Filed under: Digestive Health
Cirrhosis (sih-ROW-sis) is a term used to describe scarring of the
liver. Your liver is a large organ that sits in your upper abdomen. The
liver carries out several essential functions, such as detoxifying
harmful substances in your body, purifying your blood and manufacturing
Cirrhosis occurs in response to chronic damage to your liver. With mild
cirrhosis, your liver can make repairs and continue its role in the
body. But with more advanced cirrhosis, more and more scar tissue forms
in the liver, making it impossible to function.
A number of diseases and conditions can cause the chronic liver damage that leads to cirrhosis.
Cirrhosis often has no signs or symptoms until liver damage is extensive. When signs and symptoms do occur, they may include:
* Bleeding easily
* Easy bruising
* Fluid accumulation in your abdomen
* Loss of appetite
* Swelling in your legs
* Weight loss
When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you.
Cirrhosis is caused by scar tissue that forms in your liver in response to damage that occurs repeatedly over many years.
Each time your liver is injured, it tries to repair itself. In the
process, scar tissue forms in the liver. As the scar tissue builds up,
it becomes increasingly difficult for the liver to function. In advanced
cirrhosis, the liver no longer works. Because the liver is a vital
organ that you can't live without, if it fails it must be replaced with a
A number of causes of liver damage
A wide variety of diseases and conditions can damage the liver and lead to cirrhosis, including:
* Chronic alcohol abuse
* Hepatitis B
* Hepatitis C
* Cystic fibrosis
* Destruction of the bile ducts (primary biliary cirrhosis)
* Fat that accumulates in the liver (nonalcoholic fatty liver disease)
* Hardening and scarring of the bile ducts (primary sclerosing cholangitis)
* Inability to process sugars in milk (galactosemia)
* Iron buildup in the body (hemochromatosis)
* Liver disease caused by your body's immune system (autoimmune hepatitis)
* Parasite common in developing countries (schistosomiasis)
* Poorly formed bile ducts in babies (biliary atresia)
* Problems storing and releasing energy your cells need to function (glycogen storage disease)
* Too much copper accumulated in the liver (Wilson's disease)
Complications of cirrhosis can include:
* More frequent infections. If you have cirrhosis, your body may have difficulty fighting infections.
* Malnutrition. Cirrhosis may make it more difficult for your body
to process nutrients. This can lead to weakness and weight loss.
* High levels of toxins in the blood (hepatic encephalopathy). A
liver damaged by cirrhosis isn't able to clear toxins from the blood as
well as a healthy liver can. Toxins in the blood can cause confusion and
difficulty concentrating. With time, hepatic encephalopathy can
progress to unresponsiveness or coma.
* Increasing pressure in the main vein bringing blood to the liver
(portal hypertension). Scar tissue can make it difficult for blood to
flow freely through the liver. This causes increased pressure in the
portal vein, which causes blood to be redirected to smaller veins near
the liver. Those smaller veins may become overwhelmed by the pressure
and can burst, causing serious bleeding. Building pressure in the veins
of your esophagus is called esophageal varices. In the stomach this is
called gastric varices.
* Increased risk of liver cancer. Cirrhosis can increase your risk
of liver cancer. For this reason, your doctor may recommend regular
ultrasound examinations of your liver to look for abnormalities.
Preparing for your appointment
You're likely to start by first seeing your family doctor or a general
practitioner. If it's determined that you may have cirrhosis, you may be
referred to a doctor who specializes in the digestive system
(gastroenterologist) or the liver (hepatologist).
What you can do
* Be aware of any pre-appointment restrictions. At the time you make
the appointment, be sure to ask if there's anything you need to do in
advance, such as restrict your diet.
* Write down any symptoms you're experiencing, including any that
may seem unrelated to the reason for which you scheduled the
* Write down key personal information, including any major stresses or recent life changes.
* Make a list of all medications, as well as any vitamins or supplements, that you're taking.
* Bring copies of your medical records, including results of recent tests done by other doctors.
* Take a family member or friend along, if possible. Sometimes it
can be difficult to soak up all the information provided during an
appointment. Someone who accompanies you may remember something that you
missed or forgot.
* Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions
will help you make the most of your time together. List your questions
from most important to least important in case time runs out. For
cirrhosis, some basic questions to ask your doctor include:
* What is likely causing my cirrhosis?
* Is there a way to slow or stop my liver damage?
* Will I eventually need a liver transplant?
* What are my treatment options?
* How can I protect my liver from further damage?
* Is it OK to drink a small amount of alcohol if I have cirrhosis?
* Are there medications that can hurt my liver?
* What signs and symptoms of complications should I be alert for?
* Should I see a specialist? What will that cost, and will my insurance cover it?
* Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?
In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask questions during your appointment at any time that
you don't understand something.
Tests and diagnosis
Tests and procedures used to diagnose cirrhosis include:
* Blood tests such as a complete blood count, bilirubin test and specific tests to determine the cause of cirrhosis
* Imaging procedures such as computerized tomography (CT), ultrasound and magnetic resonance imaging (MRI)
* Examination of a sample of liver tissue (liver biopsy), which is
typically done using a needle guided by ultrasound imaging
Treatments and drugs
Treatments for the underlying cause of cirrhosis
In early cirrhosis, it may be possible to minimize damage to the liver by treating the underlying cause. For example:
* Treatment for alcohol dependency. People with cirrhosis caused by
alcohol use need to stop drinking. If stopping alcohol use is difficult,
your doctor may recommend a treatment program for alcohol addiction.
* Medications to control hepatitis. Medications may control damage to liver cells caused by hepatitis B or C.
Treatments for complications of cirrhosis
Your health care team will work to treat any complications of cirrhosis, such as:
* Excess fluid in your body. Fluid that accumulates in your abdomen
(ascites) or your legs (edema) may be managed with a low-sodium diet and
water pills. More severe fluid buildup may require procedures to drain
the fluid or surgery to relieve pressure.
* Increased pressure in the portal vein and surrounding small veins.
Blood pressure medications may control increasing pressure in the veins
around your liver. This may prevent severe bleeding. Surgery to place a
stent to hold open the portal vein also may be necessary. Your doctor
may recommend an endoscopy procedure to examine the veins in your
esophagus and stomach for signs of bleeding.
* Infections. You may receive antibiotics or other treatments for infections.
* Liver cancer screening. Your doctor may recommend periodic blood
tests and ultrasound exams to look for signs of liver cancer.
* High levels of toxins in the blood (hepatic encephalopathy). Your
doctor may instruct you to watch for signs and symptoms of hepatic
encephalopathy, which can range from confusion and mild changes in your
thinking to coma. Medications can help treat hepatic encephalopathy.
Liver transplant surgery
People with advanced cirrhosis may require liver transplants if their
livers are no longer functioning (liver failure). Liver transplant is a
procedure to remove your liver and replace it with a whole liver from a
deceased donor or with part of a liver from a living donor.
Lifestyle and home remedies
If you have cirrhosis, take precautions to limit additional liver damage. For instance:
* Don't drink alcohol. Whether your cirrhosis was caused by chronic
alcohol use or another disease, avoid alcohol. Drinking alcohol may
cause further liver damage.
* Eat a low-sodium diet. Excess salt can cause your body to retain
fluids, worsening swelling in your abdomen and legs. Use herbs for
seasoning your food, rather than salt. Choose prepared foods that are
low in sodium.
* Choose a healthy diet full of fruits and vegetables. People with
cirrhosis can experience malnutrition. Combat this with a healthy
plant-based diet that includes a variety of fruits and vegetables.
Choose lean protein, such as legumes, poultry or fish. Avoid raw
* Avoid infections. Cirrhosis makes it more difficult for you to
fight off infections. Protect yourself by avoiding people who are sick
and washing your hands frequently. Get vaccinated for hepatitis A and B,
influenza, and pneumonia.
* Use over-the-counter medications carefully. Liver cirrhosis makes
it more difficult for your liver to remove drugs from your system. For
this reason, ask your doctor before taking any medications, including
nonprescription drugs. In general, avoid aspirin and other nonsteroidal
anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) and
naproxen (Aleve, others). If you have liver damage, your doctor may
recommend acetaminophen (Tylenol, others) for pain relief.
No alternative medicine treatments have been proved to treat liver
cirrhosis. Many alternative therapies are promoted as liver cleansing or
liver flushing treatments, but there is no evidence to support this.
Talk with your doctor if you're interested in trying alternative
medicine to help you cope with cirrhosis.
Alternative treatments that are generally safe
Some alternative treatments have had some limited testing in people with
liver disease. While none has shown any clear evidence that it can help
people with liver disease, the treatments are relatively safe when
discussed with your doctor and used as directed. Examples include:
* Milk thistle
Other alternative treatments that haven't been tested in people with
cirrhosis may be helpful based on their use in people with other
diseases and conditions, such as:
* Tai chi
Alternative treatments that are unsafe
A number of herbal supplements have been found to cause liver damage, including:
* Black cohosh
* Some Chinese herbs, such as ma-huang
Reduce your risk of cirrhosis by taking care of your liver. For instance:
* Drink alcohol in moderation, if at all. If you're a man, drink no
more than two drinks a day. If you're a woman or anyone 65 or older,
drink no more than one drink a day.
* Eat a healthy diet. Choose a plant-based diet that's full of
fruits and vegetables. Select whole grains and lean sources of protein.
Reduce the amount of fatty and fried foods you eat.
* Maintain a healthy weight. An excess amount of body fat can damage your liver. Lose weight if you are obese or overweight.
* Use chemicals sparingly and carefully. Follow the directions on
household chemicals, such as cleaning supplies and insect sprays. If you
work around chemicals, follow all safety precautions. Your liver
removes toxins from your body, so give it a break by limiting the amount
of toxins it must process.
* Reduce your risk of hepatitis. Sharing needles and having
unprotected sex can increase your risk of hepatitis B and C. Protect
yourself by abstaining from sex or using a condom if you choose to have
sex. Ask your doctor whether you should be vaccinated for hepatitis B.
If you're concerned about your risk of liver cirrhosis, talk to your doctor about ways you can reduce your risk.