Cirrhosis of the Liver

Cirrhosis is the 11th leading cause of death by disease in the United States. Almost one half of these are alcohol related. About 25,000 people die from cirrhosis each year.

Description/Definition

Cirrhosis is a consequence of chronic liver disease characterized by replacement of normal, healthy liver tissue by fibrotic scar tissue, blocking the flow of blood through the organ and preventing it from working as it should, as well as regenerative nodules leading to progressive loss of liver function. The liver, the largest organ in the body, is vital in keeping the body functioning properly. It removes or neutralizes poisons from the blood, produces immune agents to control infection, and removes germs and bacteria from the blood. It makes proteins that regulate blood clotting and produces bile to help absorb fats and fat-soluble vitamins. As a result, you cannot live without a functioning liver.

Causes

In the United States, chronic alcoholism and hepatitis C are the most common causes. However, there are other factors believed to cause cirrhosis.

* Alcoholic Liver Disease - to many people, cirrhosis of the liver is synonymous with chronic alcoholism. Cirrhosis usually develops after more than a decade of heavy drinking. Alcohol seems to injure the liver by blocking the normal metabolism of protein, fats, and carbohydrates.

* Chronic Hepatitis C - Infection with this virus causes inflammation of and low grade damage to the liver that over several decades can lead to cirrhosis.

* Chronic Hepatitis B & D - the hepatitis B virus is probably the most common cause of cirrhosis worldwide, but it is less common in the United States. Hepatitis B, like hepatitis C, causes liver inflammation and injury that over several decades can lead to cirrhosis. Hepatitis D is another virus that infects the liver, but only in people who already have hepatitis B.

* Autoimmune Hepatitis - this disease appears to be caused by the immune system attacking the liver and causing inflammation, damage, and eventually scarring and cirrhosis.

* NASH (Nonalcoholic steatohepatitis) - in NASH, fat builds up in the liver and eventually causes scar tissue. This type of hepatitis appears to be associated with diabetes, protein malnutrition, obesity, coronary artery disease, and treatment with corticosteroid medications.

* Blocked Bile Ducts - when the ducts that carry bile out of the liver are blocked, bile backs up and damages liver tissue. The most common cause is primary biliary cirrhosis, a disease in which the ducts become inflamed, blocked, and scarred. Secondary biliary cirrhosis can happen after gallbladder surgery if the ducts are accidentally tied off or injured.

Symptoms

Many people with cirrhosis have no symptoms in the early stages of the disease. However, as scar tissue replaces healthy cells, liver function starts to fail and a person may experience exhaustion, fatigue, loss of appetite, nausea, weakness, weight loss, abdominal pain, and spider-like blood vessels (spider angiomas) that develop in the skin. As the disease progresses, complications may develop. In some people, these may be the first signs of the disease. The complications of cirrhosis are:

* Edema and Ascites - when the liver loses it ability to make the protein albumin, water accumulates in the legs (edema) and abdomen (ascites).

* Bruising and Bleeding - when the liver slows or stops production of the proteins needed for blood clotting, a person will bruise or bleed easily. The palms of the hands may be reddish and blotchy with palmar erythema.

* Jaundice - this is a yellowing of the skin and eyes that occurs when the diseased liver does not absorb enough bilirubin.

* Sensitivity to Medication - cirrhosis slows the liver's ability to filter medications from the blood. Because the liver does not remove drugs from the blood at the usual rate, they act longer than expected and build up in the body. This causes a person to be more sensitive to medications and their side effects.

* Portal Hypertension - normally, blood from the intestines and spleen is carried to the liver through the portal vein. But cirrhosis slows the normal flow of blood through the portal vein, which increases the pressure inside.

* Varices - when blood flow through the portal vein slows, blood from the intestines and spleen backs up into blood vessels in the stomach and esophagus. These blood vessels may become enlarged because they are not meant to carry this much blood. The enlarged blood vessels, called varices, have thins walls and carry high pressure, and thus are more likely to burst. If they do burst, the result is a serious bleeding problem in the upper stomach or esophagus.

* Insulin Resistance and Type 2 Diabetes - cirrhosis causes resistance to insulin. This hormone, produced by the pancreas, enables blood glucose to be used as energy by the cells of the body. If you have insulin resistance, your muscle, fat, and liver cells do not use insulin properly. The pancreas tries to keep up with the demand for insulin by producing more. Eventually, the pancreas cannot keep up with the body's need for insulin, and Type 2 diabetes develops as excess glucose builds up in the bloodstream.

* Hepatic Encephalopathy - when the liver does not efficiently function to cleanse the body of toxins and drugs, the mental state of patients may change dramatically and lead to coma, called Hepatic Encephalopathy. Treatment is directed at reducing the protein in the diet, avoiding sedatives and pain medications, and using laxatives and/or antibiotics to decrease the absorption of toxins from the intestines.

* Liver Cancer - hepatocellular carcinoma, a type of liver cancer commonly cause by cirrhosis, starts in the liver tissue itself. This cancer has a