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-
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.
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
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.
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
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,
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: email@example.com
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
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
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
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
U.S. DEPARTMENT OF HEALTH
AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 00–1134