Diseases & Conditions

 

Liver Cirrhosis

Diseases & Conditions

 

What is cirrhosis?

Cirrhosis is a condition in which the liver is scarred and unable to function normally.

The liver is the body’s largest internal organ and has many functions including:

  • Making bile, which helps the body absorb fats, cholesterol and fat-soluble vitamins
  • Changing food into energy
  • Cleaning alcohol and poisons from the system

The scar tissue that forms in cirrhosis harms the structure of the liver, blocking the flow of blood through the organ and slows the processing of nutrients, hormones and medications.1

 

What causes cirrhosis?

Cirrhosis has many causes. It can result from direct injury to the liver cells (from hepatitis for example) or from indirect injury via inflammation or obstruction of bile ducts. Over time, ongoing injury leads to the development of scar tissue in the liver, a process called fibrosis. Mild to moderate amounts of fibrosis do not usually lead to symptoms. However, as the amount of fibrosis increases it can lead to disruptions in the normal shape and function of the liver.

Common causes of direct liver injury include:2

  • Chronic alcoholism: Alcoholism is a common cause of cirrhosis. Heavy alcohol use over several years damages the liver and leads to inflammation and cirrhosis.
  • Chronic viral hepatitis (types B, C and D): Hepatitis is due to a viral infection that causes inflammation, or swelling, and damage to the liver and this can lead to cirrhosis over the years.
  • Fatty liver associated with obesity and diabetes: Fat builds up in the liver and causes inflammation and liver cell damage in people who are overweight or obese, have diabetes, high blood cholesterol, high blood pressure, and have metabolic syndrome.
  • Autoimmune hepatitis: In this form, the body’s immune system attacks liver cells and causes inflammation, damage, and eventually cirrhosis.
  • Inflammation or obstruction of bile ducts: Bile ducts may become inflamed, blocked, or scarred, due to several liver diseases.

 

What are the signs and symptoms of cirrhosis?

Liver cirrhosis may show no symptoms at early stages. As scar tissue replaces healthy tissue and liver function worsens, a person may experience the following symptoms:3

  • Fatigue or feeling tired
  • Weakness
  • Severe itching over large parts of the body
  • Loss of appetite
  • Weight loss
  • Nausea
  • The buildup of fluid in the abdomen causing abdominal bloating
  • The buildup of abnormal amounts of fluid in the body (edema), most frequently in the feet, ankles or legs.
  • Digestive tract bleeding: Patients with cirrhosis can develop abnormally enlarged veins called varices inside the digestive system.
  • Jaundice is a condition that causes the skin and whites of the eyes to turn yellow

 

 How is cirrhosis diagnosed?

People with early-stage cirrhosis usually do not show symptoms. Often, cirrhosis is first detected through a routine blood test or checkup. The diagnosis is based on the presence of conditions that increase the likelihood of cirrhosis such as heavy alcohol use or obesity, and symptoms. Some exams may help diagnosing cirrhosis:5

Laboratory tests:

  • Blood test is performed in order to check for:
    • Liver function: Blood is checked for certain enzymes that may indicate liver damage
    • Kidney function:  Blood is checked for creatinine
    • Hepatitis B and C
    • Clotting proteins

Imaging and other tests:

  • Magnetic resonance elastography (MRE). This noninvasive advanced imaging test detects hardening or stiffening of the liver
  • Magnetic resonance imaging (MRI)
  • Computerized tomography (CT)
  • Ultrasound to create an image of the liver
  • Biopsy: A tissue sample may be used it to identify the severity, extent and cause of liver damage

 

How is cirrhosis treated?

Treatment options for cirrhosis depend on the cause and the level of liver damage and whether complications are present. Depending on the disease causing cirrhosis, medications or lifestyle changes may be used for treatment. In the early stages of cirrhosis, the goals of treatment are to slow the progression of tissue scarring in the liver. As cirrhosis progresses, a person may need additional treatments and hospitalization to manage complications. Treatment may include the following:4

  • Avoiding alcohol and illegal substances
  • Preventing problems with medications
  • Viral hepatitis vaccination and screening
  • Treating causes of cirrhosis (antiviral medications for hepatitis B and C for example)
  • Treating symptoms and complications of cirrhosis (treating itching and abdominal pain, portal hypertension, varices, edema, ascites, hepatic encephalography and hepatorenal syndrome)

The goals of treatment are to prevent further liver damage and reduce complications. When cirrhosis cannot be treated, the liver will not be able to work and a liver transplant may be needed. Doctors will determine whether a liver transplant is the best treatment option.

 

What are the complications of cirrhosis?

As the liver fails, complications may develop. Complications associated with cirrhosis of the liver include:4

  • Portal hypertension which is an increase in the blood pressure in the portal vein
  • Edema and Ascites caused by the buildup of fluids leading to spontaneous bacterial infection
  • Varices caused by portal hypertension leading to enlarged blood vessels
  • Enlargement of the spleen caused by portal hypertension
  • Hepatic encephalopathy, which is an accumulation of toxins in the brain due to the incapacity of the liver to remove the toxins from the blood. Decreased mental functions will appear including confusion, personality changes, memory loss, trouble concentrating and a change in sleep habits
  • Metabolic bone diseases, which is a disorder of bone strength usually caused by abnormalities of vitamin D, bone mass, bone structure, or minerals
  • Gallstones and bile duct stones caused by the inability of the bile to flow freely to and from the gallbladder, hence the bile hardens into gallstones
  • Bruising and bleeding occurs when the liver slows the production of proteins needed for blood clotting
  • Sensitivity to medications caused by the slow ability of the liver to filter medications from the blood
  • Insulin resistance and type 2 diabetes caused by the resistance to insulin
  • Liver cancer which is common in people with cirrhosis

 

References:

  1. Nishikawa, Hiroki, and Yukio Osaki. "Liver Cirrhosis: Evaluation, Nutritional Status, and Prognosis." Mediators of inflammation 2015 (2015).
  2. Cirrhosis of the Liver Stages, Causes, Symptoms, Treatments (WebMD). http://www.webmd.com/digestive-disorders/cirrhosis-liver
  3. William Sanchez, MD and Jayant A. Talwalkar, MD, MPH, FACG, Mayo College of Medicine, Rochester, MN – Published January 2009. Updated December 2012.
  4. Cirrhosis (Cirrhosis). http://www.niddk.nih.gov/health-information/health-topics/liver-disease/cirrhosis/Pages/facts.aspx#comps
  5. Cirrhosis (Tests and diagnosis). http://www.mayoclinic.org/diseases-conditions/cirrhosis/basics/tests-diagnosis/con-20031617