Cirrhosis Health Article

Definition

Cirrhosis is a chronic, degenerative disease in which normal liver cells are damaged and are then replaced by scar tissue.

Description

Cirrhosis changes the structure of the liver and the blood vessels that nourish it. The disease reduces the liver's ability to manufacture proteins and process hormones, nutrients, medications, and poisons.

Cirrhosis gets worse over time and can become potentially life threatening. This disease can cause:

• excessive bleeding (hemorrhage)
• impotence
• liver cancer
• coma due to accumulated ammonia and body wastes (liver failure)
• death

Cirrhosis is the seventh leading cause of diseaserelated death in the United States. It is twice as common in men as in women. The disease occurs in more than half of all malnourished chronic alcoholics and kills about 25,000 people a year. It is the third most common cause of death in adults between the ages of 45 and 65.

Types of cirrhosis

Portal or nutritional cirrhosis is the form of the disease most common in the United States. About 30–50% of all cases of cirrhosis are this type. Nine out of every 10 people who have nutritional cirrhosis have a history of alcoholism. Portal or nutritional cirrhosis is also called Laënnec's cirrhosis.

Biliary cirrhosis is caused by intrahepatic bile-duct diseases that impede bile flow. Bile is formed in the liver and is carried by ducts to the intestines. Bile then helps digest fats in the intestines. Biliary cirrhosis can scar or block these ducts. It represents 15–20% of all cirrhosis.

Various types of chronic hepatitis, especially hepatitis B and hepatitis C, can cause postnecrotic cirrhosis.

This form of the disease affects up to 40% of all patients who have cirrhosis.

Disorders like the inability to metabolize iron and similar disorders may cause pigment cirrhosis (hemochromatosis), which accounts for 5–10% of all instances of the disease.

Causes and symptoms

Long-term alcoholism is the primary cause of cirrhosis in the United States. Men and women respond differently to alcohol. Although most men can safely consume two to five drinks a day, one or two drinks a day can cause liver damage in women. Individual tolerance to alcohol varies, but people who drink more and drink more often have a higher risk of developing cirrhosis. In some people, one drink a day can cause liver scarring.

Chronic liver infections like hepatitis B and particularly hepatitis C are commonly linked to cirrhosis. People at high risk of contracting hepatitis B include those exposed to the virus through contact with blood and body fluids. This includes healthcare workers and intraveneous (IV) drug users. People in the past have contracted hepatitis C through blood transfusions.

Liver injury, reactions to prescription medications, exposure to toxic substances, and repeated episodes of heart failure with liver congestion can cause cirrhosis. The disorder can also be a result of diseases that run in families (inherited diseases) like:

• a lack of a specific liver enzyme (alpha₁-antitrypsin deficiency)
• the absence of a milk-digesting enzyme (galactosemia)
• an inability to convert sugars to energy (glycogen storage disease)
• an absorption deficit in which excess iron is deposited in the liver, pancreas, heart, and other organs (hemochromatosis)
• a disorder characterized by accumulations of copper in the liver, brain, kidneys, and corneas (Wilson's disease)

Poor nutrition increases a person's risk of developing cirrhosis. In about 10 out of every 100 patients, the cause of cirrhosis cannot be determined. Many people who have cirrhosis do not have any symptoms (often called compensated cirrhosis). Their disease is detected during a routine physical or when tests for an unrelated medical problem are performed. This type of cirrhosis can also be detected when complications occur (decompensated cirrhosis).

Symptoms of cirrhosis are usually caused by the loss of functioning liver cells or organ swelling due to scarring. The liver enlarges during the early stages of illness. The palms of the hands turn red and patients may experience:

• constipation
• diarrhea
• dull abdominal pain
• fatigue
• indigestion
• loss of appetite
• nausea
• vomiting
• weakness
• weight loss

As the disease progresses, the spleen enlarges and fluid collects in the abdomen (ascites) and legs (edema). Spider-like blood vessels appear on the chest and shoulders, and bruising becomes common. Men sometimes lose chest hair. Their breasts may grow and their testicles may shrink. Women may have menstrual irregularities.

Cirrhosis can cause extremely dry skin and intense itching. The whites of the eyes and the skin may turn yellow (jaundice), and urine may be dark yellow or brown. Stools may be black or bloody. Sometimes the patient develops persistent high blood pressure due to the scarring (portal hypertension). This type of hypertension can be life threatening. It can cause veins to enlarge in the stomach and in the tube leading from the mouth to the stomach (esophagus). These enlarged veins are called varices, and they can rupture and bleed massively.

Other symptoms of cirrhosis include:

• anemia
• bleeding gums
• decreased interest in sex
• fever
• fluid in the lungs
• hallucinations
• lethargy
• lightheadedness
• muscle weakness
• musty breath
• painful nerve inflammation (neuritis)
• slurred speech
• tremors

If the liver loses its ability to remove toxins from the brain, the patient may have additional symptoms. The patient may become forgetful and unresponsive, neglect personal care, have trouble concentrating, and acquire new sleeping habits. These symptoms are related to ammonia intoxication and the failure of the liver to convert ammonia to urea. High protein intake in these patients can also lead to these symptoms.