, or three/four units per day
Women: maximum of 14 units per week, or two/three units per day

Individuals who have cirrhosis should abstain from alcohol completely. Alcohol accelerates the progression of the disease.

Hepatitis B and C

Use a condom when having sex

Do not share needles when injecting drugs

People at risk of becoming infected with hepatitis B, such as health care workers, social care workers, and police personnel can be vaccinated (there is currently no vaccine for hepatitis C)