Also sometimes known as end-stage liver disease, cirrhosis is a condition in which liver function is impaired by the accumulation of scar tissue. The formation of this scar tissue, a phenomenon known as fibrosis, is the result of a healing process that is triggered by damage from chronic liver disease. Over time, the impaired function of the liver can lead to serious complications and death. Indeed, each year, approximately one million people around the world die from complications of cirrhosis and chronic liver disease.
What Does the Liver Do?
To understand the impact of cirrhosis, it is helpful to know how the liver works under normal circumstances. Located in the upper right quadrant of the abdomen, the liver is an important organ with literally hundreds of functions. In addition to synthesizing and secreting a variety of biochemical compounds used in digestion, it filters toxins from our blood, stores energy in the form of glycogen, and plays a major role in the metabolism of proteins, fats, and carbohydrates.
All the blood that flows from the stomach, intestines, and spleen is filtered through the liver via the hepatic artery and the hepatic portal vein. In fact, at any given time, the liver holds around 13% (one pint) of the body’s blood supply. All of this blood is processed by the liver and filtered to utilize nutrients and remove toxins or other waste material: nutrients are broken down and distributed throughout the body, and waste material is removed from the blood and carried away via the bile ducts.
What is Cirrhosis of the Liver?
Every time the liver is damaged in some way, a healing process begins that attempts to repair that damage. Even though the damage may be healed, scar tissue is formed in the process. Over time, and with recurring damage or injury, this scar tissue will gradually replace healthy tissue and the liver will begin to shrink and harden. A patient is usually diagnosed with cirrhosis once the accumulation of scar tissue begins to impair the liver’s functionality (decompensated cirrhosis); it usually takes many years for this level of accumulation to occur.
What Causes Cirrhosis?
By the time a person is diagnosed with cirrhosis of the liver, it means there has already been years of liver damage. The slow replacement of healthy liver tissue by scar tissue is the direct cause of the condition known as cirrhosis, but there are many different kinds of damage that will result in scarring. While risk factors like obesity and high cholesterol can contribute, there are some common causes of cirrhosis that doctors have identified:
- Viral Hepatitis: Chronic hepatitis C and hepatitis B are thought to be the most common cause of cirrhosis around the world. Infection by the hepatitis B or hepatitis C virus causes inflammation in the liver; because there is no cure for this virus, the inflammation is usually chronic and ends up being a major contributor to scarring. Viral hepatitis is mostly spread through blood-to-blood contact as in a blood transfusion or an unsterilized needle.
- Alcohol Consumption: Drinking alcohol in moderation is generally OK for most people, but significant alcohol use or alcohol abuse is also a major factor in the development of cirrhosis. When alcohol is digested, it gets absorbed by blood vessels and makes its way to the liver where it is filtered. Each time this happens, the alcohol damages the organ by temporarily blocking some normal metabolic processes. It is estimated that 40% of cirrhosis deaths in the United States are because of alcohol.
- Non-alcoholic Fatty Liver Disease (NAFLD): As the name implies, NAFLD is a condition where excess fat has built up in the liver but not because of alcohol use. One subtype, known as non-alcoholic steatohepatitis (NASH), includes liver inflammation as a primary symptom. As with other conditions that cause inflammation of the liver, over time that inflammation can cause damage to the organ.
- Autoimmune Hepatitis: Like other autoimmune diseases, autoimmune hepatitis unintentionally attacks healthy cells. In this case, the disease targets healthy liver cells. The underlying cause is unknown, but it tends to develop in people with another immune system disorder.
- Hemochromatosis: This hereditary condition causes the body to absorb too much iron from the digestive tract. This iron is stored in various organs, including the liver, and can lead to liver disease.
- Wilson’s Disease: Though rare, another potential cause of liver damage is Wilson’s disease. This condition is a genetic disorder that involves too much copper building up in the body. The excess copper damages the liver in addition to causing a variety of symptoms.
- Primary Biliary Cholangitis: Once known as primary biliary cirrhosis, this chronic condition involves bile ducts in the liver degrading over time. This causes the same kind of scarring that leads to cirrhosis.
Symptoms of Cirrhosis
One of the reasons cirrhosis is such a dangerous condition is that it usually has no symptoms until it’s already in an advanced state with extensive liver damage. When symptoms do begin to present, it is because the liver’s ability to filter toxins and properly metabolize nutrients has begun to degrade. Early symptoms are typically mild and may mimic other conditions, but as liver function continues to decline, these symptoms may increase:
- fatigue or weakness
- loss of appetite
- unexplained weight loss
- cognitive impairment or confusion
- memory loss
- problems sleeping
- build up of fluid in the abdomen (ascites)
- build up of fluid in the lower legs (edema)
- yellow skin pigmentation (jaundice)
- dark-colored urine
When fibrosis occurs and healthy liver tissue is replaced by scar tissue, an increased resistance to blood flow begins to increase the blood pressure in the hepatic portal vein. This increased pressure is called portal hypertension, and it can lead to a series of secondary symptoms. In nearly half the cases, the most common symptom is an enlarged spleen. Patients can also develop problems with other veins in the area; one example involves enlarged veins in the esophagus (esophageal varices).
Prevention and Treatment
Because the liver damage involved in cirrhosis cannot be reversed, preventing it should be the top priority. Though there are cases of hereditary liver disease leading to cirrhosis, most people can make a significant effort to prevent it by reducing alcohol consumption and decreasing the likelihood of a viral hepatitis infection. Even if some scarring has already occurred, the progression of the damage can be halted and the chance for complications can be reduced by lifestyle changes and treatment.
If cirrhosis is detected at an early stage, there are a variety of methods to treat the underlying cause of the damage or to relieve some of the symptoms. Chronic cirrhosis may present other complications that require additional treatment, such as draining excess fluid build up or medication that treat varices or other effects of portal hypertension. Medication may also be prescribed to mitigate the liver’s reduced ability to filter toxins out of the blood; this may be necessary in situations like hepatic encephalopathy that can affect the nervous system.
In advanced cases of cirrhosis, the liver will essentially cease to function (liver failure) and no other treatment will work. In these cases, liver transplant surgery may be the only way forward. In fact, cirrhosis is one of the most common reasons for a liver transplant, and it can either be from a deceased donor or a section of healthy liver from a living donor. Extensive blood tests and evaluations are done to ensure compatibility, but traditionally patients with alcoholic cirrhosis are not candidates for a transplant.
When to See a Gastroenterologist
Cirrhosis is a potentially life-threatening disease, but there are also many things that can be done to prevent or forestall the kind of scarring that impairs liver function. If you have been experiencing any of the symptoms noted above, contact us at Cary Gastro to request an appointment. We are passionate about providing excellent digestive health care!