Cirrhosis

What is it?
The liver is an organ that is located in the right upper side of your abdomen, mostly behind the ribs. It is about the size of a football. The liver makes proteins and processes foods that we eat in to glucose, a form of sugar that can be used as energy throughout the body. The liver stores glucose. The liver also serves to detoxify substances that enter our body. It processes and filters used red blood cells. Cirrhosis is replacement of normal liver tissues with scar tissue. This scarring is thought to be irreversible. There may be so much scar tissue and so little remaining healthy liver tissue that the liver begins to fail. The only treatment option at that time is transplanting a new liver. Multiple complications are possible with cirrhosis.

Who gets it?
Risk factors for chronic liver disease and cirrhosis are:

  • Hepatitis
  • Alcohol consumption
  • Diabetes mellitus
  • Illicit drug use, injection or inhalation
  • Blood transfusion with blood that carries a hepatitis virus
  • Family history of liver disease
  • Presence of autoimmune disease

Why does it happen?
The most common causes of cirrhosis in the United States are: alcoholic liver disease and hepatitis C. Other chronic diseases of the liver can lead to cirrhosis, such as fatty liver disease.

What are the symptoms?
Sometimes people have no symptoms at all
Symptoms can include:

  • Fatigue
  • Easy bruising
  • Lower extremity swelling.
  • Fever
  • Weight loss
  • Diarrhea
  • Itching
  • Increasing abdominal size due to ascites (fluid in the abdomen)
  • Confusion. Ammonia is made when protein is broken down; the confusion is usually due to elevated ammonia levels that cannot be cleared by the damaged liver.
  • Sleep disturbance
  • Esophageal Varices. Esophageal Varices are enlarged veins in the esophagus. These veins can cause life threatening bleeding.

How is it diagnosed?
Chronic liver disease may be identified at the time of a physical exam by your health
professional. Abnormal findings may include:

  • Spider angiomata/telangiectasis: Small lesions on your skin appearing as a red spot with areas that extends out like a spiders legs or web. They are usually found on the trunk, face and upper limbs.
  • Palmar erythema. Redness of the palm of the hand.
  • Changes to the fingernails.
  • Abnormal horizontal white bands of the fingernails, known as “Muehrke’s Nails” or “Terry’s Nails.”
  • Clubbing. Nailbeds in the fingers or toes soften, the nail curves downward, and the end of the finger or toe may swell.
  • Dupuytren’s contracture. Thickening of the tissue underneath the palm of the hand and fingers that causes the finger to curl.
  • Breast development and smaller testicles in men.
  • Enlarged liver
  • Enlarged spleen
  • Ascites (this is the term for fluid collecting in the lining of the abdomen)
  • Caput medusa. Blood vessels on the abdomen are visible and swollen.
  • Sweet smelling breath
  • Jaundice. Yellowing of the skin, mucous membranes and eyes.
  • Asterixis (flapping of an outstretched hand)

Laboratory testing

Imaging studies. Ultrasound, CT or MRI can suggest the presence of cirrhosis. The benefit of imaging is to evaluate for complications such as ascites, hepatocellular carcinoma, (liver cancer) or clots in the veins of the liver.

Liver biopsy. This is taking a tissue sample of the liver and examining it under a microscope. This may not be necessary to perform if other testing clearly demonstrates cirrhosis. Sometimes, the biopsy helps to determine the cause for cirrhosis, if that is unknown.

Sometimes, the initial diagnosis will come with the presentation of a life threatening complication of cirrhosis such as:

  • Variceal bleeding
  • Ascites
  • Spontaneous bacterial peritonitis. In this condition the ascites fluid has become infected with bacteria.
  • Hepatic encephalopathy. Difficulty sleeping or sleeping too much, confusion, delirium or even coma.

How is it treated?
Different causes of liver injury can lead to cirrhosis, so, a specific cause should be determined. Often a cause can be determined through blood work and/or a liver biopsy. Cirrhosis cannot be cured but complications can be reduced or prevented.

  • Avoid substances that can damage the liver - this includes alcohol, many prescription and over the counter medicines (especially acetaminophen/Tylenol and nonsteoridal antiinflammatory drugs), and some herbs, vitamins and dietary supplements
  • Screen for and treat varices: an upper endoscopy will be performed. In this exam a tube with light and camera is inserted through your mouth into your throat down to your esophagus and stomach.
  • Vaccinations. You should be vaccinated against hepatitis A and B. Every year get the seasonal influenza vaccine. Obtain pneumococcal vaccine.
  • For Ascites and swelling (edema), treatment may include a water pill (diuretic) and following a low salt (low sodium) diet. Some people need to have periodic drainage of thefluid that has collected in their abdomen. This is called a paracentesis. A needle will be inserted and fluid will be withdrawn. Sometimes, a surgical procedure is performed if none of the above work to control the fluid buildup.
  • Screen for cancer of the liver (hepatocellular carcinoma)
  • Watch for encephalopathy. Treatment includes lactulose or antibiotics. Lactulose is a medicine, actually a sugar, which will pull ammonia out of the blood into the colon where it will be excreted in a bowel movement.
  • Diet
  • Exercise
  • Consideration for liver transplantation

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