By: Goodness M.C
Cirrhosis is a late stage of scarring (Fibrosis) of the liver caused by many forms of Liver diseases and conditions, such as Hepatitis And chronic alcohol abuse. The liver carries out several necessary functions, including detoxifying harmful substances in your body, cleaning your blood and making vital nutrients.
Cirrhosis occurs in response to damage to your liver. The liver damage done by cirrhosis can't be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function (decompensated cirrhosis). Advanced cirrhosis is life-threatening.
Cirrhosis often has no signs or symptoms until liver damage is extensive. When signs and symptoms do occur, they may include:
Yellow discoloration in the skin and eyes (jaundice)
Fluid accumulation in your abdomen (Ascites)
Loss of appetite
Swelling in your legs
Confusion, drowsiness and slurred speech (hepatic encephalopathy)
Spider-like blood vessels on your skin
When to see a doctor
Make an appointment with your doctor if you have persistent signs or symptoms of cirrhosis.
Cirrhosis is caused by scar tissue that forms in your liver in response to damage occurring over many years. Each time your liver is injured, it tries to repair itself. In the process, scar tissue forms. As the scar tissue builds up, liver function worsens. In advanced cirrhosis, the liver no longer works very well.
It's important to determine the cause of cirrhosis because treating that underlying cause can help prevent further liver damage. A wide range of diseases and conditions can damage the liver and lead to cirrhosis.
Some of the causes of cirrhosis are inherited or thought to be inherited:
Iron buildup in the body (Hemochromatosis)
Copper accumulated in the liver (Wilson's disease)
Poorly formed bile ducts (biliary atresia)
Inherited disorders of sugar metabolism (Galactosemia or glycogen storage disease)
Genetic digestive disorder (Alagille syndrome)
Liver disease caused by your body's immune system (Autoimmune hepatitis)
Others occur later in life:
Chronic alcohol abuse
Fat accumulating in the liver (Nonalcoholic fatty liver disease)
Destruction of the bile ducts (Primary biliary cirrhosis)
Hardening and scarring of the bile ducts (Primary sclerosing cholangitis)
Infection by a parasite common in developing countries (schistosomiasis)
Some people may have more than one cause for cirrhosis, such as alcohol abuse and viral Hepatitis. If doctors cannot find a cause for your condition, it's called cryptogenic cirrhosis. Up to 20 percent of people with cirrhosis have cryptogenic cirrhosis.
Complications of cirrhosis can include:
Complications related to blood flow:
High blood pressure in the veins that supply the liver (portal hypertension). Cirrhosis slows the normal flow of blood through the liver, thus increasing pressure in the vein that brings blood from the intestines and spleen to the liver.
Swelling in the legs and abdomen. Portal hypertension can cause Fluid to accumulate in the legs (Edema) and in the abdomen (Ascites).
Edema and Ascites also may result from the inability of the liver to make enough of certain blood proteins, such as albumin.
Enlargement of the spleen (splenomegaly).
Portal hypertension can also cause changes to the spleen. Decreased white blood cells and platelets in your blood can be the first sign of cirrhosis.
Bleeding. Portal hypertension can cause blood to be redirected to smaller veins. Strained by the extra load, these smaller veins can burst, causing serious bleeding. High blood pressure also may cause enlarged veins (Varices) and lead to life-threatening bleeding in the esophagus (Esophageal varices) or the stomach (gastric Varices). If the liver can't make enough clotting factors, this also can contribute to continued bleeding.
Infections. If you have cirrhosis, your body may have difficulty fighting infections. Ascites can lead to bacterial Peritonitis, a serious infection.
Malnutrition. Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss.
Buildup of toxins in the brain (hepatic encephalopathy).
A liver damaged by cirrhosis isn't able to clear toxins from the blood as well as a healthy liver can.
These toxins can then build up in the brain and cause mental confusion and difficulty concentrating.
With time, hepatic encephalopathy can progress to unresponsiveness or Coma.
Jaundice. Jaundice occurs when the diseased liver doesn't remove enough bilirubin, a blood waste product, from your blood. Jaundice causes yellowing of the skin and whites of the eyes and darkening of urine.
Bone disease. Some people with cirrhosis lose bone strength and are at greater risk of fractures.
Gallstones and bile duct stones. Blocked flow of bile can lead to irritation, infection and the creation of stones.
Increased risk of Liver cancer.
Acute-on-chronic cirrhosis. Some people end up experiencing multiorgan failure. Researchers now believe this is a distinct complication in some people who have cirrhosis, but they don't fully understand its causes.
PREPARING FOR YOUR APPOINTMENT
If you have cirrhosis, you may be referred to a doctor who specializes in the digestive system (gastroenterologist) or the liver (hepatologist).
Here's some information to help you get ready for your appointment and what to expect from your doctor.
What you can do
Be aware of any pre-appointment restrictions, such as diet restrictions on the day before your appointment.
Write down your symptoms, including when they started and how they may have changed or worsened over time.
Take a list of all your medications, as well as any vitamins or supplements.
Write down your key medical information, including other diagnosed conditions.
Bring results of medical tests done so far, including digital copies of CT, MRI or ultrasound images and biopsy slides if a liver biopsy has been done.
Write down key personal information, including any recent changes or stressors in your life.
Take a family member or friend along to help you remember things.
Write down questions to ask your doctor.
Questions to ask your doctor
Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. Some basic questions to ask your doctor include:
What is most likely causing my cirrhosis?
Is there a way to slow or stop my liver damage?
What are my treatment options?
How can I protect my liver from further damage?
Are there medications that can hurt my liver?
What signs and symptoms of complications should I watch for?
I have other health conditions. How can I best manage them together?
Don't hesitate to ask additional questions during your appointment.
What to expect from your doctor
Be prepared to answer questions your doctor is likely to ask, including:
When did you first begin experiencing symptoms?
Have your symptoms been continuous or occasional?
How severe are your symptoms?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?
How often do you drink alcohol?
Have you been exposed to or taken toxic drugs?
Do you have a family history of Liver disease, Hemochromatosis or Obesity?
Have you ever had viral Hepatitis?
Have you ever had a blood transfusion or used injection drugs?
Do you have any tattoos?
TESTS AND DIAGNOSIS
People with early-stage cirrhosis of the liver usually don't have symptoms. Often, cirrhosis is first detected through a routine blood test or checkup.
Your doctor may order one or more tests or procedures to diagnose cirrhosis.
Liver function. Your blood is checked for excess bilirubin and certain enzymes that may indicate liver damage.
Kidney function. Your blood is checked for creatinine.
Tests for Hepatitis B and C. Your blood is checked for the Hepatitis viruses.
Clotting. Your international normalized ratio (INR) is checked for your blood's ability to clot.
Imaging and other tests:
Magnetic resonance elastography (MRE).
This noninvasive advanced imaging testdetects hardening or stiffening of the liver.
Other imaging tests. MRI, CT and ultrasound can image the liver.
Biopsy. A tissue sample (biopsy) is not necessarily needed for diagnosis. However, your doctor may use it to identify the severity, extent and cause of liver damage.
If you have cirrhosis, your doctor is likely to recommend regular diagnostic tests to monitor for signs of disease progression or complications, especially Esophageal varices and Liver cancer.
Noninvasive tests are becoming more widely available for monitoring.