Cirrhosis is a progressive disease that develops slowly over many years. It results from chronic inflammation and damage, such as attacks from viruses (hepatitis A, B, C) or alcohol abuse. The accumulation of scar tissue can eventually stop the liver from functioning, leading to liver failure.

Conditions for the Development of Cirrhosis

For cirrhosis to develop, there must be continuous liver damage. When healthy liver tissue is destroyed and replaced by scar tissue, the condition becomes serious, as it can start blocking blood flow through the liver.

Liver Function

The liver performs several essential functions, such as processing nutrients and medications and removing harmful substances from the body. It also purifies the blood, makes vital proteins and nutrients, and produces bile, which helps in digestion. If cirrhosis is mild, the liver can repair itself and continue to function properly. If cirrhosis is advanced, the formation of scar tissue in the liver causes irreversible damage. Liver tissue is replaced by fibrous scar tissue and there may also be the formation of regenerative nodules. These are areas that appear when the liver tries to heal the damage.

Causes of Cirrhosis

Cirrhosis can occur due to several factors, but some are indicated as the main causes due to the large number of confirmed patients. The common causes of cirrhosis are:

Long-Term Alcohol Abuse

Toxins, including alcohol, are broken down by the liver. However, if the amount of alcohol is too high, the liver becomes overloaded and liver cells can eventually become damaged. Heavy, regular, long-term drinkers are much more likely to develop cirrhosis compared to other healthy individuals. Usually, excessive drinking must be sustained for at least 10 years for cirrhosis to develop. In general, some stages are reached before alcohol-induced cirrhosis actually occurs, which are: Fatty liver – this is a buildup of fat in the liver cells, also called fatty infiltration or fatty liver disease. Alcoholic hepatitis – about 35% of heavy drinkers will develop alcoholic hepatitis, where liver cells swell and become inflamed. Approximately 10% of heavy drinkers will later develop cirrhosis.

Hepatitis Infection

Hepatitis C is a blood-borne infection that can damage the liver and eventually lead to cirrhosis. Cirrhosis can also be caused by hepatitis B and D.

Non-Alcoholic Fatty Liver Disease (Fat in the Liver)

In its early stages, Non-Alcoholic Fatty Liver Disease is a buildup of fat in the liver cells. This fat causes inflammation and scarring, resulting in possible cirrhosis later if not properly treated. Non-Alcoholic Fatty Liver Disease is more likely to occur in obese individuals, patients with diabetes, those with elevated lipid (fat) levels, and people with high blood pressure (hypertension).

Autoimmune Hepatitis

The person’s own immune system attacks healthy organs in the body as if they were foreign substances. Sometimes, the liver is attacked. Eventually, the patient may develop cirrhosis.

Genetic Diseases

Hemochromatosis – iron accumulates in the liver and other parts of the body. Wilson’s disease – copper accumulates in the liver and other parts of the body.

Bile Duct Blockage

Some conditions and diseases, such as bile duct cancer or pancreatic cancer, can block the bile ducts, increasing the risk of cirrhosis.

Budd-Chiari Syndrome

There is thrombosis (blood clots) in the hepatic vein, the blood vessel that carries blood from the liver. This leads to liver enlargement and the development of collateral vessels. Other diseases and conditions that can contribute to cirrhosis include: Cystic fibrosis – a genetic disease inherited from the parents Primary sclerosing cholangitis – hardening and scarring of the bile ducts. Galactosemia – inability to process milk sugars. Schistosomiasis – a parasite commonly found in some developing countries. Biliary atresia – malformed bile ducts in babies. Glycogen storage disease – problems storing and releasing vital energy for cell function.

Symptoms of Cirrhosis

Symptoms are not common during the early stages of cirrhosis. However, as scar tissue accumulates, the liver’s ability to function properly is impaired. The following signs and symptoms may occur:

  • Small blood vessels become visible on the skin of the upper abdomen.
  • Fatigue
  • Insomnia
  • Itchy skin
  • Loss of appetite
  • Loss of body mass
  • Nausea
  • Pain in the area where the liver is located
  • Red or blotchy palms
  • Weakness

Signs of More Advanced Cirrhosis

The following signs and symptoms may appear as liver cirrhosis progresses:

  • The abdomen fills with fluid, causing a swollen belly (ascites).
  • Rapid heartbeat
  • Personality changes (toxins build up in the blood and affect the brain)
  • Bleeding of the gums.
  • Weight loss
  • Difficulty for the body to process alcohol
  • Difficulty for the body to process other types of drugs
  • Mental confusion
  • Dizziness
  • Fluid buildup in the ankles, feet, and legs (edema)
  • Hair loss
  • Tendency to bruise easily
  • Jaundice (yellowing of the skin, whites of the eyes, and tongue)
  • Loss of libido (sexual desire)
  • Memory problems

Other more frequent symptoms in advanced cirrhosis include: more frequent bowel movements (susceptible to infections), muscle cramps, nosebleeds, right shoulder pain, shortness of breath, black or very pale stools, dark urine (Coca-Cola color), and bleeding from the gastrointestinal tract.

Diagnosis of Cirrhosis

One of the main diagnostic methods is through blood tests. Because symptoms are rarely present at the onset of the disease, cirrhosis is often diagnosed when the patient is undergoing tests for some other condition or disease. The following tests may also be requested: Transaminases – these enzymes reside inside liver cells. But when the liver is damaged, these enzymes leak into the bloodstream. The test checks if ALT or AST levels (alanine transaminase and aspartate transaminase) are elevated. Imaging Tests – ultrasound, CT scan, or MRI. Besides checking if the liver is enlarged, the physician can also detect scarring or nodules. Endoscopy – a long, thin tube with a light and video camera at the end is inserted down the patient’s esophagus into the stomach. There, the doctor checks for swollen blood vessels (varicose veins), a distinct sign of cirrhosis. Biopsy – a small sample of liver cells is taken and examined under a microscope. The biopsy can confirm cirrhosis and its cause.

Treatments for Cirrhosis

If cirrhosis is diagnosed early enough, the damage can be minimized by treating the underlying cause.

Treatment for Alcohol Dependency

It is important for the patient to stop drinking if their cirrhosis was caused by long-term heavy and regular alcohol consumption. In many cases, the doctor will recommend a treatment program for alcoholism.

Medications

The patient may use medications to control the damage to liver cells caused by hepatitis B or C.

Transplant

More severe cases of cirrhosis eventually require liver transplantation—the lost organ is replaced by another from a donor. However, doctors try to avoid this solution whenever possible. This highlights the importance of early detection.

Prevention of Cirrhosis

In the case of alcohol, excessive use should be avoided. Individuals with cirrhosis should abstain from alcohol completely. Alcohol accelerates the progression of the disease. Although only a minority of people who drink excessively develop cirrhosis, risk increases proportionally with amount and duration of consumption. It is also known that smaller doses of alcohol can cause cirrhosis in women. The best prevention of viral-origin cirrhosis is through vaccination against Hepatitis B and rigorous control of blood used in transfusions. It is necessary to treat carriers of chronic hepatitis B and C before they progress to cirrhosis, and for those with early cirrhosis, to prevent progression to more advanced stages. Unfortunately, there is currently no vaccine for Hepatitis C. Also see: Fetal Alcohol Syndrome Photos: Bruceblaus