Cirrhosis is extensive scarring (fibrosis) of the liver caused by prolonged trauma. The damage occurs due to persistent and ongoing inflammation in response to chronic liver damage, be it a chronic viral hepatitis infection, excessive alcohol consumption, or a host of other causes.
The liver has the ability to repair itself. However, as scar tissue gradually builds up, it loses its ability to function normally. Over time, as scarring increases and blood flow to the liver decreases, basic liver functions deteriorate . In some cases, this can lead to liver failure and even death. More than a million people die from cirrhosis of the liver each year, including more than 40,000 in the United States .
Cirrhosis is currently the ninth leading cause of death in the United States, affecting nearly twice as many men as women.
Symptoms of cirrhosis.
Symptomatic progression of liver damage from early fibrosis to cirrhosis usually takes years or even decades. In the early years, symptoms usually show few or no symptoms.
When symptoms appear, they are sometimes misdiagnosed, ignored, or attributed to other possible causes. However, as the disease progresses , the control symptoms may become more apparent. These symptoms include:
- Soft spot
- Loss of appetite
- Slight bruising
- Jaundice (yellowing of the skin and / or eyes)
- Spider angioma (spider veins on the skin, often around the nose and cheeks)
- Swelling (swelling of the feet, ankles, and legs due to fluid build-up)
- Bloating due to ascites (accumulation of fluid in the abdomen ).
Many of these symptoms are caused by portal hypertension , in which scar tissue partially blocks normal blood flow to the liver.
- This is followed by alcohol-related liver disease , which is generally associated with excessive alcohol use for several years (on average, more than two drinks a day for women and more than three for men for ten years or more ).
- Cirrhosis associated with hepatitis B. A common cause of liver cirrhosis. Hepatitis B vaccination in many countries has reduced the incidence of hepatitis B-related complications, such as cirrhosis and liver cancer.
- Hepatitis C is one of the leading causes of cirrhosis diagnosis in the United States, as well as an important indicator of liver transplantation .
- Nonalcoholic fatty liver disease is commonly associated with obesity, as well as diabetes, high blood pressure, and high cholesterol levels. People with metabolic syndrome, characterized by a wide waist, high triglycerides, abnormal cholesterol levels, high blood pressure, and higher-than-normal blood glucose levels, are more prone to cirrhosis .
Less common causes of cirrhosis are blockages of the bile ducts of the liver and gallbladder, autoimmune hepatitis, and inherited conditions such as Wilson's disease or hemochromatosis, medications, and celiac disease.
A liver biopsy is the most accurate way to diagnose cirrhosis and correctly assess the stage of liver disease. Ultrasound or magnetic resonance elastography are non-invasive methods to detect liver fibrosis. Various blood tests and imaging tools (including ultrasound, CT scan, and MRI) can be used to track disease progression.
Cirrhosis is generally classified as compensated or decompensated. Compensated cirrhosis is simply a damaged liver that is still relatively functional, while decompensated cirrhosis is a dramatic decline in liver function. If complications cannot be controlled when the liver stops working, liver transplantation is usually indicated.
About 5 percent of people with cirrhosis will develop hepatocellular carcinoma (HCC) , the most common form of liver cancer .
Many cases of cirrhosis can be treated for many years before they progress and require a transplant. Treatment of liver cirrhosis largely depends on the cause and severity of the disease, but should be started as soon as the diagnosis is made.
Cirrhosis is generally incurable except for liver transplantation.
Several approaches should be taken to slow the progression of liver scarring, including:
- Avoid alcohol and medications that can cause liver damage .
- Avoid over-the-counter herbal preparations and supplements, as some of them can cause liver damage.
- Cirrhosis increases the risk of liver damage from prescription drugs, so all prescriptions must be carefully reviewed for effects on the liver.
- Avoid raw shellfish, which can contain bacteria that could cause a serious infection in people with advanced liver disease.
- Detection and vaccination against hepatitis A and hepatitis B , as well as detection of hepatitis C
- Antiviral treatment for hepatitis B and hepatitis C
- Detection and treatment of secondary causes of cirrhosis (eg, Ursodiol for bile duct obstruction)
- Liver transplant evaluation
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More than a million people die from cirrhosis each year, but the disease is still difficult to detect in its early stages. If you experience symptoms of cirrhosis or suspect that you are at risk for developing cirrhosis, talk to your doctor. Remember, the most common causes of cirrhosis include alcohol-related liver disease, hepatitis B, hepatitis C, and nonalcoholic fatty liver disease . Treatment of liver cirrhosis should be started immediately after diagnosis.