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
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
twelfth leading cause of death by disease, killing about 26,000
people each year. Also, the cost of cirrhosis in terms of human
suffering, hospital costs, and lost productivity is high.
Cirrhosis has many
causes. In the United States, chronic alcoholism and hepatitis C
are the most common ones.
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 a 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
Chronic hepatitis B and D.
The hepatitis B virus is probably the most common cause of
cirrhosis worldwide, but it is less common in the United
States and the Western world. Hepatitis B, like hepatitis C,
causes liver inflammation and injury that over several decades
can lead to cirrhosis. Hepatitis D is another virus that
infects the liver, but only in people who already have
This disease appears to be caused by the immune system
attacking the liver and causing inflammation, damage, and
eventually scarring and cirrhosis.
Alpha-1 antitrypsin deficiency, hemochromatosis, Wilson
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 treatment with corticosteroid medications.
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
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
all lead to cirrhosis.
Signs and Symptoms
not have signs and symptoms of cirrhosis in the early stages of
the disease. But as more scar tissue replaces healthy tissue and
liver function declines, you may experience some of the
Lack of appetite
Small, red spider veins under your skin or
Yellowing of your skin and eyes and dark,
Bleeding from engorged veins in your
esophagus or intestines
Loss of interest in sex
Fluid in your abdominal cavity (ascites)
on your hands and feet and eventually on your entire body
Swelling of your legs and feet from
retained fluid (edema)
confusion, such as forgetfulness or trouble concentrating
Although not all cases
of cirrhosis are preventable, the following measures can greatly
reduce your risk:
Avoid alcohol or drink
in moderation. Alcohol is a toxin that must be filtered by your
liver. In the process, liver cells become damaged.
Unfortunately, you may not recognize that you have a problem
with alcohol before serious liver damage has occurred. Knowing
and recognizing a family history of alcoholism for you or others
is an important step in seeking treatment. If you have
cirrhosis, you should not drink alcohol.
Protect yourself from
hepatitis C. Because there's no vaccine to prevent hepatitis C,
the only way to protect yourself is to avoid exposure to the
virus. If you aren't absolutely certain of the health status of
a sexual partner, use a new condom every time you have sex.
Don't use nasal cocaine and avoid sharing needles or other drug
paraphernalia. Contaminated drug paraphernalia is responsible
for about half of all new cases of hepatitis C. See your doctor
if you have or have had hepatitis C or think you may have been
exposed to the virus.
Protect yourself from
hepatitis B. Getting a vaccine for hepatitis B is the best way
to protect yourself and others. However, other measures also can
keep you safe. Know the health status of every sexual partner.
If you don't know, use a new condom every time you have sex. And
if you use needles to inject drugs, be sure they're sterile and
don't share them.
Talk to your doctor
about getting a vaccination for Hepatitis A if you have not been
exposed to this virus or vaccinated. This virus, although it
does not lead to cirrhosis itself, can cause significant liver
damage and be dangerous among people with cirrhosis.
Coffee also may play a
role in preventing cirrhosis caused by alcohol abuse. In a 2006
study of more than 125,000 people, one cup of coffee a day
reduced the risk of alcoholic cirrhosis by 20 percent. Four cups
a day reduced the risk by 80 percent. It's unclear whether the
caffeine or another coffee ingredient provided the protection —
but avoiding alcohol remains the only proven way to prevent
alcoholic cirrhosis. These study results are controversial and
should not be interpreted to suggest coffee as a treatment to
allow excess alcohol consumption. If alcohol is consumed, it
should be done so in moderation. People with cirrhosis should
not consume any alcohol.
cirrhosis seldom causes signs and symptoms in the early stages,
your doctor may discover the disease during a routine medical
examination. By gently pressing your abdomen, your doctor can
often tell whether your liver is enlarged and firm, a sign of
liver disease. As cirrhosis progresses, however, your liver
often shrinks, leading to a backflow of blood and an enlarged
spleen, which also may be detected in a physical exam.
If your doctor suspects
cirrhosis, you're likely to have certain tests, including:
Blood Tests. A damaged liver releases
certain enzymes. Measuring these enzymes may help determine
whether you have liver damage.
Bilirubin, a red-yellow pigment that
results from the normal breakdown of red blood cells, is
metabolized in your liver and excreted in your urine. But in
advanced cirrhosis, your liver can't process bilirubin, leading
to high blood levels of the pigment.
Ultrasound. This noninvasive test uses
sound waves to produce a picture of internal organs, including
the liver. Ultrasound is painless and usually takes less than 30
minutes. While you lie on a bed or examining table, a
wand-shaped device (transducer) is placed on your body. It emits
sound waves that are reflected from your liver and transformed
into a computer image.
Computerized Tomography (CT) Scan. This test uses X-rays to produce cross-sectional images of your
body. It can provide an accurate look at internal organs, but it
generates more radiation than conventional X-rays do.
Magnetic Resonance Imaging
(MRI). Instead of X-rays, MRI creates
images using a magnetic field and radio waves. Sometimes a
contrast dye also may be used. The test can take from 15 minutes
to an hour.
Liver Biopsy. Although other tests can provide a great deal of information
about the extent and type of liver damage, a biopsy is the only
way to definitively diagnose cirrhosis. In this procedure, a
small sample of tissue is removed from your liver and examined
under a microscope. Your doctor is likely to use a thin cutting
needle to obtain the sample. Needle biopsies are relatively
simple procedures requiring only local anesthesia, but your
doctor may choose not to do one if you have bleeding problems or
severe abdominal swelling (ascites). Risks include bruising,
bleeding and infection.
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