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What Is Cirrhosis of the Liver? The liver weighs about 3 pounds and is the

largest organ in the body. It is located in the upper-right side of the

abdomen, below the ribs. When chronic diseases cause the liver to become

permanently injured and scarred, the condition is called cirrhosis.

The scar tissue that forms in cirrhosis harms the structure of the liver,

blocking the flow of blood through the organ. The loss of normal liver tissue

slows the processing of nutrients, hormones, drugs, and toxins by the liver.

Also slowed is production of proteins and other substances made by the liver.

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What Is the Impact of Cirrhosis? Cirrhosis is the seventh leading cause of

death by disease. About 25,000 people die from cirrhosis each year. There

also is a great toll in terms of human suffering, hospital costs, and the

loss of work by people with cirrhosis.

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What Are the Major Causes of Cirrhosis? Cirrhosis has many causes. In the

United States, chronic alcoholism is the most common cause. Cirrhosis also

may result from chronic viral hepatitis (types B, C, and D). Liver injury

that results in cirrhosis also may be caused by a number of inherited

diseases such as cystic fibrosis, alpha-1 antitrypsin deficiency,

hemochromatosis, 's disease, galactosemia, and glycogen storage

diseases.

Two inherited disorders result in the abnormal storage of metals in the liver

leading to tissue damage and cirrhosis. People with 's disease store

too much copper in their livers, brains, kidneys, and in the corneas of their

eyes. In another disorder, known as hemochromatosis, too much iron is

absorbed, and the excess iron is deposited in the liver and in other organs,

such as the pancreas, skin, intestinal lining, heart, and endocrine glands.

If a person's bile duct becomes blocked, this also may cause cirrhosis. The

bile ducts carry bile formed in the liver to the intestines, where the bile

helps in the digestion of fat. In babies, the most common cause of cirrhosis

due to blocked bile ducts is a disease called biliary atresia. In this case,

the bile ducts are absent or injured, causing the bile to back up in the

liver. These babies are jaundiced (their skin is yellowed) after their first

month in life. Sometimes they can be helped by surgery in which a new duct is

formed to allow bile to drain again from the liver.

In adults, the bile ducts may become inflamed, blocked, and scarred due to

another liver disease, primary biliary cirrhosis. Another type of biliary

cirrhosis also may occur after a patient has gallbladder surgery in which the

bile ducts are injured or tied off.

Other, less common, causes of cirrhosis are severe reactions to prescribed

drugs, prolonged exposure to environmental toxins, and repeated bouts of

heart failure with liver congestion.

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What Are the Symptoms of Cirrhosis? People with cirrhosis often have few

symptoms at first. The two major problems that eventually cause symptoms are

loss of functioning liver cells and distortion of the liver caused by

scarring. The person may experience fatigue, weakness, and exhaustion. Loss

of appetite is usual, often with nausea and weight loss.

As liver function declines, less protein is made by the organ. For example,

less of the protein albumin is made, which results in water accumulating in

the legs (edema) or abdomen (ascites). A decrease in proteins needed for

blood clotting makes it easy for the person to bruise or to bleed.

In the later stages of cirrhosis, jaundice (yellow skin) may occur, caused by

the buildup of bile pigment that is passed by the liver into the intestines.

Some people with cirrhosis experience intense itching due to bile products

that are deposited in the skin. Gallstones often form in persons with

cirrhosis because not enough bile reaches the gallbladder.

The liver of a person with cirrhosis also has trouble removing toxins, which

may build up in the blood. These toxins can dull mental function and lead to

personality changes and even coma (encephalopathy). Early signs of toxin

accumulation in the brain may include neglect of personal appearance,

unresponsiveness, forgetfulness, trouble concentrating, or changes in

sleeping habits.

Drugs taken usually are filtered out by the liver, and this cleansing process

also is slowed down by cirrhosis. The liver does not remove the drugs from

the blood at the usual rate, so the drugs act longer than expected, building

up in the body. People with cirrhosis often are very sensitive to medications

and their side effects.

A serious problem for people with cirrhosis is pressure on blood vessels that

flow through the liver. Normally, blood from the intestines and spleen is

pumped to the liver through the portal vein. But in cirrhosis, this normal

flow of blood is slowed, building pressure in the portal vein (portal

hypertension). This blocks the normal flow of blood, causing the spleen to

enlarge. So blood from the intestines tries to find a way around the liver

through new vessels.

Some of these new blood vessels become quite large and are called varices.

These vessels may form in the stomach and esophagus (the tube that connects

the mouth with the stomach). They have thin walls and carry high pressure.

There is great danger that they may break, causing a serious bleeding problem

in the upper stomach or esophagus. If this happens, the patient's life is in

danger, and the doctor must act quickly to stop the bleeding.

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How Is Cirrhosis Diagnosed? The doctor often can diagnose cirrhosis from the

patient's symptoms and from laboratory tests. During a physical exam, for

instance, the doctor could notice a change in how your liver feels or how

large it is. If the doctor suspects cirrhosis, you will be given blood tests.

The purpose of these tests is to find out if liver disease is present. In

some cases, other tests that take pictures of the liver are performed such as

the computerized axial tomography (CAT) scan, ultrasound, and the

radioisotope liver/spleen scan.

The doctor may decide to confirm the diagnosis by putting a needle through

the skin (biopsy) to take a sample of tissue from the liver. In some cases,

cirrhosis is diagnosed during surgery when the doctor is able to see the

entire liver. The liver also can be inspected through a laparoscope, a

viewing device that is inserted through a tiny incision in the abdomen.

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What Are the Treatments for Cirrhosis? Treatment of cirrhosis is aimed at

stopping or delaying its progress, minimizing the damage to liver cells, and

reducing complications. In alcoholic cirrhosis, for instance, the person must

stop drinking alcohol to halt progression of the disease. If a person has

hepatitis, the doctor may administer steroids or antiviral drugs to reduce

liver cell injury.

Medications may be given to control the symptoms of cirrhosis, such as

itching. Edema and ascites (fluid retention) are treated by reducing salt in

the diet. Drugs called diuretics are used to remove excess fluid and to

prevent edema from recurring. Diet and drug therapies can help to improve the

altered mental function that cirrhosis can cause. For instance, decreasing

dietary protein results in less toxin formation in the digestive tract.

Laxatives such as lactulose may be given to help absorb toxins and speed

their removal from the intestines.

The two main problems in cirrhosis are liver failure, when liver cells stop

working, and the bleeding caused by portal hypertension. The doctor may

prescribe blood pressure medication, such as a beta blocker, to treat the

portal hypertension. If the patient bleeds from the varices of the stomach or

esophagus, the doctor can inject these veins with a sclerosing agent

administered through a flexible tube (endoscope) that is inserted through the

mouth and esophagus. In critical cases, the patient may be given a liver

transplant or another surgery (such as a portacaval shunt) that is sometimes

used to relieve the pressure in the portal vein and varices.

Patients with cirrhosis often live healthy lives for many years. Even when

complications develop, they usually can be treated. Many patients with

cirrhosis have undergone successful liver transplantation.

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Additional Readings Biliary Atresia. This brochure presents information on

biliary atresia and cirrhosis, including discussions of diagnosis, treatment,

and complications. Available from the American Liver Foundation. 1428 Pompton

Avenue, Cedar Grove, NJ 07009. (800) 223-0179 or (201) 256-2550.

Cirrhosis. This fact sheet presents general information on cirrhosis of the

liver, research, and the work of the American Liver Foundation. Available

from the foundation.

Clayman CB, ed. The American Medical Association Encyclopedia of Medicine.

New York: Random House. 1989. Authoritative reference guide for patients,

with sections on cirrhosis, hepatitis, and other disorders affecting the

liver. Widely available in libraries and bookstores.

Primary Biliary Cirrhosis. This fact sheet presents information on PBC and

cirrhosis, including discussions of diagnosis, treatment, and liver

transplantation. Available from the American Liver Foundation.

Rosenfeld I. Second Opinion: Your Comprehensive Guide to Treatment. New York:

Bantam Books, 1988. General medical guide with sections on cirrhosis and

other disorders affecting the liver. Widely available in libraries and

bookstores.

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Resources American Liver Foundation

1425 Pompton Avenue

Cedar Grove, NJ 07009

(800) 223-0179 or (201) 256-2550

United Network for Organ Sharing

1100 Boulders Parkway, Suite 500

P.O. Box 13770

Richmond, VA 23225-8770

(804) 330-8500

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National Digestive Diseases Information Clearinghouse

2 Information Way

Bethesda, MD 20892-3570

E-mail: nddic@...

The National Digestive Diseases Information Clearinghouse (NDDIC) is a

service of the National Institute of Diabetes and Digestive and Kidney

Diseases (NIDDK). NIDDK is part of the National Institutes of Health under

the U.S. Public Health Service. Established in 1980, the clearinghouse

provides information about digestive diseases to people with digestive

disorders and to their families, health care professionals, and the public.

NDDIC answers inquiries; develops, reviews, and distributes publications; and

works closely with professional and patient organizations and Government

agencies to coordinate resources about digestive diseases.