cirrosis
Introduction
The liver, the largest organ in the body, is essential in keeping the
body functioning properly. It removes or neutralizes poisons from the
blood, produces immune agents to control infection, and removes germs and
bacteria from the blood. It makes proteins that regulate blood clotting
and produces bile to help absorb fats and fat-soluble vitamins. You cannot
live without a functioning liver.
|
In cirrhosis of the liver, scar tissue replaces normal, healthy tissue,
blocking the flow of blood through the organ and preventing it from
working as it should. Cirrhosis is the eighth leading cause of death by
disease, killing about 25,000 people each year. Also, the cost of
cirrhosis in terms of human suffering, hospital costs, and lost
productivity is high.
This picture shows the liver and nearby organs.
|
Causes
Cirrhosis has many causes. In the United States, chronic alcoholism and
hepatitis C are the most common causes.
Alcoholic liver disease. To many people, cirrhosis of the liver
is synonymous with chronic alcoholism, but in fact, alcoholism is only one
of the causes. Alcoholic cirrhosis usually develops after more than a
decade of heavy drinking. The amount of alcohol that can injure the liver
varies greatly from person to person. In women, as few as two to three
drinks per day have been linked with cirrhosis and in men, as few as three
to four drinks per day. Alcohol seems to injure the liver by blocking the
normal metabolism of protein, fats, and carbohydrates.
Chronic hepatitis C. The hepatitis C virus ranks with alcohol as
the major cause of chronic liver disease and cirrhosis in the United
States. Infection with this virus causes inflammation of and low grade
damage to the liver that over several decades can lead to cirrhosis.
Chronic hepatitis B and D. The hepatitis B virus is probably the
most common cause of cirrhosis worldwide, but in the United States and
Western world it is less common. Hepatitis B, like hepatitis C, causes
liver inflammation and injury that over several decades can lead to
cirrhosis. The hepatitis D virus is another virus that infects the liver,
but only in people who already have hepatitis B.
Autoimmune hepatitis. This type of hepatitis is caused by a
problem with the immune system.
Inherited diseases. Alpha-1 antitrypsin deficiency,
hemochromatosis, Wilson's disease, galactosemia, and glycogen storage
diseases are among the inherited diseases that interfere with the way the
liver produces, processes, and stores enzymes, proteins, metals, and other
substances the body needs to function properly.
Nonalcoholic steatohepatitis (NASH). In NASH, fat builds up in
the liver and eventually causes scar tissue. This type of hepatitis
appears to be associated with diabetes, protein malnutrition, obesity,
coronary artery disease, and corticosteroid treatment.
Blocked bile ducts. When the ducts that carry bile out of the
liver are blocked, bile backs up and damages liver tissue. In babies,
blocked bile ducts are most commonly caused by biliary atresia, a disease
in which the bile ducts are absent or injured. In adults, the most common
cause is primary biliary cirrhosis, a disease in which the ducts become
inflamed, blocked, and scarred. Secondary biliary cirrhosis can happen
after gallbladder surgery, if the ducts are inadvertently tied off or
injured.
Drugs, toxins, and infections. Severe reactions to prescription
drugs, prolonged exposure to environmental toxins, the parasitic infection
schistosomiasis, and repeated bouts of heart failure with liver congestion
can each lead to cirrhosis.
|
Symptoms
Many people with cirrhosis have no symptoms in the early stages of the
disease. However, as scar tissue replaces healthy cells, liver function
starts to fail and a person may experience the following symptoms:
- Exhaustion
- Fatigue
- Loss of appetite
- Nausea
- Weakness
- Weight loss.
As the disease progresses, complications may develop. In some people,
these may be the first signs of the disease.
|
Complications of Cirrhosis
Loss of liver function affects the body in many ways. Following are
common problems, or complications, caused by cirrhosis.
Edema and ascites. When the liver loses its ability to make the
protein albumin, water accumulates in the leg (edema) and abdomen
(ascites).
Bruising and bleeding. When the liver slows or stops production
of the proteins needed for blood clotting, a person will bruise or bleed
easily.
Jaundice. Jaundice is a yellowing of the skin and eyes that
occurs when the diseased liver does not absorb enough bilirubin.
Itching. Bile products deposited in the skin may cause intense
itching.
Gallstones. If cirrhosis prevents bile from reaching the
gallbladder, a person may develop gallstones.
Toxins in the blood or brain. A damaged liver cannot remove
toxins from the blood, causing them to accumulate in the blood and
eventually the brain. There, toxins can dull mental functioning and cause
personality changes, coma, and even death. Signs of the buildup of toxins
in the brain include neglect of personal appearance, unresponsiveness,
forgetfulness, trouble concentrating, or changes in sleep habits.
Sensitivity to medication. Cirrhosis slows the liver's ability
to filter medications from the blood. Because the liver does not remove
drugs from the blood at the usual rate, they act longer than expected and
build up in the body. This causes a person to be more sensitive to
medications and their side effects.
Portal hypertension. Normally, blood from the intestines and
spleen is carried to the liver through the portal vein. But cirrhosis
slows the normal flow of blood through the portal vein, which increases
the pressure inside it. This condition is called portal hypertension.
Varices. When blood flow through the portal vein slows, blood
from the intestines and spleen backs up into blood vessels in the stomach
and esophagus. These blood vessels may become enlarged because they are
not meant to carry this much blood. The enlarged blood vessels, called
varices, have thin walls and carry high pressure, and thus are more likely
to burst. If they do burst, the result is a serious bleeding problem in
the upper stomach or esophagus that requires immediate medical attention.
Problems in other organs. Cirrhosis can cause immune system
dysfunction, leading to infection. Ascites (fluid) in the abdomen may
become infected with bacteria normally present in the intestines, and
cirrhosis can also lead to kidney dysfunction and failure.
|
Diagnosis
The doctor may diagnose cirrhosis on the basis of symptoms, laboratory
tests, the patient's medical history, and a physical examination. For
example, during a physical examination, the doctor may notice that the
liver feels harder or larger than usual and order blood tests that can
show whether liver disease is present.
If looking at the liver is necessary to check for signs of disease, the
doctor might order a computerized axial tomography (CAT) scan, ultrasound,
or a scan of the liver using a radioisotope (a harmless radioactive
substance that highlights the liver). Or the doctor might look at the
liver using a laparoscope, an instrument inserted through the abdomen that
relays pictures back to a computer screen.
A liver biopsy will confirm the diagnosis. For a biopsy, the doctor
uses a needle to take a small sample of tissue from the liver, then
examines it for scarring or other signs of disease.
|
Treatment
Liver damage from cirrhosis cannot be reversed, but treatment can stop
or delay further progression and reduce complications. Treatment depends
on the cause of cirrhosis and any complications a person is experiencing.
For example, cirrhosis caused by alcohol abuse is treated by abstaining
from alcohol. Treatment for hepatitis-related cirrhosis involves
medications used to treat the different types of hepatitis, such as
interferon for viral hepatitis and corticosteroids for autoimmune
hepatitis. Cirrhosis caused by Wilson's disease, in which copper builds up
in organs, is treated with medications to remove the copper. These are
just a few examples--treatment for cirrhosis resulting from other diseases
will depend on the underlying cause. In all cases, regardless of the
cause, following a healthy diet and avoiding alcohol are essential because
the body needs all the nutrients it can get, and alcohol will only lead to
more liver damage.
Treatment will also include remedies for complications. For example,
for ascites and edema, the doctor may recommend a low-sodium diet or the
use of diuretics, which are drugs that remove fluid from the body.
Antibiotics will be prescribed for infections, and various medications can
help with itching. Protein causes toxins to form in the digestive tract,
so eating less protein will help decrease the buildup of toxins in the
blood and brain. The doctor may also prescribe laxatives to help absorb
the toxins and remove them from the intestines.
For portal hypertension, the doctor may prescribe blood pressure
medication such as a beta-blocker. If varices bleed, the doctor may either
inject them with a clotting agent or perform a rubber-band ligation, which
uses a special device to compress the varices and stop the bleeding.
When complications cannot be controlled or when the liver becomes so
damaged from scarring that it completely stops functioning, a liver
transplant is necessary. In liver transplantation surgery, a diseased
liver is removed and replaced with a healthy one from an organ donor.
About 80 to 90 percent of people survive liver transplantation. Survival
rates have improved over the past several years because of drugs such as
cyclosporine and tacrolimus, which suppress the immune system and keep it
from attacking and damaging the new liver.
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
A new service available to patients provides a convenient means of staying informed, and ensures that the information is both reliable and accurate. If you wish to find out more about HealthNewsflash's innovative service, take the tour.
|
|
