CIRRHOSIS

Cirrhosis CLD

Cirrhosis is a slowly progressing disease in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properly. The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins. It also slows the production of proteins and other substances made by the liver.
Causes and risk factors
  • Hepatitis C infection (long-term infection)
  • Long-term alcohol abuse 
  • Autoimmune inflammation of the liver
  • Disorders of the drainage system of the liver (the biliary system), such as primary biliary cirrhosis and primary sclerosing cholangitis
  • Hepatitis B (long-term infection)
  • Medications
  • Metabolic disorders of iron and copper (hemochromatosis and Wilson's disease)
  • Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH)
Symptoms
Symptoms may develop gradually, or there may be no symptoms. When symptoms do occur, they can include:

  • Confusion or problems thinking
  • Impotence, loss of interest in sex, and breast development (gynecomastia) in men
  • Loss of appetite
  • Nausea and vomiting
  • Nosebleeds or bleeding gums
  • Pale or clay-colored stools
  • Small, red spider-like blood vessels on the skin
  • Swelling or fluid buildup of the legs  and in the abdomen 
  • Vomiting blood or blood in stools
  • Weakness
  • Weight loss
  • Yellow color in the skin, mucus membranes, or eyes
Treatment
All patients with cirrhosis can benefit from certain lifestyle changes, including:

  • Stop drinking alcohol.
  • Limit salt in the diet.
  • Eat a nutritious diet.
  • Get vaccinated for influenza, hepatitis A and hepatitis B, and pneumococcal pneumonia (if recommended by your doctor).
  • Tell your doctor about all prescription and nonprescription medications, and any herbs and supplements you take now or are thinking of taking.

Other treatment options are available for the complications of cirrhosis:

  • Bleeding varices -- upper endoscopy with banding and sclerosis
  • Excess abdominal fluid (ascites) -- take diuretics, restrict fluid and salt, and remove fluid (paracentesis)
  • Coagulopathy -- blood products or vitamin K
  • Confusion or encephalopathy -- lactulose medication and antibiotics
  • Infections -- antibiotics

A procedure called transjugu larintrahe paticporto systemic shunt (TIPS) is sometimes needed for bleeding varices or ascites. When cirrhosis progresses to end-stage liver disease, patients may be candidates for a liver transplant. (Link to live liver transplant)