Cirrhosis

Cirrhosis is diagnosed and treated by the GI Division at Premier Medical Group.

What is Cirrhosis?

Cirrhosis is scarring of the liver, a very serious condition. When a person has cirrhosis, scar tissue forms and replaces the healthy liver tissue. This scarring blocks the normal flow of blood through the liver. It can also cause high pressure, or portal hypertension, which is caused when vessels in the liver are blocked, making it difficult for the blood to flow. The liver is responsible for many vital functions, such as:

  • Filtering poisons from the blood
  • Storing vitamins and minerals
  • Making bile, which helps digestion and clotting factors to stop bleeding
  • Controlling sugar, fat, and protein in the bloodstream

Cirrhosis can be deadly, but early treatment can help stop damage to the liver.

What are the causes of cirrhosis?

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In the United States, long-term alcohol consumption and chronic hepatitis C have been the most common causes of cirrhosis. Obesity is also a growing concern, either as the single cause or in combination with alcohol, hepatitis C (link), or both. More than one cause of liver damage is often found in people with cirrhosis. Other causes include:

  • Drugs, medicines and harmful chemicals
  • Autoimmune diseases such as autoimmune hepatitis or primary sclerosing cholangitis (PSC)
  • Nonalcoholic steatohepatitis (NASH) or fatty liver disease
  • Diseases that block or destroy bile ducts
  • Inherited diseases, such as Wilson’s diseasecystic fibrosis, or hemochromatosis
  • Long term exposure to poisons such as arsenic or other harmful chemicals
  • Exposure to certain herbal medicines

What are the symptoms of cirrhosis?

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Early stages of cirrhosis do not generally show symptoms. However, as the disease progresses, the most common symptoms can include:

  • Weight loss
  • Nosebleeds and/or easy bruising
  • Extreme fatigue and weakness
  • Bleeding in the stomach or in the esophagus (the tube leading from mouth to stomach)
  • Fluid buildup in the belly (ascites)
  • Confusion
  • Yellowing of the skin , mucus membranes or eyes (jaundice)
  • Itching
  • Pale or clay colored stools
  • Small, red, spider-like blood vessels on the skin

How is cirrhosis diagnosed?

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The first step in diagnosing cirrhosis is a complete physical examination by your doctor. A compete medical history will be collected, any symptoms, and any risk factors such as high alcohol use or obesity will be noted. During the examination, your doctor will look for signs of enlarged or hardened liver, and ascites (fluid in the belly). If cirrhosis is suspected, he or she will order blood tests and imaging exams such as an ultrasound, MRI, or CT scan.

The next step is a liver biopsy (small sample of tissue removed and sent to lab) which would confirm a diagnosis of cirrhosis, or another cause of liver damage, and the severity. This is may be done under anesthesia to minimize discomfort. Some patients will be screened for liver cancer with a blood test (and imaging exams) to check for levels of alpha fetoprotein.

Your doctor will also look for other physical evidence of cirrhosis, such as:

  • Excess breast tissue
  • Small testicles
  • Reddened palms
  • Dilated veins in abdomen
  • Yellow skin and eyes
  • Enlarged liver or spleen

How is cirrhosis treated?

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The treatment for cirrhosis will depend on the cause, the severity, and if there are any complications present. Your doctor will chose the treatment best suited for you to slow the development of the scar tissue in the liver. If there are extreme complications present, hospitalization may be required.

The most important thing you can do if you have just been diagnosed with cirrhosis is to stop drinking alcohol. You need to quit completely.[Note] Discuss all medications with your doctor, including nonprescription drugs and vitamins, as they can affect liver function. Eating nutritious, well-balanced mealsis important. If ascites or fluid build-up develops, eating a low sodium diet is recommended. Your doctor may want you to be immunized for hepatitis A (link) and B (link) and influenza. Other treatment recommendations may include:

  • Liquid supplements by mouth or nasogastric tube.
  • Surgery
  • Medications
  • Careful monitoring of how the disease is progressing or responding to treatment
  • Removal of the fluid (ascites) from the stomach
  • Oral antibiotics
  • Diuretics
  • For portal hypertension, the doctor may prescribe a beta-blocker or nitrate
  • Hepatic encephalopathy is treated by cleansing the bowel with lactulose—a laxative given orally or in enemas
  • Reducing dietary protein intake

[Note] Mention speaking to your doctor about recovery options if your drinking habits are excessive.

Frequently Asked Questions about Cirrhosis

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When is a liver transplant considered?

A liver transplant is only considered for those who would have the best chance of survival with the new liver, and only when all other treatments have failed to control the disease and any complications associated with the cirrhosis. Unfortunately, the number of people who need a liver transplant far exceeds the number of available organs.

Is Milk Thistle good for the liver?

Some patients with liver disorders use Milk Thistle. The main ingredient in Milk Thistle is silymarin, which is an anti-inflammatory and antioxidant. There is no scientific proof at this time that Milk Thistle can aid in liver problems, but some studies suggest Milk Thistle helps people with alcohol-related liver disease. A number of people claim it’s good for the heart by lowering cholesterol, diabetes, and helps to reduce cancer cells in the breast as well as cervical and prostate cancers. More studies are necessary before doctors will agree that it really helps the liver, especially since a large, well-designed scientific study failed to show any benefits from Milk Thistle in liver disease.

What are the complications of cirrhosis?

  • Edema and ascites (fluid buildup in the legs and in the abdomen is called ascites; ascites can lead to spontaneous bacterial peritonitis, a serious infection)
  • Bruising and bleeding
  • Portal hypertension
  • Esophageal varices and gastropathy (enlarged blood vessels in the esophagus, called varices, or in the stomach, called gastropathy (or both) are more likely to burst due to thin walls and increased pressure which could cause serious bleeding and require immediate medical attention)
  • Splenomegaly (enlarged spleen)
  • Jaundice (yellowing of the skin and eyes and darkening of urine)
  • Gallstones
  • Liver cancer
  • Sensitivity to medications
  • Hepatic encephalopathy (toxins accumulate in the brain as the result of a failing liver; the buildups can cause a decrease in mental function and result in a coma)
  • Insulin resistance and type 2 diabetes
  • Other problems such as immune system dysfunction leading to risk of infection, lung and kidney failure

How is the severity of cirrhosis measured?

The test most commonly used to measure for end-stage liver disease is called the MELD score. This consists of three blood tests: the INR (tests for clotting of blood), bilirubin (tests for amount of bile pigment in the blood), and creatinine (tests kidney function).