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
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
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.
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Cirrhosis has many causes. In the United States,
chronic alcoholism and hepatitis C are the most common
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 cirrhosis.
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 hepatitis B.
Autoimmune hepatitis. This disease
appears to be caused by the immune system attacking the liver and
causing inflammation, damage, and eventually scarring and
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
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
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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:
As the disease progresses, complications may
develop. In some people, these may be the first signs of the
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Loss of liver function affects the body in many
ways. Following are the common problems, or complications, caused by
Edema and ascites. When the liver loses
its ability to make the protein albumin, water accumulates in the
legs (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. The palms of the hands may be
reddish and blotchy with palmar erythema.
Jaundice. Jaundice is a yellowing of the
skin and eyes that occurs when the diseased liver does not absorb
Itching. Bile products deposited in the
skin may cause intense itching.
Gallstones. If cirrhosis prevents bile
from reaching the gallbladder, gallstones may develop.
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
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
Insulin resistance and type 2 diabetes.
Cirrhosis causes resistance to insulin. This hormone, produced by
the pancreas, enables blood glucose to be used as energy by the
cells of the body. If you have insulin resistance, your muscle, fat,
and liver cells do not use insulin properly. The pancreas tries to
keep up with the demand for insulin by producing more. Eventually,
the pancreas cannot keep up with the body's need for insulin, and
type 2 diabetes develops as excess glucose builds up in the
Liver cancer. Hepatocellular carcinoma, a
type of liver cancer commonly caused by cirrhosis, starts in the
liver tissue itself. It has a high mortality rate.
Problems in other organs. Cirrhosis can
cause immune system dysfunction, leading to infection. Fluid in the
abdomen (ascites) may become infected with bacteria normally present
in the intestines. Cirrhosis can also lead to impotence, kidney
dysfunction and failure, and osteoporosis.
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The doctor may diagnose cirrhosis on the basis
of symptoms, laboratory tests, the 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
If looking at the liver is necessary to check
for signs of disease, the doctor might order a computerized axial
tomography (CAT) scan, ultrasound, magnetic resonance imaging (MRI),
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 that is inserted
through the abdomen and relays pictures back to a computer
A liver biopsy will confirm the diagnosis. For a
biopsy, the doctor uses a needle to take a tiny sample of liver
tissue, then examines it under the microscope for scarring or other
signs of disease.
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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 depends 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. Light physical activity
can help stop or delay cirrhosis as well.
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 a blood pressure medication such as a beta-blocker. If
varices bleed, the doctor may either inject them with a clotting
agent or perform a so-called rubber-band ligation, which uses a
special device to compress the varices and stop the
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
patients 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.
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American Liver Foundation
75 Maiden Lane, Suite 603
New York, NY
Phone: 1-800-GO-LIVER (465-4837),
504 Blick Drive
Phone: 1-800-891-0707 or 301-622-4200
Network for Organ Sharing
P.O. Box 2484
Phone: 1-888-894-6361 or 804-782-4800
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