What is Cirrhosis of the Liver?
The liver functions to help eliminate waste, regulate cholesterol, store glucose, make protein and metabolize medications. It also makes bile, which is necessary to digest food. If there is chronic injury to the liver, healthy cells die and result in scarring. If the scarring progresses to where it involves a significant portion of the liver, then this is referred to as cirrhosis.
Symptoms and Diagnosis
In its early stages, cirrhosis often does not cause any signs or symptoms. With time, if cirrhosis progresses it can lead to various physical exam findings and laboratory abnormalities.
- Jaundice- Jaundice refers to yellowing of the skin and eyes. This can occur if the liver is not able to properly excrete bile and it accumulates in the bloodstream.
- Fluid retention- Part of the liver’s job is to deal with salt and to manufacture a protein called albumin. With cirrhosis, the liver cannot properly manage salt that is ingested in the diet. It also does not make enough albumin. Lastly there are alterations in blood circulation. All of these factors can lead to fluid leaking into the tissues and abdomen. Fluid that accumulates in the abdomen is called ascites.
- Bleeding- Part of the liver’s job is to make clotting factors. Patients with cirrhosis are not able to make enough clotting factors leading to thinning of the blood and bleeding. Patients with cirrhosis also have alterations in blood circulation that leads to lower levels of platelets. Platelets are blood cells that help with clotting and if they are low, bleeding can occur.
- Varices- Varices are enlarged veins in the esophagus and stomach. They occur in patients with cirrhosis who due to alterations in blood circulation. When these veins are under pressure, they can rupture and bleed.
- Confusion- Hepatic encephalopathy refers to confusion that occurs in patients with cirrhosis. Part of the liver’s function is to clear toxins from the bloodstream. In cirrhosis, these toxins can accumulate causing confusion, sleep disturbances, falls and sometimes coma.
- Liver Cancer- all patients with cirrhosis are at risk for liver cancer and should be regularly monitored for this
- Cirrhosis of Liver is the 12th leading cause of death by disease.
- Hepatitis C, Fatty Liver Disease, and alcohol abuse are the most common causes of Cirrhosis of Liver.
- There is no cure for Cirrhosis of Liver, but there are treatments available that can stop or delay its progress.
There are many different causes of cirrhosis. The most common causes include Non-Alcoholic Steatohepatits (NASH) or Fatty Liver Disease, Chronic Hepatitis C, and Alcohol abuse. Other causes include Chronic Hepatitis B, Autoimmune Hepatitis, Primary Biliary Cirrhosis, Primary Sclerosing Cholangitis, Wilson’s Disease and Hemochromatosis.
Prevention & Treatment
Treatment of cirrhosis is aimed at removing the offending cause, so as to slow or prevent the progression of the disease. General principles include:
- Vaccinate for Hepatitis A or B if not immune
- Avoid alcohol
- Avoid Tylenol in excess amounts, or other medications which could affect the liver
- Have a healthy diet that is low in fat. Avoid gaining excess amounts of weight. Salt may need to be restricted especially if there is fluid retention or ascites (insert sodium restricted diet link)
- Regular follow-up with Dr.Singh including labs at least every 6 months, ultrasound or CT scan to monitor for liver cancer each year, and a periodic upper endoscopy to check for and treat varices.
- Specific causes of cirrhosis may require specific treatments- Hepatitis B or C can be treated with antiviral medications which may help delay progression of cirrhosis. Autoimmune hepatitis can be treated with steroids or immunosuppressants. PBC or PSC can be treated with Ursodiol. NASH should be treated with diet, exercise, and weight loss. Vitamin E or Vitamin C may be helpful.
- If cirrhosis has progressed to its final stages, liver transplantation may be considered.