Cirrhosis

What is cirrhosis?

Cirrhosis is defined as scarring of the liver. It usually happens after the liver has been inflamed for years but in some cases, the progression from liver injury to cirrhosis may occur over weeks. This is most often cause alcohol abuse or viral hepatitis. Other causes of cirrhosis include mediations, fatty liver, hereditary or autoimmune conditions. In some cases, no cause can be found.

What are the symptoms of cirrhosis?

Some people with cirrhosis have normal liver function and may be asymptomatic. These patients can have a reasonably normal life expectancy. When symptoms do occur, it is indicative of decreased liver function and possibly liver failure or end-stage liver disease. Common symptoms include:

  • Accumulation of fluid in the abdomen (called ascites), legs, and/or lungs
  • Easy bruising or easy bleeding; including large volume bleeding from engorged vessels in the esophagus called varices.
  • Trouble breathing
  • Fatigue
  • Trouble getting enough sleep or sleeping too much
  • Yellowing of the skin or whites of the eyes, called jaundice
  • Somnolence or confusion

What causes cirrhosis?

  • Heavy alcohol use
  • Hepatitis B or hepatitis C viral infection. People can catch the viruses by sharing needles or having sex with people who are infected.
  • Nonalcoholic steatohepatitis (NASH), a condition preceded by fatty liver. People with this condition often are overweight and have diabetes.

How can cirrhosis be diagnosed?

  • A liver biopsy is the most sensitive test. This is usually performed as an outpatient procedure using ultrasound or CT guidance.
  • Blood tests can show evidence of liver dysfunction and assist with determining the cause of liver disease.
  • Imaging may show a nodular and small liver which would suggest cirrhosis

How can you prevent further liver damage?

  • Abstain from any alcohol
  • Consult with your doctor before you start taking any new medicines, including over-the-counter medications and herbals.
  • Avoid pain killer and sleeping aid medications as they increase your risk of confusion
  • Get vaccinated against hepatitis A and B if you have not had the infections before

How is cirrhosis treated?

Cirrhosis is an irreversible process. Treatment focuses on achieving compensation and prevention of complications. However, when able to identify the cause of liver damage, treatment would focus on this. 

  • Treat the cause of the disease: People with cirrhosis caused by alcohol abuse should try to stop drinking. People with chronic hepatitis C or B can take medicines to control or cure the infection.
  • Lower the risk of bleeding: If varices (engorged vessels in the esophagus) are present, medicines to decrease the pressure in these vessels or a procedure where small rubber bands are placed endoscopically, can prevent bleeding.
  • Decrease fluid buildup in the abdomen, legs, and lungs: Water pills could be prescribed by your doctor to get rid of the extra fluid. A procedure called a paracentesis could also be performed in cases of large volume ascites (fluid buildup in the abdomen) or when the cause is not known.
  • Treat or prevent infection: People with cirrhosis have a higher than normal chance of getting infections. When they get an infection, they can also get much sicker than people without cirrhosis. People with cirrhosis should get vaccinated against the flu, pneumococcal pneumonia, hepatitis A and B viruses. They may also need antibiotics to prevent or treat infection when fluid buildup in the abdomen is present.
  • Treat confusion: Advanced or decompensated cirrhosis can lead to confusion. Constipation can also lead to confusion in people with cirrhosis and should be avoided. Medications such as lactulose and rifaximin are used to prevent and/or treat confusion in patients with cirrhosis