Cirrhosis of the Liver

Cirrhosis of the Liver: Overview

Alternative Names: Chronic liver disease

Cirrhosis of the liver is a condition in which scar tissue replaces normal, healthy tissue, blocking the flow of blood through the organ and preventing it from working as it should.  Cirrhosis is the eighth leading cause of death by disease and the cost of cirrhosis in terms of human suffering, hospital costs and lost productivity is high because loss of liver function affects the body in many ways.

Causes and Development

In the United States, chronic alcoholism and hepatitis C are the most common of its many causes.

Autoimmune hepatitis is caused by a problem with the immune system.

Inherited diseases including Alpha-1 antitrypsin deficiency, hemochromatosis, Wilson's disease, galactosemia, and glycogen storage diseases interfere with the way the liver produces, processes, and stores enzymes, proteins, metals, and other substances the body needs to function properly.

In cases of Nonalcoholic steatohepatitis (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 corticosteroid treatment.

Blocked bile ducts.  When the ducts that carry bile out of the liver are blocked, bile backs up and damages liver tissue.  In babies, blocked bile ducts are most commonly caused by biliary atresia, a disease in which the bile ducts are absent or injured.  In adults, 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 inadvertently tied off or injured.

Drugs, toxins, and infections.  Severe reactions to prescription drugs, prolonged exposure to environmental toxins, the parasitic infection schistosomiasis, and repeated bouts of heart failure with liver congestion can each lead to cirrhosis.

Signs and 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 various symptoms.  As the disease progresses, complications may develop.

Symptoms include:
  • Ascites
  • Swelling of the legs
  • Vomiting blood
  • Confusion
  • Jaundice
  • Small, red spider-like blood vessels on the skin
  • Loss of appetite
  • Weakness
  • Weight loss
  • Nausea and vomiting
  • Impotence and loss of interest in sex
  • Bleeding hemorrhoids
  • Exhaustion
  • Fatigue
Additional symptoms that may be associated with this disease:
  • Urine output, decreased
  • Swelling, overall
  • Stools, pale or clay colored
  • Nosebleed or bleeding gums
  • Gynecomastia (breast development in males)
  • Abdominal pain
  • Abdominal indigestion
  • Fevers
Symptoms may develop gradually, or there may be no symptoms.

Diagnosis and Tests

The doctor may diagnose cirrhosis on the basis of symptoms, laboratory tests, the patient's medical history and a physical examination.  The doctor may, for example, notice that the liver feels harder or larger than usual and order blood tests that can show whether liver disease is present.

If a liver examination is necessary, the doctor might order a computerized axial tomography (CAT) scan, ultrasound, a scan of the liver using a radioisotope, or look at the liver using a laparoscope.  A liver biopsy will confirm the diagnosis.  For a biopsy, the doctor uses a needle to take a small sample of tissue from the liver, then examines it for scarring or other signs of disease.

A physical examination may reveal an enlarged liver or spleen, distended abdomen, yellow eyes or skin (jaundice), red spider-like blood vessels on the skin, excess breast tissue, small testicles in men, contracted fingers, or dilated abdominal wall veins.

Tests can reveal liver problems including:
  • Anemia (detected on a CBC)
  • Coagulation abnormalities
  • Elevated liver enzymes
  • Elevated bilirubin
  • Serum albumin low
  • Enlarged liver (seen with an abdominal X-ray.)
A liver biopsy confirms cirrhosis.

This disease may also alter the results of the following tests:

Treatment and Prevention

Liver damage from cirrhosis cannot be reversed, but treatment can stop or delay further progression and reduce complications.  Treatment depends on the cause of cirrhosis and any complications a person is experiencing.  For example, cirrhosis caused by alcohol abuse is treated by abstaining from alcohol; treatment for hepatitis-related cirrhosis involves medications used to treat the different types of hepatitis, such as interferon for viral hepatitis and corticosteroids for autoimmune hepatitis; cirrhosis caused by Wilson's disease, in which copper builds up in organs, is treated with medications to remove the copper.  Treatment will also include remedies for complications such as edema, infections and itching.

Treatment is directed at managing the complications of cirrhosis and preventing further liver damage.
  • Offending medications and alcohol are stopped.
  • Bleeding varices are treated by upper endoscopy with banding or sclerosis.
  • Ascites (excess abdominal fluid) is treated with diuretics, fluid and salt restriction, and removal of fluid (paracentesis).
  • Coagulopathy may be treated with blood products or vitamin K.
  • Encephalopathy is treated with the medication lactulose – sometimes antibiotics are used and patients should avoid a diet high in protein.
  • Infections are treated with antibiotics.
  • If cirrhosis progresses and becomes life-threatening, a liver transplant should be considered.
The stress of illness can often be eased by joining a support group whose members share common experiences and problems.

Prevention
Don't drink heavily.  If you find that your drinking is getting out of hand, seek professional help.  Avoiding intravenous drug use (or only using clean needles and never sharing other equipment) will reduce the risk of hepatitis B and C.  Some research indicates that hepatitis C may be spread via shared use of straws or items used to snort cocaine or other drugs.  Avoid snorting drugs or sharing any related paraphernalia.  If you have a problem with illicit drugs, seek help.

Prognosis; Complications; Seek medical attention if...

Survival depends on the severity of complications of cirrhosis and the underlying causes.

When complications cannot be controlled or when the liver becomes so damaged from scarring that it completely stops functioning, a liver transplant is necessary.

Other types of complication:

Edema and ascites. When the liver loses its ability to make the protein albumin, water accumulates in the leg (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.  For example, bleeding esophageal varices.

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

Itching. Bile products deposited in the skin may cause intense itching.

Gallstones. If cirrhosis prevents bile from reaching the gallbladder, a person may develop gallstones.

Toxins in the blood or brain. A damaged liver cannot remove toxins from the blood, causing them to accumulate in the blood (sepsis) and eventually the brain.  There, toxins can dull mental functioning and cause personality changes, coma, and even death.  Signs of the buildup of toxins in the brain include neglect of personal appearance, unresponsiveness, forgetfulness, trouble concentrating, mental confusion, or changes in sleep habits.

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.  Hence the "Tell your doctor if you have liver problems..." statement on drug ads.

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 it.  This condition is called portal hypertension.

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 thin 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 that requires immediate medical attention.

Problems in other organs. Cirrhosis can cause immune system dysfunction, leading to infection.  Ascites (fluid retention) in the abdomen may become infected with bacteria normally present in the intestines (bacterial peritonitis), and cirrhosis can also lead to kidney dysfunction and failure.

Also:
-Hepatic encephalopathy
-Liver cancer (hepatocellular carcinoma)
-Kidney failure (hepatorenal syndrome)

Call your health care provider if symptoms develop that are suggestive of cirrhosis.

Call your provider, or go to the emergency room or call the local emergency number if vomiting blood or if rapid changes in alertness or consciousness occur.

Cirrhosis Of The Liver

Information On This Page

Signs, symptoms & indicators of Cirrhosis of the Liver:

Lab Values - Cells

Lab Values - Chemistries

Lab Values - Hormones

Symptoms - Allergy

Being/being very medication sensitive is often a sign or symptom of Cirrhosis of the LiverBeing/being very medication sensitive
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.
Counter-indicators:
Not being medication sensitive often contraindicates Cirrhosis of the LiverNot being medication sensitive
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.

Symptoms - Food - General

Symptoms - Gas-Int - General

Symptoms - General

Symptoms - Metabolic

Edema of the abdomen may be a sign or symptom of Cirrhosis of the LiverEdema of the abdomen
When the liver loses its ability to make the protein albumin, water accumulates in the legs and abdomen.
Edema of the ankles/lower legs may be a sign or symptom of Cirrhosis of the LiverEdema of the ankles/lower legs
When the liver loses its ability to make the protein albumin, water accumulates in the legs and abdomen.

Symptoms - Nails

Nails that are mostly white is often a sign or symptom of Cirrhosis of the LiverNails that are mostly white
Mainly white nails, or Terry's Nails, are a significant indicator of hepatic cirrhosis.  [Terry (1954) Lancet, 1:757]

Symptoms - Skin - General

Itchy skin is often a sign or symptom of Cirrhosis of the LiverItchy skin
Some people with liver or biliary cirrhosis experience intense itching due to bile products that are deposited in the skin.
Red palms/fingertips may be a sign or symptom of Cirrhosis of the LiverRed palms/fingertips
Red palms (palmar erythema – liver palms) are often found in patients with alcohol-induced cirrhosis and can be seen in patients with primary biliary cirrhosis.

Conditions that suggest Cirrhosis of the Liver:

Circulation

Bleeding Tendency may suggest Cirrhosis of the LiverBleeding Tendency
When the liver slows or stops production of the proteins needed for blood clotting, a person will bruise or bleed easily.
Bruising Susceptibility may suggest Cirrhosis of the LiverBruising Susceptibility
When the liver slows or stops production of the proteins needed for blood clotting, a person will bruise or bleed easily.

Hormones

Immunity

Weakened Immune System may suggest Cirrhosis of the LiverWeakened Immune System
Cirrhosis can cause immune system dysfunction leading to infection.

Lab Values

Elevated Bilirubin Levels often suggests Cirrhosis of the LiverElevated Bilirubin Levels
Diseases that cause liver damage can lead to increased bilirubin levels.  Cirrhosis may cause normal, moderately high or high levels of bilirubin, depending on the type of cirrhosis.

Mental

Poor Memory may suggest Cirrhosis of the LiverPoor Memory
A damaged liver cannot remove toxins from the blood, causing them to accumulate in the blood and eventually the brain.  Once there, toxins can dull mental functioning and cause personality changes, coma, or even death.  Signs of toxin buildup in the brain include neglect of personal appearance, unresponsiveness, forgetfulness, trouble concentrating, or changes in sleep habits.

Metabolic

Ascites strongly suggests Cirrhosis of the LiverAscites
Approximately 80% of the ascites cases are thought to be due to cirrhosis.
Jaundice may suggest Cirrhosis of the LiverJaundice
Jaundice is a yellowing of the skin and eyes that occurs when the diseased liver does not process enough bilirubin.

Nutrients

Vitamin B12 Requirement may suggest Cirrhosis of the LiverVitamin B12 Requirement
The liver is the body's main store of vitamin B12.

Organ Health

Gallbladder Disease may suggest Cirrhosis of the LiverGallbladder Disease
If cirrhosis prevents bile from reaching the gallbladder, a person may develop gallstones as a result.
Kidney Disease may suggest Cirrhosis of the LiverKidney Disease
Liver Cirrhosis can lead to kidney dysfunction and failure.

Symptoms - Liver / Gall Bladder

Counter-indicators:

Risk factors for Cirrhosis of the Liver:

Addictions

Alcohol-related Problems often increases risk of Cirrhosis of the LiverAlcohol-related Problems
To many people, cirrhosis of the liver is synonymous with chronic alcoholism.  It is a major cause, but nevertheless one of several.  Alcoholic cirrhosis usually develops after more than a decade of heavy drinking.  The amount of alcohol that can injure the liver varies from person to person.  In women, as few as two to three drinks per day have been linked with cirrhosis and in men, as few as three to four drinks per day.  Alcohol seems to injure the liver by blocking the normal metabolism of protein, fats and carbohydrates.

Autoimmune

Ulcerative Colitis may increase risk of Cirrhosis of the LiverUlcerative Colitis
Cirrhosis of the liver can occur when the immune system triggers inflammation there as a result of ulcerative colitis.

Metabolic

Hemochromatosis (Iron overload) may increase risk of Cirrhosis of the LiverHemochromatosis (Iron overload)
Cirrhosis is the most common severe consequence of hemochromatosis.

Organ Health

Hepatitis often increases risk of Cirrhosis of the LiverHepatitis
The hepatitis C virus ranks with alcohol as the major cause of chronic liver disease and cirrhosis in the United States.  Infection with this virus causes inflammation of and low grade damage to the liver that over several decades can lead to cirrhosis.

Hepatitis B is probably the most common cause of cirrhosis worldwide, but in the United States and Western world it is less common.  Hepatitis B, like hepatitis C, causes liver inflammation and injury that over several decades can lead to cirrhosis. 

The hepatitis D virus is another virus that infects the liver, but only in people who already have hepatitis B.

Supplements and Medications

Counter-indicators:
Frequent/regular/some aspirin use may decrease risk of Cirrhosis of the LiverFrequent/regular/some aspirin use
A study published on November 28th, 2012 in the Journal of the National Cancer Institute showed that those who used aspirin saw a 45% reduction in the risk of death from chronic liver disease.  The study followed 300,000 people aged between 51 and 70 for between 10 and 12 years.  Those who took other types of NSAIDs had a 26% lower chance of dying from chronic liver disease, but had no corresponding reduction in the risk of liver cancer.

Cirrhosis of the Liver suggests the following may be present:

Nutrients

Counter-indicators:
Cirrhosis of the Liver greatly reduces the likelihood of Manganese RequirementManganese Requirement
Preliminary research suggests that individuals with cirrhosis may not be able to properly excrete manganese.  Until more is known, these people should not supplement manganese.  [Lancet 1995;346: pp.270-4]

Cirrhosis of the Liver can lead to:

Circulation

Cirrhosis of the Liver often leads to Bleeding TendencyBleeding Tendency
When the liver slows or stops production of the proteins needed for blood clotting, a person will bruise or bleed easily.
Cirrhosis of the Liver often leads to Bruising SusceptibilityBruising Susceptibility
When the liver slows or stops production of the proteins needed for blood clotting, a person will bruise or bleed easily.

Mental

Cirrhosis of the Liver often leads to Poor MemoryPoor Memory
A damaged liver cannot remove toxins from the blood, causing them to accumulate in the blood and eventually the brain.  Once there, toxins can dull mental functioning and cause personality changes, coma, or even death.  Signs of toxin buildup in the brain include neglect of personal appearance, unresponsiveness, forgetfulness, trouble concentrating, or changes in sleep habits.

Metabolic

Cirrhosis of the Liver sometimes leads to AscitesAscites
Approximately 80% of the ascites cases are thought to be due to cirrhosis.

Organ Health

Cirrhosis of the Liver sometimes leads to Kidney DiseaseKidney Disease
Liver Cirrhosis can lead to kidney dysfunction and failure.

Recommendations for Cirrhosis of the Liver:

Botanical

Not recommended:

Diet

Alcohol Avoidance is highly recommended for Cirrhosis of the LiverAlcohol Avoidance
In all cases, regardless of cause, following a healthy diet and avoiding alcohol are essential because the body needs all the nutrients it can get.
Not recommended:
High/Increased Protein Diet is often not recommended for Cirrhosis of the LiverHigh/Increased Protein Diet
Protein causes toxins to form in the digestive tract, so eating less protein will help decrease the buildup of toxins in the blood and brain.

Drug

Not recommended:
NSAIDs is often not recommended for Cirrhosis of the LiverNSAIDs
Certain medications are potentially hepatotoxic (can damage the liver) and should be used with caution in patients with chronic liver disease.  In general, NSAIDs should be avoided; acetaminophen at under 2gm per day is the safest choice.

Preventive measures against Cirrhosis of the Liver:

Vitamins

Vitamin Niacinamide may help prevent Cirrhosis of the LiverVitamin Niacinamide
Niacinamide can protect the liver against alcohol-induced damage.

KEY

Weak or unproven link: may be a sign or symptom of; may suggest; may increase risk of; sometimes leads to
Weak or unproven link:
may be a sign or symptom of; may suggest; may increase risk of; sometimes leads to
Strong or generally accepted link: is often a sign or symptom of; often suggests; often increases risk of; often leads to
Strong or generally accepted link:
is often a sign or symptom of; often suggests; often increases risk of; often leads to
Definite or direct link: strongly suggests
Definite or direct link:
strongly suggests
Weakly counter-indicative: may decrease risk of
Weakly counter-indicative:
may decrease risk of
Strong counter-indication: often contraindicates
Strong counter-indication:
often contraindicates
Definitely or absolutely counter-indicates: greatly reduces the likelihood of
Definitely or absolutely counter-indicates:
greatly reduces the likelihood of
May be useful: may help with; may help prevent
May be useful:
may help with; may help prevent
Moderately useful: often helps with
Moderately useful:
often helps with
Very useful: is highly recommended for
Very useful:
is highly recommended for
Often counterindicated: is often not recommended for
Often counterindicated:
is often not recommended for