| Cirrhosis
 The
liver is a large organ that sits in the right upper abdomen, just under the
right lung. It is one of the body's most "intelligent" organs in that
it performs so many different functions at the same time. The liver makes
proteins, eliminates waste material from the body, produces cholesterol, stores
and releases glucose energy and metabolizes many drugs used in medicine. It also
produces bile that flows through bile ducts into the intestine where it helps to
digest food. This remarkable organ also has the ability to regenerate itself if
it is injured or partially removed. The liver receives blood from two different
sources -- the heart and the intestine. All of this blood flows through the
liver and returns to the heart. It is no wonder that the ancient Chinese viewed
the liver, not the heart, as the center of the body.
What Is Cirrhosis?
Many types of chronic injury to the liver can result in scar tissue. This
scarring distorts the normal structure and regrowth of liver cells. The flow of
blood through the liver from the intestine is blocked and the work done by the
liver, such as processing drugs or producing proteins, is hindered.
What Causes Cirrhosis?
Cirrhosis can be caused by many things, some known and others unknown:
Alcohol -- Using alcohol in excess is the most common cause of
cirrhosis in the United States.
Chronic Viral Hepatitis -- Type B and Type C hepatitis, and perhaps
other viruses, can infect and damage the liver over a prolonged time and
eventually cause cirrhosis.
Chronic Bile Duct Blockage -- This condition can occur at birth (biliary
atresia) or develop later in life (primary biliary cirrhosis). The cause of
the latter remains unknown. When the bile ducts outside the liver become
narrowed and blocked, the condition is called primary sclerosing cholangitis.
This condition is often associated with chronic ulceration of the colon
(colitis).
Abnormal Storage of Copper (Wilson's Disease) or Iron (Hemochromatosis)
-- These metals are present in all body cells. When abnormal amounts of them
accumulate in the liver, scarring and cirrhosis may develop.
Drugs and Toxins -- Prolonged exposure to certain chemicals or drugs
can scar the liver.
Autoimmune Hepatitis -- This chronic inflammation occurs when the
body's protective antibodies fail to recognize the liver as its own tissue.
The antibodies injure the liver cells as though they were a foreign protein or
bacteria.
Cystic Fibrosis and Alpha l-antitrypsin Deficiency -- These
disorders are inherited.
What Are the Signs and Symptoms?
Cirrhosis takes years to develop. During this time, there are usually no
symptoms, although fatigue, weakness and decreased appetite may occur and worsen
with time. When cirrhosis is fully developed, a number of signs may be present:
Fluid retention in the legs and abdomen -- The liver produces a
protein, called albumin, that holds fluid in blood vessels. When the blood
level of albumen falls, fluid seeps out of the tissues into the legs and
abdomen, causing edema (fluid accumulation) and swelling.
Jaundice -- The liver produces bile that normally flows into the
intestine.With advanced cirrhosis, bile can back up into the blood, causing
the skin and eyes to turn yellow and the urine to darken.
Intense Itching -- Certain types of cirrhosis, such as chronic bile
duct blockage, can produce troublesome itching.
Gallstones -- Cirrhosis causes the abnormal metabolism of bile
pigment. Because of this, gallstones develop twice as often in cirrhosis
patients as in those without the disorder.
Coagulation Defects -- The liver makes certain proteins that help
clot blood. When these proteins are deficient, excessive or prolonged bleeding
happens.
Mental Function Change -- The liver processes toxins from the
intestine. When these substances escape into the bloodstream, as occurs in
severe cases of cirrhosis, a variety of changes in mental function can
develop.
Esophageal Vein Bleeding -- In advanced cirrhosis, intestinal blood
bypasses the liver and flows up and around the esophagus (the food tube) to
the heart. The veins in the esophagus dilate (widen) and may rupture, causing
slow or massive intestinal bleeding.
 Diagnosis
and Liver Biopsy
The physician can always suspect cirrhosis from the patient's medical history
and physical examination. In addition, certain blood tests and scans or
ultrasound (sonography) can provide helpful information. To make a definite
diagnosis, however, a liver biopsy (tissue sample) is required. This is
performed by anesthetizing the skin of the right-lower chest and inserting a
thin, needle into the liver. A core or specimen of tissue is removed and
examined under a microscope.
What Is the Course of Cirrhosis?
When cirrhosis is diagnosed, the patient and physician begin a plan of action
designed to preserve the remaining liver cells and correct the complications
mentioned above. By following this plan, most patients can lead long, productive
lives.
Prevention
Perhaps 90 percent of cirrhosis is caused by excessive alcohol consumption or
hepatitis viruses. Of course, alcohol can be avoided. Alcohol consumption should
always be limited to no more than 1 or 2 drinks per day. And type B hepatitis
now has an effective vaccine against it. Vaccination against B hepatitis virus
is safe and inexpensive. It should be taken especially by certain high-risk
groups: all health care professionals, persons traveling to third world
countries, homosexuals, intravenous drug users, and prostitutes.
Treatment
Often, the only required treatment for cirrhosis is removing the offending
cause:
 | The alcoholic patient must permanently stop consuming alcohol.
| When iron is being retained in the body, chronic removal of blood by vein
eliminates large amounts of iron.
| Cortisone medicine helps treat autoimmune hepatitis and cirrhosis.
| Restricting salt and using fluid pills (diuretics ) reduce edema and
abdominal swelling.
| Toxins and injurious drugs must be avoided.
| Decreasing dietary protein and using certain laxatives generally can
prevent changes in mental function.
| Bleeding veins in the esophagus can be injected with sclerosing (clotting)
agents or closed with small rubber bands. Occasionally, surgery is necessary
to prevent recurrent massive bleeding.
| Ursodiol (Actigall) and other drugs have been helpful in treating primary
biliary cirrhosis and primary sclerosing cholangitis. |
| | | | | | |
Liver Transplant
Liver transplantation has progressed to the stage where it can now be considered
as standard treatment for selected patients.
Summary
Cirrhosis of the liver is a common disorder that has many causes. With early
diagnosis, much can be done to prevent serious complications. Various treatments
are available, depending on the cause of the liver injury and its complications.
Ongoing medical research promises major advances in treating cirrhosis in the
future.
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