What is Cirrhosis?

Cirrhosis is a disease in which normal liver cells are damaged and replaced with scar tissue, disrupting liver function. It may be caused by direct injury to liver cells, or by indirect injury, such as inflammation or obstruction of the ducts that drain bile from the liver.

The liver is the largest internal organ in the body. It is located mainly in the upper right side of the abdomen, situated mostly under the lower ribs. It weighs about 3 pounds and is roughly the size of a football.

Most of the blood that leaves the stomach and intestines passes through the liver. The liver performs hundreds of functions necessary for survival, including:

• Producing blood proteins that regulate blood clotting
• Producing bile and enzymes necessary for digestion
• Metabolizing cholesterol
• Storing energy to fuel muscles
• Helping to maintain glucose (blood sugar) concentration
• Helping to regulate hormones
• Removing toxins from drugs and poisons, including alcohol

Under normal circumstances, the liver has the ability to heal itself by repairing or replacing damaged cells. With cirrhosis, the healing process is altered. Special cells, called stellate cells, increase dramatically in size and number and cause excess scar tissue to form. When scar tissue is present, it decreases the amount of normal tissue and interferes with normal blood flow through the liver which, in turn, causes liver function to deteriorate. Cirrhosis usually progresses slowly over time, but the damage done to the liver is irreversible.

How is it diagnosed?

Cirrhosis may be diagnosed by a physician during a physical examination that includes a medical history and list of medications. A physician can sometimes identify early stages of cirrhosis by gently pressing the abdomen to determine whether the liver is enlarged and firm. During later stages of the disease the liver shrinks, causing an enlarged spleen which a physician may also identify by gently touching the abdomen.

If a patient is suspected to have cirrhosis, blood tests may be performed. These can detect changes in the body that occur as a result of cirrhosis. Tests include:

• Hematology tests. Patients with cirrhosis are often anemic and also tend to have larger-than-normal spleens, which leads to abnormally low platelet counts. The loss of functioning liver leads to less clotting protein production and abnormal coagulation labs.
• Liver function test. When a liver is damaged, it releases enzymes, which may be detected with a blood test.
• Bilirubin test. Bilirubin (substance formed from the breakdown of red blood cells that gives bile its color) is processed in the liver and excreted in urine. When the liver is damaged, it cannot process bilirubin, leading to high levels of bilirubin in the blood.

Imaging tests that detect liver damage may also be performed. They include:

• Ultrasound. An imaging technology that uses sound waves to produce images of the shape and outline of various tissues and organs of the body.
• CAT scan (computed axial tomography). A test that allows for multiple x-rays to be taken from different angles around the patient. It creates images of organs and bones within the body.
• MRI (magnetic resonance imaging). Safe and noninvasive or minimally invasive imaging test that can help physicians diagnose diseases of numerous organs and vessels. It uses powerful magnets to produce images on a computer screen and film.
• Liver scan. A radioactive substance (radioisotope) that highlights the liver is injected into a vein. After the liver absorbs the substance, the liver is scanned and images are displayed on a computer screen.
• Laparoscopy. A laparoscope (thin, lighted tube with a tiny video camera) is inserted into the abdomen through a small incision. Images are displayed on a computer screen.

A liver biopsy is often performed to confirm a diagnosis of cirrhosis. During this procedure, a needle is inserted into the abdomen and a tiny sample of liver tissue is removed. The tissue is examined under a microscope for the presence of scarring or other signs of disease.

Tests may also be performed to screen for complications of cirrhosis, such as a CAT scan, upper endoscopy or capsule endoscopy for esophageal varices.

How is Cirrhosis treated?

There is no cure for cirrhosis. The liver is capable of repairing some damage, but it is limited. The focus of treatment is to prevent or delay further progression of the disease and to reduce complications. This may involve treating the underlying cause of the disease.

All patients, including those with cirrhosis caused by alcohol abuse, must stop drinking alcohol. Some patients require assistance to help them quit, which may involve a chemical dependency evaluation, intervention, counseling, support groups, outpatient treatment program or inpatient residential program. Other drugs that may be related to liver damage should also be avoided. These include acetaminophen, some other over-the-counter drugs and certain vitamin supplements.

Patients with cirrhosis, regardless of the cause of the disease, must follow a healthy diet because the liver requires nutrients to heal. In addition, patients should avoid eating raw seafood because of the potential presence of bacteria. A diet that restricts salt may also be recommended because of the potential for swelling (edema) and fluid in the abdomen (ascites).

Patients with cirrhosis caused by hepatitis may be treated with medication, such as interferon for viral hepatitis (hepatitis B or hepatitis C virus) or corticosteroids for autoimmune hepatitis.

When the liver is so severely damaged that it does not function, patients need a liver transplant. This involves removing the damaged liver and replacing it with one from an organ donor. Though liver transplantation is successful in a large number of patients, the number of patients who need a new liver is much larger than the number of donated organs. In addition, newer technologies, such as living donors who donate a portion of their liver to another person, are being performed. These transplants may become increasingly available to people seeking a liver.

Researchers are studying potential alternatives to a liver transplant, such as an experimental drug that has treated cirrhosis in mice.

Medications

• Iron supplements for anemia resulting from hemorrhage or poor nutrition.
• Diuretics to reduce fluid retention.
• Antibiotics, such as neomycin, to reduce ammonia buildup.
• Stool softeners.

Aldactone (Spironolactone), Imuran (Azathioprine), Revia (Naltrexone)

What might complicate it?

Almost all forms of cirrhosis are associated with portal hypertension, esophageal bleeding, enlarged spleen, fluid retention (ascites and edema), and coma. Other complications may include portal vein thrombosis (blood clot formation), the development of liver tumors, altered drug metabolism, spontaneous bacterial peritonitis in which fluid accumulating within the abdomen becomes infected, and hepatic encephalopathy in which the brain is poisoned by high blood levels of certain metabolic byproducts.

Alternatives

Differential diagnoses include other causes of liver cell injury, idiopathic portal hypertension, schistosomiasis, and congenital hepatic fibrosis.

Appropriate specialists

Gastroenterologist, pathologist, and general surgeon.

Activity

• Maintain as active a life as possible.
• Elevate swollen feet and legs when resting.

Diet

• In the early stages, eat a well-balanced diet that is high in carbohydrates, high in protein and low in salt.
• Late stages may require protein reduction.
• Vitamin and mineral supplements may be necessary.
• Don't drink alcohol.

Last updated 4 July 2015