Description

Advanced cirrhosis, scarring of the liver caused by many diseases and conditions, including hepatitis or alcohol use disorder.

Each time that the liver is injured — whether by alcohol use disorder, or other cause, such as infection tries to repair itself. In the process, scar tissue forms. As the cirrhosis gets worse, more and more scar tissue, which makes it difficult for the liver to do its job. Advanced cirrhosis is life-threatening.

The liver damage caused by cirrhosis generally can't be undone. But if liver cirrhosis is diagnosed and the underlying cause is treated, further damage can be limited. In rare cases, can be reversed.

Symptoms

Cirrhosis often has no symptoms until liver damage is severe. When present, symptoms may include:

  • Extreme tiredness.
  • Easy bruising or bleeding.
  • Loss of appetite.
  • Nausea.
  • Swelling in the legs, feet or ankles, called edema.
  • The loss of weight.
  • Itching in the skin.
  • Yellowing of the skin and eyes called jaundice.
  • Accumulation of fluid in the abdomen, called ascites (uh-SAHY-teez).
  • Spiderlike blood vessels on the skin.
  • Redness on the palms of the hands.
  • Pale nails, especially the thumb and the index finger.
  • The disco of the fingers of the hands, in which the tips of the fingers out and become more round than usual.
  • For women, the absence or loss of periods not related to menopause.
  • For men, the loss of sex drive, testicular shrinkage or enlargement of the breast, known as gynecomastia.
  • Confusion, drowsiness, or difficulty speaking.

When to see a doctor

Make an appointment with a health care professional if you have any of the symptoms listed above.

Causes

A wide range of diseases and conditions can damage the liver and lead to cirrhosis. Some of the causes include:

  • Long-term abuse of alcohol.
  • Course of viral hepatitis (hepatitis B, C and D).
  • The metabolic dysfunction associated with the steatotic liver disease — formerly called non-alcoholic fatty liver — a condition in which fat accumulates in the liver.
  • Hemochromatosis, a disease that causes the accumulation of iron in the body.
  • Autoimmune hepatitis, which is a disease of the liver caused by the body's immune system.
  • The destruction of the bile ducts caused by primary biliary cholangitis.
  • The hardening and scarring of the bile ducts caused by primary sclerosing cholangitis.
  • Wilson's disease, a condition in which copper accumulates in the liver.
  • Cystic fibrosis.
  • Alpha-1 antitrypsin deficiency.
  • Little formed in the bile ducts, a condition known as biliary atresia.
  • Disorders of sugar metabolism such as galactosemia or glycogen storage disease.
  • Alagille syndrome, a genetic digestive disorder.
  • The infection, such as syphilis and brucellosis.
  • Medications, including methotrexate, or isoniazid.

Risk factors

  • Drinking too much alcohol. The abuse of Alcohol is a risk factor for cirrhosis.
  • The overweight. Being obese increases the risk of diseases that can lead to cirrhosis. These conditions include metabolic dysfunction associated with the steatotic liver disease, formerly called non-alcoholic fatty liver; and the metabolic dysfunction associated with steatohepatitis, formerly called non-alcoholic steatohepatitis.
  • Have viral hepatitis. Not all people with chronic hepatitis will develop cirrhosis, but it is one of the main causes of liver disease.

Complications

Complications of cirrhosis may include:

  • Of high pressure of the blood in the veins that supply blood to the liver. This condition is known as portal hypertension. Cirrhosis slows the regular flow of blood through the liver. This increases the pressure in the vein that carries blood to the liver.
  • Swelling of the legs and belly. The increased pressure in the portal vein can cause accumulation of fluid in the legs, called edema, and in the abdomen, called ascites. The Edema and ascites can also happen if the liver can't produce enough of certain proteins in the blood, such as albumin.
  • Inflammation of the spleen. Portal hypertension can cause the spleen to catch the white blood cells and platelets. This causes the spleen to swell, a condition known as splenomegaly. A lower number of white blood cells and platelets in the blood may be the first sign of cirrhosis.
  • The bleeding. Portal hypertension can cause blood to be redirected to the smallest veins. Strained by the extra pressure, these small veins can explode and cause serious bleeding. Portal hypertension can also cause enlargement of the veins, called varicose veins (VAIR-uh-sis), in the esophagus or in the stomach. These varicose veins can also lead to life-threatening bleeding. If the liver cannot make enough clotting factors, this can also contribute to the continuity of bleeding.
  • Infections. Having cirrhosis makes it difficult for the body to fight infections. Ascites can also lead to bacterial peritonitis, a serious infection.
  • Malnutrition. Cirrhosis may make it more difficult for the body to process nutrients, which leads to weakness and loss of weight.
  • The accumulation of toxins in the brain. A liver damaged by cirrhosis can't remove toxins from the blood, as well as a healthy liver can. These toxins can then accumulate in the brain and cause mental confusion, and difficulty concentrating. This is known as hepatic encephalopathy. With time, hepatic encephalopathy can progress to unresponsiveness or coma.
  • Jaundice. Jaundice occurs when the diseased liver does not remove enough bilirubin, a waste product of the blood, of the blood. Causes of jaundice. yellowing of the skin and the whites of the eyes and darkening of the urine.
  • Disease of the bones. Some people with cirrhosis lose bone strength and are at a greater risk of fractures.
  • Increased risk of liver cancer. A large proportion of people who develop liver cancer have pre-existing cirrhosis.
  • Acute-on-chronic cirrhosis. Some people end up experiencing multiple organ failure. Now, the researchers believe that this is a complication in some people who have cirrhosis. However, they do not fully understand what the cause.

Prevention

To reduce the risk of cirrhosis by taking these measures for the care of the liver:

  • Do not drink alcohol if you have cirrhosis. If you have liver disease, you should not drink alcohol.
  • Eat a healthy diet. Choose a diet full of fruits and vegetables. Select whole grains and lean sources of protein. Reduce the amount of fatty and fried food that you eat.
  • Maintain a healthy weight. Too much fat in the body can damage the liver. Talk with a health professional about a weight loss plan if you are obese or overweight.
  • To reduce the risk of hepatitis. Sharing needles and having unprotected sex can increase the risk of hepatitis B and C. Ask a healthcare provider about the vaccines of hepatitis.

If you are concerned about your risk of cirrhosis of the liver, consult a health professional about ways to reduce their risk.

Diagnosis

People with early-stage cirrhosis of the liver, usually have no symptoms. Often, the cirrhosis was found for the first time through a routine blood test or checkup. To help confirm a diagnosis, a combination of lab and imaging tests are usually performed.

Tests

A health professional may order one or more tests to check your liver function, including:

  • The laboratory tests.A healthcare provider may order blood tests to check if there are signs of malfunction of the liver, such as high levels of bilirubin or of certain enzymes. To assess the kidney function, the blood is analyzed for creatinine. A blood count would be measured and the blood is filtered by the hepatitis a virus. An international normalized ratio (INR) is also marked by the ability of the blood to clot. Based on the history and results of blood tests, a medical professional may be able to diagnose the underlying cause of the cirrhosis. Blood tests can also help to identify the stage of cirrhosis.
  • Imaging tests. Certain imaging tests, including transient or magnetic resonance elastography (MRE), may be recommended. These tests of non-invasive imaging to search for hardening or stiffness of the liver. Other imaging tests, such as magnetic resonance imaging, computed tomography, and ultrasound, can also be done.
  • The biopsy. A sample of tissue, called a biopsy, it is not necessarily needed for diagnosis. However, it can be done to discover how severe liver damage is and what causes it.

The laboratory tests. A healthcare provider may order blood tests to check if there are signs of malfunction of the liver, such as high levels of bilirubin or of certain enzymes. To assess the kidney function, the blood is analyzed for creatinine. A blood count would be measured and the blood is filtered by the hepatitis a virus. An international normalized ratio (INR) is also marked by the ability of the blood to clot.

Based on the history and results of blood tests, a medical professional may be able to diagnose the underlying cause of the cirrhosis. Blood tests can also help to identify the stage of cirrhosis.

If you have cirrhosis, a health professional will likely recommend regular tests to see if the liver disease has progressed, or the presence of signs of complications, especially esophageal varices and liver cancer. The non-invasive tests are becoming more widely available to keep an eye on the liver disease.

Treatment

Treatment for cirrhosis depends on the cause and the degree of liver damage. The goals of treatment are to slow the progression of scar tissue in the liver and prevent or treat the symptoms and complications of cirrhosis. For severe liver damage, hospitalization may be necessary.

The treatment of the underlying cause of the cirrhosis

At the beginning of cirrhosis, it may be possible to minimize the damage to the liver for the treatment of the underlying cause. The options include:

  • The treatment for alcohol dependency. People with cirrhosis caused by excessive consumption of alcohol should try to quit drinking. If you stop the consumption of alcohol is difficult, a health professional may recommend a treatment program for alcohol addiction. For people with cirrhosis, it is very important to stop drinking, because any amount of alcohol is toxic to the liver.
  • The loss of weight. People with cirrhosis caused by the metabolic dysfunction associated with the steatotic liver disease may be healthier if you lose weight and control their blood sugar levels.
  • Medications for the control of hepatitis. The drug can limit the damage to the cells of the liver caused by the hepatitis B or C through a specific treatment of these viruses.
  • Medications for the control of other causes and symptoms of cirrhosis. Medications can slow the progression of certain types of liver cirrhosis. For example, for people with primary biliary cholangitis is diagnosed on time, the medicine may significantly delay the progression to cirrhosis.

Other medications may relieve symptoms such as itching, fatigue, and pain. Nutritional supplements may be prescribed to treat the malnutrition-associated cirrhosis. Supplements can also help prevent weak bones, known as osteoporosis.

Treatment of the complications of cirrhosis

A healthcare professional will work to treat any complications of cirrhosis, including:

  • A buildup of fluid in the body. A low-sodium diet and medication to prevent the accumulation of fluid in the body can help to control the ascites and swelling. The more serious the accumulation of fluid may need procedures to drain fluid or surgery to relieve the pressure.
  • The Portal hypertension.Certain blood pressure medications can handle the increased pressure in the veins that supply blood to the liver, called portal hypertension, and prevent severe bleeding. An upper endoscopy can be done on a regular basis to look for dilated veins in the esophagus or in the stomach, which may bleed. These veins are known as varicose veins. If someone develops varicose veins, medicine likely be prescribed to reduce the risk of bleeding. If there are signs of varicose veins are bleeding or are prone to bleeding, a procedure known as band ligation may be required. Band ligation can stop the bleeding or reduce the risk of major hemorrhage. In severe cases, a small tube called a transjugular intrahepatic portosystemic shunt may be placed in the vein to reduce the blood pressure in the liver.
  • Infections. Antibiotics or other treatments for infection may be necessary. A health professional is also likely to be recommended for the vaccination of influenza, pneumonia, and hepatitis.
  • The increased risk of liver cancer. A health professional will likely recommend regular blood tests and ultrasound exams to look for signs of liver cancer.
  • Hepatic encephalopathy. Some people may prescribe medications to help reduce the buildup of toxins in the blood caused by poor liver function.

The Portal hypertension. Certain blood pressure medications can handle the increased pressure in the veins that supply blood to the liver, called portal hypertension, and prevent severe bleeding. An upper endoscopy can be done on a regular basis to look for dilated veins in the esophagus or in the stomach, which may bleed. These veins are known as varicose veins.

If someone develops varicose veins, medicine likely be prescribed to reduce the risk of bleeding. If there are signs of varicose veins are bleeding or are prone to bleeding, a procedure known as band ligation may be required. Band ligation can stop the bleeding or reduce the risk of major hemorrhage. In severe cases, a small tube called a transjugular intrahepatic portosystemic shunt may be placed in the vein to reduce the blood pressure in the liver.

Liver transplant surgery

In advanced cases of cirrhosis, when the liver stops functioning properly, a liver transplant may be the only treatment option. A liver transplant is a procedure to replace the liver with a healthy liver from a deceased donor, or part of a liver from a living donor. Cirrhosis is one of the most common reasons for liver transplant. Candidates for a liver transplant have extensive testing to determine if they are healthy enough to have a good outcome after surgery.

Historically, people with alcoholic cirrhosis have not been candidates for liver transplantation because of the risk of a return to harmful drinking after transplantation. However, recent studies suggest that the carefully selected people with severe alcoholic cirrhosis have been post-transplant survival rates similar to those of liver transplant recipients with other types of liver disease.

For the transplant to be an option if you have alcoholic cirrhosis, you will need to:

  • To find a program that works with people who have alcoholic cirrhosis.
  • To comply with the requirements of the program. These include a life-long commitment to abstinence from alcohol, as well as other specific requirements of each transplant center.

Potential future treatments

Scientists are working to expand the current treatment for cirrhosis, but success has been limited. Due to the cirrhosis has a variety of causes and complications, there are many possible avenues of approach. A combination of increased screening, lifestyle changes and the new drugs may improve outcomes for people with liver damage if started early.

The researchers are working on therapies that specifically target the cells of the liver, helping to slow or even reverse the fibrosis that leads to cirrhosis. However, no targeted therapy is very ready.

Lifestyle and home remedies

If you have cirrhosis, be careful to limit additional damage in the liver:

  • Do not drink alcohol. If your cirrhosis was caused by the chronic use of alcohol or other disease, does not drink alcohol. Drinking alcohol can cause more damage in the liver.
  • Eating a diet low in sodium. The excess of salt may cause your body to retain fluids, worsening of the swelling in the abdomen and the legs. The use of herbs to season your food instead of salt. Choose foods that are low in sodium.
  • Eat a healthy diet. People with cirrhosis may experience malnutrition. To combat this with a healthy diet that includes a variety of fruits and vegetables. Choose lean proteins, such as vegetables, chicken or fish. Do not eat raw seafood.
  • To protect themselves from infection. Cirrhosis makes it harder to fight infections. Protect yourself by avoiding people who are sick and washing your hands frequently. Get vaccinated against hepatitis a and B, influenza, and pneumonia.
  • The use of over-the-counter medications carefully. Cirrhosis makes it difficult for the liver to process medications. For this reason, ask a health professional before taking any medication, including over-the-counter ones. Do not take aspirin and ibuprofen (Advil, Motrin IB, others). If you have liver damage, a care professional may recommend that you do not take acetaminophen (Tylenol, others) or taken at low doses for the relief of pain.

Preparing for your appointment

If you have cirrhosis, you may be referred to a health professional who specializes in the digestive system, called a gastroenterologist, or the liver, called a hepatologist.

Here's some information to help you prepare for your appointment, and what to expect.

What you can do

  • Be aware of any pre-appointment restrictions, such as restrictions of the diet on the day prior to your appointment.
  • Write down your symptoms, including when they started and how they may have changed or worsened with time.
  • Bring a list of all your medications, as well as any vitamins or supplements.
  • Write down your key medical information, including other conditions diagnosed.
  • The results of the medical tests carried out to date, including digital copies of CT, MRI, or ultrasound imaging, and biopsy slides, if a liver biopsy has been done.
  • Write down key personal information, including any recent changes or stressors in your life.
  • Have a family member or a friend to help you remember things.
  • Write questions to ask their doctor.

Questions to ask your doctor

Prepare a list of questions can help you make the most of your time. Some basic questions to ask include:

  • What is most likely causing my cirrhosis?
  • There is a way to delay or stop my liver damage?
  • What are my treatment options?
  • There are drugs or supplements that can damage my liver?
  • What are the signs and symptoms of complications should I be aware?
  • I have other health conditions. How can I best manage them together?

Do not hesitate to ask questions during your appointment.

What to expect from your doctor

Be prepared to answer questions, including:

  • When did you first begin experiencing symptoms?
  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • How often do you consume alcohol?
  • Has been exposed to or taken drugs toxic?
  • Do you have a family history of liver disease, hemochromatosis, or obesity?
  • Have you ever had viral hepatitis?
  • Have you ever had jaundice?
  • Have you ever had a blood transfusion or used injected drugs?
  • Do you have any tattoos?
Symptoms and treatment of Cirrhosis