Cirrhosis
Cirrhosis is a chronic, degenerative disease in which normal liver cells aredamaged and are then replaced by scar tissue. Cirrhosis changes the structureof the liver and the blood vessels that nourish it. The disease reduces theliver's ability to manufacture proteins and process hormones, nutrients, medications, and poisons.
Cirrhosis gets worse over time and can become potentially life threatening. It can cause excessive bleeding (hemorrhage),, impotence, liver cancer, coma due to accumulated ammonia and body wastes (liver failure), and death.
Cirrhosis is the seventh leading cause of disease-related death in the UnitedStates. It is twice as common in men as in women. The disease occurs in morethan half of all malnourished chronic alcoholics and kills about 25,000 people a year. It is the third most common cause of death in adults between the ages of 45 and 65.
Portal or nutritional cirrhosis is the form of the disease most common in theUnited States. About 30-50% of all cases of cirrhosis are this type. Nine out of every 10 people who have nutritional cirrhosis have a history of alcoholism. Portal or nutritional cirrhosis is also called Laënnec's cirrhosis.
Biliary cirrhosis is caused by diseases within the liver that impede bile flow. Bile is formed in the liver and is carried by ducts to the intestines. Bile then helps digest fats in the intestines. Biliary cirrhosis can scar or block these ducts. It represents 15-20% of all cirrhosis.
Various types of chronic hepatitis, especially hepatitis B and hepatitis C, can cause postnecrotic cirrhosis. This form of the disease affects up to 40% of all patients who have cirrhosis.
Disorders like the inability to metabolize iron may cause pigment cirrhosis (hemochromatosis), which accounts for 5-10% of all instances of the disease.
Long-term alcoholism is the primary cause of cirrhosis in the United States.Men and women respond differently to alcohol. Although most men can safely consume two to five drinks a day, one or two drinks a day can cause liver damage in women. Individual tolerance to alcohol varies, but people who drink moreand drink more often have a higher risk of developing cirrhosis. In some people, one drink a day can cause liver scarring.
Liver injury, reactions to prescription medications, exposure to toxic substances, and repeated episodes of heart failure with liver congestion can causecirrhosis. The disorder can also be a result of diseases that run in families(inherited diseases) or from poor nutrition. In about 10 out of every 100 patients, the cause of cirrhosis cannot be determined. Many people with cirrhosis do not have any symptoms.
Symptoms of cirrhosis result from the loss of functioning liver cells or organ swelling due to scarring. The liver enlarges during the early stages of illness, and the palms of the hands turn red. Other symptoms include loss of appetite, nausea, weakness, and weight loss.
As the disease progresses, the spleen enlarges and fluid collects in the abdomen (ascites) and legs (edema). Spiderlike blood vessels appear on the chestand shoulders bruise easily.
Cirrhosis can cause dry skin and intense itching. The whites of the eyes andthe skin may turn yellow (jaundice), and urine may be dark yellow or brown. Stools may be black or bloody, and the patient may develop persistent high blood pressure (portal hypertension).
If the liver loses its ability to remove toxins from the brain, the patient may become forgetful and unresponsive, neglect personal care, have trouble concentrating, and acquire new sleeping habits. High protein intake in these patients can also lead to these symptoms.
A patient's medical history can reveal illnesses or lifestyles likely to leadto cirrhosis. Liver changes can be seen during a physical examination. A doctor who suspects cirrhosis may order blood and urine tests to measure liver function. Because only a small number of healthy cells are needed to carry outessential liver functions, test results may be normal even when cirrhosis ispresent.
Computed tomography scans (CT), ultrasound, and other imaging techniques canbe used to determine the size of the liver, indicate healthy and scarred areas of the organ, and detect gallstones. Cirrhosis may also be diagnosed duringsurgery or by examining the liver with a laparoscope. This viewing device isinserted into the patient's body through a tiny incision in the abdomen.
Liver biopsy is usually needed to confirm a diagnosis of cirrhosis. In this procedure, a tissue sample is removed from the liver and is examined under a microscope in order to learn more about the organ.
The goal of treatment is to cure or reduce the condition causing cirrhosis, prevent or delay disease progression, and prevent or treat complications.
Salt and fluid intake is often limited, and activity is encouraged. A diet high in calories and moderately high in protein can benefit some patients. Tubefeedings or vitamin supplements may be prescribed if the liver continues todeteriorate. Patients are asked not to consume alcohol. A variety of other drugs are availabe to treat the many symptoms of cirrhosis.
Liver transplants can benefit patients with advanced cirrhosis. However, thenew liver will eventually become diseased unless the underlying cause of cirrhosis is removed. Patients with alcoholic cirrhosis must demonstrate a willingness to stop drinking before being considered suitable transplant candidates.
Cirrhosis-related liver damage cannot be reversed, but further damage can beprevented by patients who eat properly, get enough rest, do not consume alcohol, and remain free of infection.
If the underlying cause of cirrhosis cannot be corrected or removed, scarringwill continue. The liver will fail, and the patient will probably die withinfive years. Eliminating alcohol abuse could prevent 75-80% of all cases of cirrhosis. Patients who stop drinking after being diagnosed with cirrhosis canincrease their likelihood of living more than a few years from 40% to 60-70%.
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