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					Cirrhosis
of the Liver
                National Digestive Diseases Information Clearinghouse

               The liver, the largest organ in the body, is es-   Chronic hepatitis C. The hepatitis C virus
               sential in keeping the body functioning prop-      ranks with alcohol as the major cause of
               erly. It removes or neutralizes poisons from       chronic liver disease and cirrhosis in the
National       the blood, produces immune agents to con-          United States. Infection with this virus
Institute of   trol infection, and removes germs and bacte-       causes inflammation of and low grade dam-
Diabetes and
Digestive      ria from the blood. It makes proteins that         age to the liver that over several decades
and Kidney     regulate blood clotting and produces bile to       can lead to cirrhosis.
Diseases
               help absorb fats and fat-soluble vitamins.
NATIONAL       You cannot live without a functioning liver.       Chronic hepatitis B and D. The hepatitis B
INSTITUTES                                                        virus is probably the most common cause
OF HEALTH      In cirrhosis of the liver, scar tissue replaces    of cirrhosis worldwide, but in the United
               normal, healthy tissue, blocking the flow of       States and Western world it is less com-
               blood through the organ and preventing it          mon. Hepatitis B, like hepatitis C, causes
               from working as it should. Cirrhosis is the        liver inflammation and injury that over
               eighth leading cause of death by disease, kill-    several decades can lead to cirrhosis. The
               ing about 25,000 people each year. Also, the       hepatitis D virus is another virus that in-
               cost of cirrhosis in terms of human suffering,     fects the liver, but only in people who
               hospital costs, and lost productivity is high.     already have hepatitis B.
                                                                  Autoimmune hepatitis. This type of hepa-
               Causes                                             titis is caused by a problem with the im-
               Cirrhosis has many causes. In the United           mune system.
               States, chronic alcoholism and hepatitis C
               are the most common causes.                        Inherited diseases. Alpha-1 antitrypsin defi-
                                                                  ciency, hemochromatosis, Wilson’s disease,
               Alcoholic liver disease. To many people,           galactosemia, and glycogen storage diseases
               cirrhosis of the liver is synonymous with          are among the inherited diseases that inter-
               chronic alcoholism, but in fact, alcoholism is     fere with the way the liver produces, pro-
               only one of the causes. Alcoholic cirrhosis        cesses, and stores enzymes, proteins,
               usually develops after more than a decade of       metals, and other substances the body
               heavy drinking. The amount of alcohol that         needs to function properly.
               can injure the liver varies greatly from per-
               son to person. In women, as few as                 Nonalcoholic steatohepatitis (NASH). In
               two to three drinks per day have been linked       NASH, fat builds up in the liver and eventu-
               with cirrhosis and in men, as few as three to      ally causes scar tissue. This type of hepatitis
               four drinks per day. Alcohol seems to injure       appears to be associated with diabetes, pro-
               the liver by blocking the normal metabolism        tein malnutrition, obesity, coronary artery
               of protein, fats, and carbohydrates.               disease, and corticosteroid treatment.
Blocked bile ducts. When the ducts that           Edema and ascites. When the liver loses its
carry bile out of the liver are blocked, bile     ability to make the protein albumin, water
backs up and damages liver tissue. In ba-         accumulates in the leg (edema) and abdo-
bies, blocked bile ducts are most commonly        men (ascites).
caused by biliary atresia, a disease in which
                                                  Bruising and bleeding. When the liver slows
the bile ducts are absent or injured. In
                                                  or stops production of the proteins needed
adults, the most common cause is primary
                                                  for blood clotting, a person will bruise or
biliary cirrhosis, a disease in which the ducts
                                                  bleed easily.
become inflamed, blocked, and scarred.
Secondary biliary cirrhosis can happen after      Jaundice. Jaundice is a yellowing of the skin
gallbladder surgery, if the ducts are inad-       and eyes that occurs when the diseased liver
vertently tied off or injured.                    does not absorb enough bilirubin.
Drugs, toxins, and infections. Severe reac-       Itching. Bile products deposited in the skin
tions to prescription drugs, prolonged expo-      may cause intense itching.
sure to environmental toxins, the parasitic
infection schistosomiasis, and repeated           Gallstones. If cirrhosis prevents bile from
bouts of heart failure with liver congestion      reaching the gallbladder, a person may de-
can each lead to cirrhosis.                       velop gallstones.
                                                  Toxins in the blood or brain. A damaged
Symptoms                                          liver cannot remove toxins from the blood,
                                                  causing them to accumulate in the blood
Many people with cirrhosis have no symp-
                                                  and eventually the brain. There, toxins can
toms in the early stages of the disease. How-
                                                  dull mental functioning and cause personal-
ever, as scar tissue replaces healthy cells,
                                                  ity changes, coma, and even death. Signs of
liver function starts to fail and a person may
                                                  the buildup of toxins in the brain include
experience the following symptoms:
                                                  neglect of personal appearance, unrespon-
  • Exhaustion                                    siveness, forgetfulness, trouble concentrat-
                                                  ing, or changes in sleep habits.
  • Fatigue
                                                  Sensitivity to medication. Cirrhosis slows
  • Loss of appetite
                                                  the liver’s ability to filter medications from
  • Nausea                                        the blood. Because the liver does not re-
  • Weakness                                      move drugs from the blood at the usual
                                                  rate, they act longer than expected and
  • Weight loss.                                  build up in the body. This causes a person
As the disease progresses, complications          to be more sensitive to medications and
may develop. In some people, these may            their side effects.
be the first signs of the disease.                Portal hypertension. Normally, blood from
                                                  the intestines and spleen is carried to the
                                                  liver through the portal vein. But cirrhosis
Complications of Cirrhosis                        slows the normal flow of blood through the
Loss of liver function affects the body in        portal vein, which increases the pressure
many ways. Following are common prob-             inside it. This condition is called portal
lems, or complications, caused by cirrhosis.      hypertension.




2 Cirrhosis of the Liver
Varices. When blood flow through the por-       Treatment
tal vein slows, blood from the intestines and   Liver damage from cirrhosis cannot be re-
spleen backs up into blood vessels in the       versed, but treatment can stop or delay fur-
stomach and esophagus. These blood ves-         ther progression and reduce complications.
sels may become enlarged because they are       Treatment depends on the cause of cirrho-
not meant to carry this much blood. The         sis and any complications a person is experi-
enlarged blood vessels, called varices, have    encing. For example, cirrhosis caused by
thin walls and carry high pressure, and thus    alcohol abuse is treated by abstaining from
are more likely to burst. If they do burst,     alcohol. Treatment for hepatitis-related
the result is a serious bleeding problem in     cirrhosis involves medications used to treat
the upper stomach or esophagus that re-         the different types of hepatitis, such as in-
quires immediate medical attention.             terferon for viral hepatitis and cortico-
Problems in other organs. Cirrhosis can         steroids for autoimmune hepatitis.
cause immune system dysfunction, leading        Cirrhosis caused by Wilson’s disease, in
to infection. Ascites (fluid) in the abdomen    which copper builds up in organs, is treated
may become infected with bacteria normally      with medications to remove the copper.
present in the intestines, and cirrhosis can    These are just a few examples—treatment
also lead to kidney dysfunction and failure.    for cirrhosis resulting from other diseases
                                                will depend on the underlying cause. In all
                                                cases, regardless of the cause, following a
Diagnosis                                       healthy diet and avoiding alcohol are essen-
The doctor may diagnose cirrhosis on the        tial because the body needs all the nutrients
basis of symptoms, laboratory tests, the        it can get, and alcohol will only lead to more
patient’s medical history, and a physical ex-   liver damage.
amination. For example, during a physical
                                                Treatment will also include remedies for
examination, the doctor may notice that the
                                                complications. For example, for ascites and
liver feels harder or larger than usual and
                                                edema, the doctor may recommend a low-
order blood tests that can show whether
                                                sodium diet or the use of diuretics, which
liver disease is present.
                                                are drugs that remove fluid from the body.
If looking at the liver is necessary to check   Antibiotics will be prescribed for infections,
for signs of disease, the doctor might order    and various medications can help with itch-
a computerized axial tomography (CAT)           ing. Protein causes toxins to form in the di-
scan, ultrasound, or a scan of the liver        gestive tract, so eating less protein will help
using a radioisotope (a harmless radioactive    decrease the buildup of toxins in the blood
substance that highlights the liver). Or the    and brain. The doctor may also prescribe
doctor might look at the liver using a lap-     laxatives to help absorb the toxins and re-
aroscope, an instrument inserted through        move them from the intestines.
the abdomen that relays pictures back to a
                                                For portal hypertension, the doctor may
computer screen.
                                                prescribe blood pressure medication such as
A liver biopsy will confirm the diagnosis.      a beta-blocker. If varices bleed, the doctor
For a biopsy, the doctor uses a needle to       may either inject them with a clotting agent
take a small sample of tissue from the liver,   or perform a rubber-band ligation, which
then examines it for scarring or other signs    uses a special device to compress the
of disease.                                     varices and stop the bleeding.




3 Cirrhosis of the Liver
When complications cannot be controlled or         National Digestive Diseases
when the liver becomes so damaged from
scarring that it completely stops functioning,
                                                   Information Clearinghouse
a liver transplant is necessary. In liver trans-       2 Information Way
plantation surgery, a diseased liver is re-            Bethesda, MD 20892–3570
moved and replaced with a healthy one from             Tel: (301) 654–3810
an organ donor. About 80 to 90 percent of              Fax: (301) 907–8906
people survive liver transplantation. Survival         E-mail: nddic@info.niddk.nih.gov
rates have improved over the past several          The National Digestive Diseases Informa-
years because of drugs such as cyclosporine        tion Clearinghouse (NDDIC) is a service
and tacrolimus, which suppress the immune          of the National Institute of Diabetes and
system and keep it from attacking and dam-         Digestive and Kidney Diseases (NIDDK).
aging the new liver.                               NIDDK is part of the National Institutes
                                                   of Health under the U.S. Department of
For More Information                               Health and Human Services. Established
                                                   in 1980, the clearinghouse provides infor-
Information about cirrhosis is also
                                                   mation about digestive diseases to people
available from
                                                   with digestive disorders and to their fami-
American Liver Foundation                          lies, health care professionals, and the
1425 Pompton Avenue                                public. NDDIC answers inquiries; devel-
Cedar Grove, NJ 07009                              ops, reviews, and distributes publications;
Tel: (800) 465–4837 or (888) 443–7222              and works closely with professional and
Fax: (201) 256–3214                                patient organizations and Government
Internet: www.liverfoundation.org                  agencies to coordinate resources about
                                                   digestive diseases.
Hepatitis Foundation International
30 Sunrise Terrace                                 Publications produced by the clearinghouse
Cedar Grove, NJ 07009–1423                         are carefully reviewed for scientific accu-
Tel: (800) 891–0707                                racy, content, and readability.
Fax: (973) 857–5044
Internet: www.hepfi.org
                                                      This publication is not copyrighted.
United Network for Organ Sharing (UNOS)
                                                      The clearinghouse encourages users
P.O. Box 13770
                                                      of this fact sheet to duplicate and
Richmond, VA 23225–8770
                                                      distribute as many copies as desired.
Tel: 1–888–894–6361 or (804) 330–8500
Internet: www.unos.org                                This publication is also available
                                                      under “Health Information” at
                                                      www.niddk.nih.gov/.



                                                   U.S. DEPARTMENT OF HEALTH
                                                   AND HUMAN SERVICES
                                                   National Institutes of Health

                                                   NIH Publication No. 00–1134
                                                   January 2000

				
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