Cirrhosis is the term used to describe a severely scarred liver. There are a variety of factors that can damage liver tissue and any of these can lead to cirrhosis if it occurs for a long enough period of time. Even if liver cells try and regrow, they form abnormal clumps called nodules. At this point the liver is beginning to fail to perform its vital functions. In addition, the scarring and nodules themselves cause problems by interrupting the normal blood flow through the liver. Damage may be reversible early on, when the liver enters “fibrosis”. If the condition causing the damage cannot be corrected, fibrosis turns into cirrhosis.
In the United States and most developed countries, the cause of cirrhosis is usually alcohol abuse or untreated viral hepatitis C. In other parts of the world, hepatitis B is the most common cause.
Cases without a known cause are called cryptogenic cirrhosis.
A long list of conditions, infections and toxic agents or medications can cause cirrhosis, including (but not limited to):• Alcohol• Medications such as methotrexate, isoniazid, and methyldopa, among others• Infections – hepatitis B and C, plus other viruses and parasites• Blood flow obstructions caused by heart failure or clots• Inherited diseases which cause damage or prevent the liver from working normally, including Wilson’s disease (too much copper storage), hemochromatosis (too much iron) and other rare disorders that affect normal metabolism• Obstructions to the flow of bile out of the liver• Autoimmune disorders in which the body mistakenly attacks the liver
Symptoms are due to the failure of the liver as well as the blockage of its blood flow and include:• Abdominal discomfort, and sometimes abdominal pain• Swelling of the abdomen as fluid accumulates (called ascites)• Jaundice, a yellowing of the skin and whites of the eye due to high levels of bilirubin. The urine also turns dark while the stool is pale• Fatigue, lack of appetite, and weight loss• Changes in mental state with confusion, because the liver is not clearing the body of toxins• Fever• Bleeding from the intestinal tract• Kidney failure
Some people with cirrhosis have a known liver condition that has progressed, such as viral hepatitis or alcoholic liver disease. For those who do not, the diagnosis can be suspected based on physical exam and characteristic abnormalities in blood tests. Which tests are done depends on a person’s history and physical exam.
Sometimes imaging exams like ultrasound or CT scans are helpful.
If the diagnosis is not certain from examination, blood tests and imaging studies, or a liver biopsy may be necessary to get a definite diagnosis.
There is no way to cure cirrhosis. Further damage can be prevented if a person follows treatment instructions. That could mean discontinuing alcohol consumption. There are medications that can be used for some types of viral hepatitis.
Otherwise, treatment is aimed at reducing the symptoms and serious complications of cirrhosis by providing nutritional support, medications, and sometimes surgery. The serious complications include significant fluid collection in the abdomen, kidney failure, and gastrointestinal bleeding.
For some patients with liver failure due to cirrhosis, a liver transplant is the only option. Suitability depends on the cause of the cirrhosis and any other medical problems.
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