Cirrhosis, the liver loses function
Cirrhosis is a condition where normal liver tissue is replaced by “scar tissue” (Fibrosis). The scarring tends to be a gradual process. This scar tissue affects the normal structure and regrowth of liver cells. Liver cells become damaged and die as scar tissue gradually develops. Therefore, the liver gradually loses its ability to function well. The scar tissue can also affect the blood flow through the liver which can cause back pressure in the blood vessels which bring blood to the liver. This back pressure is called Portal Hypertension.
The two most common causes of Cirrhosis are heavy alcohol drinking and Hepatitis C infection. Treatments may vary, depending on the cause. If cirrhosis becomes severe, a liver transplant may be the only option.
Types and Causes of Liver Cirrhosis
There are many causes of Cirrhosis; however, in the United States the most common causes are heavy alcohol drinking and infection with the Hepatitis C virus.
- Hepatitis B: Worldwide, this is the most common cause of Cirrhosis; however, alcohol and Hepatitis C are the most common causes in the United States.
- Hepatitis C: Persistent infection with the Hepatitis C virus causes long-term inflammation in the liver. This can eventually lead to liver ‘scarring’ and Cirrhosis. Up to 1 in 5 people with Hepatitis C develop Cirrhosis but this usually takes about 20 years or even longer from the initial infection.
- Alcoholic Cirrhosis: Your liver cells break down alcohol but too much alcohol can damage the liver cells. As a rule, the heavier your drink, the more your risk of developing Cirrhosis. Alcoholic Cirrhosis is not just a condition of alcoholics. People who are social heavy drinkers can also develop Cirrhosis. It is not clear why some people are more prone to their liver cells becoming damaged by alcohol and to developing cirrhosis. There may be an inherited (genetic) tendency. Women who are heavy drinkers seem to be more prone than men to cirrhosis.
- Autoimmune Hepatitis: The immune system normally makes antibodies to attack bacteria, viruses and other germs. In people with autoimmune diseases, the immune system makes antibodies against part(s) of the body. Something triggers the immune system to make these autoantibodies but the trigger is not known. In autoimmune hepatitis, the immune system makes antibodies against liver cells, which can lead to damage and Cirrhosis.
- Blocked Bile Ducts: can cause back pressure and damage to the liver cells. For example, primary Biliary Cirrhosis, Sclerosing Cholangitis, and congenital problems of the bile ducts.
- Non-Alcoholic Steatohepatitis (NASH). This is a condition which causes fat to build up in the liver. This can lead to “scarring” and Cirrhosis. Being overweight/obese increases the risk of developing NASH.
- Severe reactions to certain medicines
- Certain poisons and environmental toxins
- Infections caused by Bacteria and Parasites: These are usually found only in tropical countries. Parasites are living things that live within, or on, another organism.
- Severe Heart Failure: Severe Heart Failure can cause congestion in the liver.
- Rare Inherited Diseases: Some diseases can cause damage to liver cells. For example:
- Haemochromatosis: This is a condition which causes an abnormal build-up of iron in the liver and other parts of the body.
- Wilson’s disease: This is a condition which causes an abnormal build-up of copper in the liver and other parts of the body.
Symptoms of Cirrhosis
In the early stages of the condition, often there are no symptoms. You can get by with a reduced number of working liver cells. However, as more and more liver cells die and more and more scar tissue builds up, the liver begins to suffer.
- Tiredness and weakness.
- Fluid leaks from the bloodstream and builds up in the legs and tummy.
- Loss of appetite, feeling sick.
- Weight loss.
- A tendency to bleed and bruise easily.
- Yellowing of the skin or the whites of the eyes.
- Itch due to a build-up of toxins.
- Mental health changes which can develop in severe cases as toxins build up in the bloodstream and affect the brain. This can cause changes to your personality and behaviour, confusion, forgetfulness, and difficulty concentrating. Eventually, it can lead to loss of consciousness and hepatic coma. These changes are known as Hepatic Encephalopathy.
Dr. Singh, Dr. Rashbaum, Dr. Nitin Parikh, Dr. Sumana Moole, Dr. Long B. Nguyen, Tammi D’Elena, PA-C; and Vanessa T. Dang, MSN, APRN; may suspect, from your symptoms and a physical examination, that you have cirrhosis if you have a history of heavy alcohol drinking or have had a previous episode of Hepatitis. Blood tests may show abnormal liver function. An ultrasound scan (or a CT scan or MRI scan) may show that you have a damaged liver. To confirm the diagnosis, a small sample (biopsy) of the liver may be taken to be looked at under the microscope. The scarring of the liver and damage to liver cells can be seen on a biopsy. If the underlying cause of the Cirrhosis is not clear, further tests may be done to clarify the cause.
Treatment for Cirrhosis
Cirrhosis tends to get progressively worse if the underlying cause persists and is not treated. In general, once the damage is done the scarring is not reversible. Therefore, the aim of treatment is, if possible, to prevent further liver scarring or to slow the progression of the scarring process. Patients are advised to follow the guidelines:
- Cirrhosis of the Liver: For Cirrhosis caused by alcohol abuse, you must stop drinking alcohol to halt the progression of cirrhosis.
- Hepatitis: If a patient has Hepatitis, they may be prescribed steroids or antiviral drugs to reduce liver cell injury.
- Autoimmune Diseases: Patients that have Cirrhosis caused by autoimmune diseases, (Wilson’s disease, or Hemochromatosis), the treatment varies.
- Liver Transplant: Liver transplantation may be needed for some people with severe Cirrhosis.
Medications may sometimes be given to control the symptoms of cirrhosis. edema (fluid retention) and Ascites (fluid in the abdomen) 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 improve the altered mental function that Cirrhosis can cause. Laxatives such as Lactulose may be given to help absorb toxins and speed their removal from the intestines.
Board certified physicians Dr. Singh, Dr. Rashbaum, Dr. Nitin Parikh, Dr. Sumana Moole, Dr. Long B. Nguyen, Tammi D’Elena, PA-C; and Vanessa T. Dang, MSN, APRN; care for patients in the north Atlanta, GA; area including Alpharetta, Ga; Cumming, Ga; Johns Creek GA; Cumming GA; Lawrenceville, Georgia. The In-House Endoscopy Suite at Digestive Care Physicians is a certified facility which has achieved the highest level of accreditation by the Association for Ambulatory Health Care (AAAHC). If you suffer from gastrointestinal problems or suspect that you have liver disease, contact us at (770) 227-2222 to schedule an appointment.