Cirrhosis

The liver is the largest internal organ of the body. (Read about "The Liver") Located behind your ribs, on the right side of your abdomen, it's also essential to life, performing such key tasks as removal of poisons, germs and bacteria from the blood (Read about "Microorganisms"), production of bile (which helps our bodies absorb fats and fat-soluble vitamins) as well as production of important immune-building agents and blood clot regulating agents.

Cirrhosis is a progressive disease of the liver with no known cure. In cirrhosis, scar tissue replaces normal, healthy liver tissue and blocks the flow of blood through the organ. As a result, the liver can't perform its critical functions. The disease may have no symptoms at first, but that doesn't mean damage isn't occurring. Cirrhosis can result in damage to the brain. (Read about "The Brain") When the liver doesn't work the way it should to neutralize toxins in the body, those toxins can build up, resulting in encephalopathy. (Read about "Encephalopathy")

Left unchecked, cirrhosis can be fatal. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says cirrhosis is the eighth leading cause of death by disease, killing about 25,000 people each year. According to the American Liver Foundation, cirrhosis is the fourth disease-related cause of death for people between the ages of 25 and 44.

Causes

Contrary to popular belief, alcoholism (Read about "Alcoholism") is not the only cause of cirrhosis. However, according to the National Digestive Diseases Information Clearinghouse (NDDIC), it is one of the most common ones in the United States, the other being Hepatitis C. (Read about "Hepatitis C")

No one knows for sure why alcohol affects some people's livers more than others. For example, NIDDIC says that 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 can lead to cirrhosis. Alcohol may injure the liver by blocking the normal metabolism of protein, fats and carbohydrates.

Hepatitis C is the other 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 time can lead to cirrhosis.

Other causes of cirrhosis, according to NDDIC and the American Gastroenterological Association (AGA), include:

• Hepatitis B (Read about "Hepatitis B"), which is the most common cause of cirrhosis in many parts of the world. Hepatitis B, like hepatitis C, causes liver inflammation. The hepatitis D virus (Read about "Hepatitis D") is another virus that infects the liver, but only in people who already have hepatitis B.
• Autoimmune hepatitis, which is caused by a problem with the immune system. (Read about "The Immune System")
• Alpha-1 antitrypsin deficiency, hemochromatosis, Wilson's disease, galactosemia and glycogen storage diseases, which are inherited diseases that interfere with the way the liver produces, processes, and stores substances the body needs. (Read about "Hemochromatosis")
• Nonalcoholic steatohepatitis or NASH, in which fat builds up in the liver and eventually causes scar tissue. This type of hepatitis appears to be associated with diabetes (Read about "Diabetes"), protein malnutrition, obesity, coronary artery disease (Read about "Obesity" "Coronary Heart Disease"), and corticosteroid treatment.
• Blocked or defective bile ducts, which causes bile to back up and damage the liver. There can be several reasons for bile duct problems:
  • Biliary atresia - NIDDK says that in babies, blocked bile ducts are most commonly caused by biliary atresia, a disease in which the bile ducts are absent or injured. Surgical treatment is needed to correct the problem.
  • Primary biliary cirrhosis - Primary biliary cirrhosis is a disease in which the ducts become inflamed, blocked and scarred. This disease affects women more often than men, and usually occurs between the ages of 30 and 60 years. NIDDK says treatment may include taking vitamin and calcium supplements (Read about "Vitamins & Minerals"), hormone therapy and medicines to relieve symptoms. Some research suggests that the disease might be caused by a problem within the immune system. (Read about "The Immune System")
  • Secondary biliary cirrhosis - This can happen after gallbladder surgery, if the ducts are inadvertently blocked or injured. (Read about "Gallstones")
• Severe reactions to prescription drugs, prolonged exposure to environmental toxins, the parasitic infection schistosomiasis and repeated bouts of heart failure with liver congestion can also lead to cirrhosis. (Read about "Congestive Heart Failure")

Symptoms

In its early stages, AGA says cirrhosis often produces no symptoms. But over time, as liver function starts to fail, a person may experience fatigue, loss of appetite, nausea, weakness and weight loss. Left unchecked, NIDDK says cirrhosis in its later stages can cause edema or swelling of the legs (Read about "Feet, Ankles and Legs") and abdomen, a tendency to bruise and bleed easily, jaundice or yellowing of the skin (Read about "Jaundice"), intense itching and gallstones. (Read about "Gallstones") Since the liver can't remove toxins the way it's supposed to, someone with advanced cirrhosis may also start to build up toxins in their blood, they may develop intestinal infections or kidney problems (Read about "Kidney Disease") and they may be extra sensitive to medications. In addition, they may develop a specific type of high blood pressure, called portal hypertension, in the blood vessels that go from the intestine to the liver. Veins at the lower end of the esophagus (esophageal varices) may also enlarge and the American Liver Foundation says obstruction of the venous circulation can cause severe vomiting of blood.

Diagnosis and treatment

Cirrhosis can be discovered during a routine doctor's visit if, for example, the doctor notices that the liver feels harder or larger than usual. If cirrhosis is suspected, blood tests may be used. If further testing is needed, a CAT scan, ultrasound (Read about "CT Scan - Computerized Tomography" "Ultrasound Imaging") or a scan of the liver using a radioisotope or radioactive substance that highlights the liver can be used. At that point, the American Liver Foundation says a liver biopsy (Read about "Biopsy"), in which a small sample of tissue is taken with a needle and then examined under a microscope, will confirm the diagnosis.

Although cirrhosis has no cure, treatment can stop or delay further progression and reduce complications. NDDIC says 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. In severe cases, liver transplantation may be needed. (Read about "Transplants") Cirrhosis is the most common reason for liver transplantation, according to NIDDK.

In addition to treating the cause of the cirrhosis, a doctor may want to treat specific symptoms. For example, diuretics may be used in cases of edema or swelling, or antibiotics may be needed for secondary infections. In all cases, regardless of the cause, following a healthy diet and avoiding alcohol are essential because the body needs all the nutrients it can get, and alcohol will only lead to more liver damage.

If the disease has progressed to an advanced stage, a liver transplant may be the only solution. NIDDK says that about 80 to 90 percent of people survive liver transplantation.

Related Information:

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