Cirrhosis

The Liver Serves Many Vital Functions

The liver is a large organ that sits in the right upper abdomen, just under the right lung. It is one of the body’s most “intelligent” organs in that it performs so many different functions at the same time.

The liver:

• Makes proteins
• Eliminates waste material from the body
• Produces cholesterol
• Stores and releases glucose energy
• Metabolizes many drugs used in medicine
• Produces bile that flows through bile ducts into the intestine where it helps to digest food.

This remarkable organ also has the ability to regenerate itself if it is injured or partially removed. The liver receives blood from two different sources—the heart and the intestine. All of this blood flows through the liver and returns to the heart. It is no wonder that the ancient Chinese viewed the liver, not the heart, as the center of the body.

What Is Cirrhosis?

Many types of chronic injury to the liver can result in scar tissue. This scarring distorts the normal structure and regrowth of liver cells. The flow of blood through the liver from the intestine is blocked and the work done by the liver, such as processing drugs or producing proteins, is hindered.

What Causes Cirrhosis?

Cirrhosis can be caused by many things, some known and others unknown:

• Alcohol – Using alcohol in excess is the most common cause of cirrhosis in the United States.
• Chronic Viral Hepatitis – Type Band Type C hepatitis, and other viruses, can infect and damage the liver over a prolonged time and eventually cause cirrhosis.
• Chronic Bile Duct Blockage – This condition can occur at birth (biliary atresia) or develop later in life (primary biliary cirrhosis). The cause of the latter remains unknown. When the bile ducts outside the liver become narrowed and blocked, the condition is called primary sclerosing cholangitis. This condition is often associated with chronic ulceration of the colon (colitis).
• Abnormal Storage of Copper (Wilson’s Disease) or Iron (Hemochromatosis) – These metals are present in all body cells. When abnormal amounts of them accumulate in the liver, scarring and cirrhosis may develop.
• Drugs and Toxins – Prolonged exposure to certain chemicals or drugs can scar the Iiver.
• Autoimmune Hepatitis – This chronic inflammation occurs when the body’s protective antibodies fail to recognize the liver as its own tissue. The antibodies injure the liver cells as though they were a foreign protein or bacteria.
• Cystic Fibrosis and Alpha 1-antitrypsin Deficiency – These disorders are inherited.

Signs and Symptoms

Cirrhosis takes years to develop. During this time, there are usually no symptoms, although fatigue, weakness and decreased appetite may occur and worsen with time. When cirrhosis is fully developed, multiple signs may be present:

• Jaundice – The liver produces bile that normally flows into the intestine. With advanced cirrhosis, bile can back up into the blood, causing the skin and eyes to turn yellow and the urine to darken.
• Fluid Retention in the Legs and Abdomen – The liver produces a protein, called albumin, that holds fluid in blood vessels. When the blood level of albumen falls, fluid seeps out of the tissues into the legs and abdomen, causing edema (fluid accumulation) and swelling.
• Intense Itching – Certain types of cirrhosis, such as chronic bile duct blockage, can produce troublesome itching.
• Gallstones – Cirrhosis causes the abnormal metabolism of bile pigment. Because of this, gallstones develop twice as often in cirrhosis patients as in those without the disorder.
• Coagulation Defects – The liver makes certain proteins that help clot blood. When these proteins are deficient, excessive or prolonged bleeding happens.Mental Function Change – The liver processes toxins from the intestine. When these substances escape into the bloodstream, as occurs in severe cases of cirrhosis, a variety of changes in mental function can develop.
• Esophageal Vein Bleeding – In advanced cirrhosis, intestinal blood bypasses the liver and flows up and around the esophagus (the food tube) to the heart. The veins in the esophagus dilate (widen) and may rupture, causing slow or massive intestinal bleeding.

Diagnosis and Liver Biopsy

The physician can always suspect cirrhosis from the patient’s medical history and physical examination. In addition, certain blood tests and scans or ultrasound (sonography) can provide helpful information. To make a definite diagnosis, however, a liver biopsy (tissue sample) is required. This is performed by anesthetizing the skin of the right-lower chest and inserting a thin, needle into the liver. A core or specimen of tissue is removed and examined under a microscope.When cirrhosis is diagnosed, a treatment plan is designed to preserve the remaining liver cells and correct the complications mentioned in this brochure. By following this plan, most patients can lead long, productive lives.

Prevention

Excessive alcohol consumption or hepatitis viruses cause about 90 percent of cirrhosis cases. Of course, alcohol can be avoided. Alcohol consumption should always be limited to no more than 1 or 2 drinks per day.

Type B hepatitis now has an effective vaccine against it. Vaccination against the hepatitis B virus (HBV) is safe, inexpensive, and especially recommended if you have a higher risk of infection. Because the Hepatitis B virus (HBV) spreads through contact with blood, semen, or other body fluids from an infected person, your risk of infection increases if you:

• Have unprotected sex with multiple partners or with someone who's infected with HBV
• Share needles during IV drug use
• Are a man who has sex with other men
• Live with someone who has a chronic HBV infection
• Are an infant born to an infected mother
• Have a job that exposes you to human blood
• Travel to regions with high infection rates of HBV, such as Asia, the Pacific Islands, Africa and Eastern Europe

Treatment

Often, the only required treatment for cirrhosis is removing the offending cause:

• The excessive drinker must permanently stop consuming alcohol.
• When your body is retaining iron, chronic removal of blood by vein eliminates large amounts of iron.
• Cortisone helps treat autoimmune hepatitis and cirrhosis.
• Restricting salt and using fluid pills (diuretics) reduce edema and abdominal swelling.
• Avoiding toxins and injurious drugs.
• Decreasing dietary protein and using certain laxatives generally can prevent changes in mental function.
• Your providers can inject bleeding veins in the esophagus with sclerosing (clotting) agents or close them with small rubber bands. Occasionally, surgery is necessary to prevent recurrent massive bleeding.
• Ursodiol (Actigall) and other drugs have been helpful in treating primary biliary cirrhosis and primary sclerosing cholangitis.

Liver Transplant

Liver transplantation has progressed to the stage where patients can now consider it a viable option.

This content was last medically reviewed in May 2022 by Sharlotte Manley, MSN, FNP, Erlanger Gastroenterology.