Cirrhosis

Definition

Cirrhosis is scarring of the liver that causes lasting damage. The scar tissue causes problems with blood flow and prevents the liver from working as it should. This can disrupt normal functions in the body.

Early treatment can improve outcomes.

Cirrhosis of the Liver.

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Causes

Cirrhosis can be caused by:

• Alcohol use disorder
• Hepatitis C, B, and D
• Autoimmune hepatitis
• Inherited diseases, such as glycogen storage disease, hemochromatosis, or cystic fibrosis
• Genetic problems, such as:
  • Galactosemia
  • Fructose intolerance
  • Tyrosinemia
  • Wilson disease
  • Alpha1-antitrypsin deficiency
• Nonalcoholic fatty liver disease (NAFLD)
• Bile duct blockages
• Drugs and toxins, such as:
  • Arsenic
  • Isoniazid
  • Methotrexate
  • Excess vitamin A
• Infections, such as:
  • Schistosomiasis
  • Brucellosis
  • Echinococcosis
  • Advanced or congenital syphilis
• Heart failure

Risk Factors

Things that may raise the risk of this problem are:

• Alcohol use disorder
• Hepatitis infection
• Liver cancer
• Use of drugs that are toxic to the liver
• Being overweight
• Poorly controlled diabetes
• Taking in too much iron
• Nonalcoholic fatty liver disease

Symptoms

Cirrhosis often does not cause symptoms in the early stages. Symptoms start when scar tissue replaces healthy cells and the liver starts to fail. The symptoms a person has depends on the amount of damage.

Problems may be:

• Feeling tired and weak
• Nausea
• Lack of hunger
• Weight loss
• Small, red spider-like blood vessels under the skin
• Breasts that are enlarged and tender in men
• Problems keeping an erection in men

When the disease worsens, problems may be:

• Loss of body hair
• Bleeding and bruising
• Belly swelling, tenderness, and pain
• Itching
• Yellowing of the skin or eyes
• Vomiting blood
• Changes in mental function
• Dark urine
• Swelling in the legs and belly

Diagnosis

The doctor will ask about symptoms and health history. A physical exam will be done.

Blood tests will be done to look for signs of liver problems.

A liver biopsy can confirm the diagnosis. A needle is used to take a sample of tissue from the liver. A lab will look for signs of scarring or disease in the tissue.

Other tests may be done to look for the cause or severity.

Treatment

Any underlying causes will need to be treated.

There is no cure. The goal of treatment is to prevent further damage, manage symptoms, and lower the risk of problems. Choices are:

• Dietary changes, such as eating a well-balanced diet and limiting protein and salt
• Lifestyle changes, such as not drinking alcohol
• Medicines to:
  • Reduce the absorption of waste products and toxins in the digestive system
  • Reduce the risk of a broken blood vessel
  • Fight infections
  • Shed excess fluids
• Getting vaccines for flu, pneumonia, and hepatitis

People who are not helped by these methods may need a liver transplant. Others may need an endoscopy to tie off bleeding blood vessels or to inject drugs to cause clotting.

Prevention

This risk of cirrhosis may be lowered by:

• Avoiding or limiting alcohol
• Not smoking
• Practicing safe sex
• Not sharing needles for IV drug use
• Getting vaccinated against hepatitis B
• Keeping a healthy weight