Cirrhosis

By Stephen Holt, MD, PhD, FACP

• What is Cirrhosis?
• Causes
• Who is at Risk?
• Signs and Symptoms?
• How is it Diagnosed?
• Treatment
• Are There Alternative Treatments?
• Suggested Articles

What is Cirrhosis?

Cirrhosis is defined as widespread nodules in the liver and fibrosis. Fibrosis is excessive accumulation of scar tissue that results from ongoing inflammation and liver cell death. Scar tissue replaces normal, healthy liver tissue, preventing the liver from working as it should.

The liver carries out several essential functions, such as detoxifying harmful substances in your body, purifying your blood and manufacturing vital nutrients. When cirrhosis is present, the liver no longer has the ability to perform the necessary essential functions and if not treated, will fail altogether putting the patient at risk of death.

Cirrhosis is considered the end stage of any chronic liver disease.

Causes

Many people have more than one cause for liver damage. A wide variety of diseases and conditions can damage the liver, leading to cirrhosis. Not all liver diseases cause it– only those that cause chronic, ongoing damage to the liver can lead to permanent scarring of liver tissue. Any chronic liver disease can cause cirrhosis and it can take many years for liver damage to lead to cirrhosis.

• Long-term alcohol abuse – the leading cause of cirrhosis in the United States
• Long-term infection with Hepatitis C virus – the second leading cause of cirrhosis in the United States
• Chronic Hepatitis B and Hepatitis D
• Cystic Fibrosis (CF) – an inherited disorder of the secretory glands, including the glands that make mucous and sweat. CF mostly affects lungs, pancreas, liver, intestines, sinuses and sex organs. Liver disease is a relatively frequent and early complication of cystic fibrosis.
• Bile duct disease (primary schlerosing cholangitis and primary biliary cholangitis) –bile backs up into the liver causing the liver to swell
• Poorly formed bile ducts
• Non-alcoholic fatty liver disease (nonalcoholic steatohepatitis (NASH)) – fat that accumulates in the liver not caused by alcohol abuse
• Hemochromatosis –a genetic disease that causes iron to build up in the body
• Wilson’s Disease – a genetic disease that causes an over accumulation of copper in the liver
• Glycogen Storage Disease – a genetic disease that causes problems with storing and releasing energy needed by cells to function
• Autoimmune hepatitis – caused by the body’s immune system attacking the liver
• Poorly formed bile ducts (biliary atresia)
• Schistosomiasis – also known as bilharzia, is a disease caused by parasitic worms. Although the worms that cause schistosomiasis are not found in the United States, more than 200 million people are infected worldwide. In terms of impact this disease is second only to malaria as the most devastating parasitic disease. Schistosomiasis is considered one of the Neglected Tropical Diseases (NTDs).
• Excessive intake of vitamins – such as vitamin A. Being fat-soluble, vitamin A is stored to a variable degree in the body (liver), making it more likely to cause toxicity when taken in excess amounts
• Certain herbal remedies – cascara, chaparral, comfrey, kava and ephedra are considered to be dangerous to the liver
• Certain medications – such as methotrexate, isoniazid and Aldomet
• Congestive heart failure – during congestive heart failure, fluid accumulates in the liver, thereby impairing its ability to rid the body of toxins and produce essential proteins
• Vascular anomalies – such as Budd-Chairi syndrome which is caused by Hepatic vein obstruction, a blockage of the hepatic vein, which carries blood away from the liver. Hepatic vein obstruction prevents blood from flowing out of the liver and back to the heart. This blockage can cause liver damage
• Obesity – either as the sole cause or in combination with alcohol
• Prolonged exposure to toxic substances – common chemicals that can cause liver damage include the dry cleaning solvent carbon tetrachloride, a substance used to make plastics called vinyl chloride, the herbicide paraquat and a group of industrial chemicals called polychlorinated biphenyls.

Who is at Risk?

In the United States, chronic Hepatitis C and heavy alcohol consumption are the most common causes of cirrhosis, although people who have never consumed alcohol can develop it. Other risk factors that include genetic predisposition, environmental factors, and lifestyle choices all play a role in the risk of developing cirrhosis. However, just because a person is at risk, doesn’t necessarily mean that he will definitely develop this condition over the course of a normal life span.

Cirrhosis is irreversible scarring of the liver. However, because cirrhosis progresses slowly, it allows a person to obtain treatment from a liver specialist before it actually occurs.

Signs and Symptoms

Because cirrhosis and liver disease in general, is silent, few if any symptoms are experienced until the later stages of the disease. Symptoms may be vague for some people or more severe in others, depending on the stage of the disease. Signs and symptoms that occur may be:

• Loss of appetite
• Nausea
• Vomiting
• Fatigue
• Weight loss
• Edema (swelling in the legs)
• Bruising easily
• Bleeding easily
• Ascites – Abdominal pain and bloating (caused by fluid retention)
• Itching
• Spiderlike blood vessels on the skin
• Impotence and loss of interest in sex
• Pale or clay colored stools

It is important to know that a person with cirrhosis is at increased risk of developing serious complications such as:

• Bleeding problems – some people with cirrhosis have difficulty clotting which causes excessive bleeding
• Kidney problems – liver disease places a great deal of stress on the kidneys causing fluid retention and in advanced liver disease, possibly a progressive deterioration of kidney function
• Osteoporosis (bone loss) – decreased bone mass and decreased bone density causing bone fractures
• Liver cancer (hepatocellular carcinoma) and (hepatoma) – risk varies with the cause of liver disease
• Enlarged spleen (Splenomegaly)
• Esophageal and gastric varices – essentially, varicose veins in the esophagus and stomach, one of the most serious complications because they can rupture and bleed. This internal bleeding can be life-threatening
• Jaundice – yellowing of the eyes and skin from bilirubin retention
• Hepatic encephalopathy – high levels of toxins in the blood causing mental changes exhibited as mild confusion or in extreme cases – coma
• Low or high blood sugars
• Cachexia (wasting) – a wasting syndrome that causes weakness and a loss of weight, fat, and muscle
• Malnutrition – as a result of cachexia
• Spontaneous bacterial peritonitis – infected fluid in the abdomen
• More frequent infections – due to the body’s inability to fight infection
• Gallstones – hardened bile resulting in stones when bile is prevented from flowing freely to and from the gallbladder

How is i Diagnosed?

A thorough physical examination along with the patient’s medical history, observation for signs of the disease, symptoms, blood tests, imaging procedures such as ultrasound, computerized tomography (CT) and magnetic resonance imaging (MRI) and finally examination of liver tissue (liver biopsy) are tests and procedures used to diagnose cirrhosis.

Treatment

Treatment depends on the cause and whether complications exist. Depending on the type of hepatitis virus, interferon and specific antiviral medications may be prescribed, corticosteroids and other immune suppressing drugs may be required to treat autoimmune hepatitis, diuretics may be prescribed for edema and ascites to remove fluid from the body, and antibiotics may be administered for infection. Depending on the type and severity of complications, hospitalization may be required.

The process leading to cirrhosis can often be slowed and sometimes even halted. Treating the underlying cause of cirrhosis can prevent further liver damage and reduce complications, such as treatment for alcohol dependency and medications to control the hepatitis B or C virus.

All individuals with cirrhosis will benefit by making the following lifestyle changes:

• Totally eliminate the consumption of alcohol
• Eat a nutritious diet which includes plenty of fruits and vegetables
• Exercise regularly and get plenty of rest
• Abstain from using illicit drugs
• Do not share toothbrushes, razors, needles or other personal items with others
• Avoid tattoos and piercings
• Consult the advice of a physician before using certain prescription drugs, over-the-counter drugs and herbal supplements
• Limit dietary sodium
• Limit the risk of infection by avoiding people who are ill and discuss getting vaccinated for influenza, pneumonia, hepatitis A and hepatitis B with a physician
• Avoid eating raw shellfish
• Practice safe sex (to prevent the risk of contracting a disease that could further damage the liver)

Individuals with advanced cirrhosis whose liver has stopped functioning may require a liver transplant. During a liver transplant procedure, the diseased, non-functioning liver is removed and replaced with a healthy liver donated by a deceased person or a portion of a healthy liver from a living donor.

Are There Alternative Treatments?

There are very few safe alternative methods for treating liver diseases. Cirrhosis of the liver is a serious condition which can lead to many life threatening complications. Some alternative treatments that have proven safe to help manage cirrhosis are milk thistle, and SAMe.

Unsafe alternative treatments that are known to cause liver damage are:

• Pennyroyal
• Comfrey
• Camphor
• Skullcap
• Chaparral
• Kava
• Ma-huang (a Chinese herb)

This information is intended for educational purposes only and should not be used in any other manner. This information is not intended to substitute for informed medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified health care provider.

Suggested Articles

• What is Liver Cirrhosis and How is it Prevented?
• The Advantages and Disadvantages of Liver Fibrosis Evaluation Methods
• The High Infection Risk Associated with Cirrhosis
• New Evidence Suggests Chocolate for Cirrhosis
• Important Facts About Salt and Cirrhosis
• Cirrhosis and When to Treat Hepatitis C
• Sulfasalazine’s Potential for Reversing Fibrosis

About the Author

Stephen Holt, MD, PhD, FACP

Stephen Holt, M.D. is a Distinguished Professor of Medicine NYCPM (Emerite) and a medical practitioner in New York State. He has published many peer-review papers in medicine and he is a best-selling author with more than twenty books in national and international distribution. He has received many awards for teaching and research. Dr. Holt is a frequent lecturer at scientific meetings and healthcare facilities throughout the world. He is a best selling author and the founder of the Holt Institute of Medicine.