The scar tissue that forms in cirrhosis harms the structure of the liver, blocking the flow of blood through the organ. The loss of normal liver tissue slows the processing of nutrients, hormones, drugs, and toxins by the liver. Also slowed is production of proteins and other substances made by the liver.
Two inherited disorders result in the abnormal storage of metals in the liver leading to tissue damage and cirrhosis. People with Wilson's disease store too much copper in their livers, brains, kidneys, and in the corneas of their eyes. In another disorder, known as hemochromatosis, too much iron is absorbed, and the excess iron is deposited in the liver and in other organs, such as the pancreas, skin, intestinal lining, heart, and endocrine glands.
If a person's bile duct becomes blocked, this also may cause cirrhosis. The bile ducts carry bile formed in the liver to the intestines, where the bile helps in the digestion of fat. In babies, the most common cause of cirrhosis due to blocked bile ducts is a disease called biliary atresia. In this case, the bile ducts are absent or injured, causing the bile to back up in the liver. These babies are jaundiced (their skin is yellowed) after their first month in life. Sometimes they can be helped by surgery in which a new duct is formed to allow bile to drain again from the liver.
In adults, the bile ducts may become inflamed, blocked, and scarred due to another liver disease, primary biliary cirrhosis. Another type of biliary cirrhosis also may occur after a patient has gallbladder surgery in which the bile ducts are injured or tied off.
Other, less common, causes of cirrhosis are severe reactions to prescribed drugs, prolonged exposure to environmental toxins, and repeated bouts of heart failure with liver congestion.
As liver function declines, less protein is made by the organ. For example, less of the protein albumin is made, which results in water accumulating in the legs (edema) or abdomen (ascites). A decrease in proteins needed for blood clotting makes it easy for the person to bruise or to bleed.
In the later stages of cirrhosis, jaundice (yellow skin) may occur, caused by the buildup of bile pigment that is passed by the liver into the intestines. Some people with cirrhosis experience intense itching due to bile products that are deposited in the skin. Gallstones often form in persons with cirrhosis because not enough bile reaches the gallbladder.
The liver of a person with cirrhosis also has trouble removing toxins, which may build up in the blood. These toxins can dull mental function and lead to personality changes and even coma (encephalopathy). Early signs of toxin accumulation in the brain may include neglect of personal appearance, unresponsiveness, forgetfulness, trouble concentrating, or changes in sleeping habits.
Drugs taken usually are filtered out by the liver, and this cleansing process also is slowed down by cirrhosis. The liver does not remove the drugs from the blood at the usual rate, so the drugs act longer than expected, building up in the body. People with cirrhosis often are very sensitive to medications and their side effects.
A serious problem for people with cirrhosis is pressure on blood vessels that flow through the liver. Normally, blood from the intestines and spleen is pumped to the liver through the portal vein. (See figure 2.) But in cirrhosis, this normal flow of blood is slowed, building pressure in the portal vein (portal hypertension). This blocks the normal flow of blood, causing the spleen to enlarge. So blood from the intestines tries to find a way around the liver through new vessels.
Some of these new blood vessels become quite large and are called varices. (See figure 3.) These vessels may form in the stomach and esophagus (the tube that connects the mouth with the stomach). They have thin walls and carry high pressure. There is great danger that they may break, causing a serious bleeding problem in the upper stomach or esophagus. If this happens, the patient's life is in danger, and the doctor must act quickly to stop the bleeding.
The doctor may decide to confirm the diagnosis by putting a needle through the skin (biopsy) to take a sample of tissue from the liver. In some cases, cirrhosis is diagnosed during surgery when the doctor is able to see the entire liver. The liver also can be inspected through a laparoscope, a viewing device that is inserted through a tiny incision in the abdomen.
Medications may be given to control the symptoms of cirrhosis, such as itching. Edema and ascites (fluid retention) are treated by reducing salt in the diet. Drugs called diuretics are used to remove excess fluid and to prevent edema from recurring. Diet and drug therapies can help to improve the altered mental function that cirrhosis can cause. For instance, decreasing dietary protein results in less toxin formation in the digestive tract. Laxatives such as lactulose may be given to help absorb toxins and speed their removal from the intestines.
The two main problems in cirrhosis are liver failure, when liver cells stop working, and the bleeding caused by portal hypertension. The doctor may prescribe blood pressure medication, such as a beta blocker, to treat the portal hypertension. If the patient bleeds from the varices of the stomach or esophagus, the doctor can inject these veins with a sclerosing agent administered through a flexible tube (endoscope) that is inserted through the mouth and esophagus. In critical cases, the patient may be given a liver transplant or another surgery (such as a portacaval shunt) that is sometimes used to relieve the pressure in the portal vein and varices.
Patients with cirrhosis often live healthy lives for many years. Even when complications develop, they usually can be treated. Many patients with cirrhosis have undergone successful liver transplantation.
Cirrhosis. This fact sheet presents general information on cirrhosis of the liver, research, and the work of the American Liver Foundation. Available from the foundation.
Clayman CB, ed. The American Medical Association Encyclopedia of Medicine. New York: Random House. 1989. Authoritative reference guide for patients, with sections on cirrhosis, hepatitis, and other disorders affecting the liver. Widely available in libraries and bookstores.
Primary Biliary Cirrhosis. This fact sheet presents information on PBC and cirrhosis, including discussions of diagnosis, treatment, and liver transplantation. Available from the American Liver Foundation.
Rosenfeld I. Second Opinion: Your Comprehensive Guide to Treatment. New York: Bantam Books, 1988. General medical guide with sections on cirrhosis and other disorders affecting the liver. Widely available in libraries and bookstores.
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