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Cirrhosis

Liver cirrhosis; Chronic liver disease; End-stage liver disease

 

Cirrhosis is scarring of the liver and poor liver function. It is the last stage of chronic liver disease.

Causes

 

Cirrhosis is the end result of chronic liver damage caused by chronic liver disease. Common causes of chronic liver disease in the United States are:

  • Hepatitis B or hepatitis C infection
  • Alcohol abuse

Less common causes of cirrhosis include:

  • When immune cells mistake the liver's normal cells for harmful invaders and attack them.
  • Bile duct disorders.
  • Some medicines.
  • Liver diseases passed down in families.
  • Buildup of fat in the liver that is NOT caused by drinking too much alcohol (called nonalcoholic fatty liver disease [NAFLD] and nonalcoholic steatohepatitis [NASH]). It is closely related to being overweight.

 

Symptoms

 

There may be no symptoms, or symptoms may come on slowly, depending on how well the liver is working. Often, it is discovered by chance when an x-ray is done for another reason.

Early symptoms include:

  • Fatigue and loss of energy
  • Poor appetite and weight loss
  • Nausea or belly pain
  • Small, red spider-like blood vessels on the skin

As liver function worsens, symptoms may include:

  • Fluid buildup of the legs (edema) and in the abdomen (ascites)
  • Yellow color in the skin, mucous membranes, or eyes (jaundice)
  • Redness on the palms of the hands
  • In men, impotence, shrinking of the testicles, and breast swelling
  • Easy bruising and abnormal bleeding, most often from swollen veins in the digestive tract
  • Confusion or problems thinking
  • Pale or clay-colored stools

 

Exams and Tests

 

Your health care provider will do a physical exam to look for:

  • An enlarged liver or spleen
  • Excess breast tissue
  • Swollen abdomen, as a result of too much fluid
  • Reddened palms
  • Red spider-like blood vessels on the skin
  • Small testicles
  • Widened veins in the abdomen wall
  • Yellow eyes or skin (jaundice)

You may have the following tests to measure liver function:

  • Complete blood count
  • Prothrombin time
  • Liver function tests
  • Blood albumin level

Other tests to check for liver damage include:

  • Computed tomography (CT) of the abdomen
  • Magnetic resonance imaging (MRI) of the abdomen
  • Endoscopy to check for abnormal veins in the esophagus or stomach
  • Ultrasound of the abdomen

You might need a liver biopsy to confirm the diagnosis.

 

Treatment

 

LIFESTYLE CHANGES

Some things you can do to help take care of your liver disease are:

  • Drink no alcohol.
  • Eat a healthy diet that is low in salt.
  • Get vaccinated for diseases such as influenza, hepatitis A and B, and pneumococcal pneumonia.
  • Talk to your doctor about all medicines you take, including herbs and supplements and over-the-counter medicines.

MEDICINES FROM YOUR DOCTOR

  • Water pills (diuretics) to get rid of fluid build-up
  • Vitamin K or blood products to prevent excess bleeding
  • Medicines for mental confusion
  • Antibiotics for infections

OTHER TREATMENTS

  • Endoscopic treatments for enlarged veins in the throat (bleeding varices)
  • Removal of fluid from the abdomen (paracentesis)
  • Placement of a transjugular intrahepatic portosystemic shunt (TIPS) to repair blood flow in the liver

When cirrhosis progresses to end-stage liver disease, a liver transplant may be needed.

 

Support Groups

 

You can often ease the stress of illness by joining a liver disease support group whose members share common experiences and problems.

 

Outlook (Prognosis)

 

Cirrhosis is caused by scarring of the liver. In most cases, the liver cannot heal or return to normal function once damage is severe. Cirrhosis can lead to serious complications.

 

Possible Complications

 

Complications may include:

  • Bleeding disorders
  • Buildup of fluid in the abdomen (ascites) and infection of the fluid (bacterial peritonitis)
  • Enlarged veins in the esophagus, stomach, or intestines that bleed easily (esophageal varices)
  • Increased pressure in the blood vessels of the liver (portal hypertension)
  • Kidney failure (hepatorenal syndrome)
  • Liver cancer (hepatocellular carcinoma)
  • Mental confusion, change in the level of consciousness, or coma (hepatic encephalopathy)

 

When to Contact a Medical Professional

 

Call your provider if you develop symptoms of cirrhosis.

Get emergency medical help right away if you have:

  • Abdominal or chest pain
  • Abdominal swelling or ascites that is new or suddenly becomes worse
  • A fever (temperature greater than 101°F or 38.3°C)
  • Diarrhea
  • Confusion or a change in alertness, or it gets worse
  • Rectal bleeding, vomiting blood, or blood in the urine
  • Shortness of breath
  • Vomiting more than once a day
  • Yellowing skin or eyes (jaundice) that is new or gets worse quickly

 

Prevention

 

DO NOT drink alcohol heavily. Talk to your provider if you are worried about your drinking. Take steps to prevent getting or passing hepatitis B or C.

 

 

References

Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the AmericanGastroenterological Association. Hepatology. 2012;55(6):2005-23. PMID: 22488764 www.ncbi.nlm.nih.gov/pubmed/22488764.

Garcia-Tsao G, Lim JK; Members of Veterans Affairs Hepatitis C Resource Center Program. Management and treatment of patients with cirrhosis and portal hypertension: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program. Am J Gastroenterol. 2009;104(7):1802-29. PMID: 19455106 www.ncbi.nlm.nih.gov/pubmed/19455106.

Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 153.

Kamath PS, Shah VH. Overview of cirrhosis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 74.

Mehta G, Rothstein KD. Health maintenance issues in cirrhosis. Med Clin North Am. 2009;93(4):901-15. PMID: 19577121 www.ncbi.nlm.nih.gov/pubmed/19577121.

O'Shea RS, Dasarathy S, McCullough AJ. Alcoholic liver disease. Hepatology. 2010;105(1). PMID: 19904248 www.ncbi.nlm.nih.gov/pubmed/19904248.

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  • Liver cirrhosis, CT scan

    Liver cirrhosis, CT scan

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      Liver cirrhosis, CT scan

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    A Closer Look

     

    Tests for Cirrhosis

     
       

      Review Date: 8/14/2015

      Reviewed By: Subodh K. Lal, MD, gastroenterologist at Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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