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Cirrhosis
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Cirrhosis

From MayoClinic.com

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DIGESTIVE SYSTEM
Diseases & Conditions  

Cirrhosis - a condition that causes irreversible scarring of the liver. Cirrhosis is particularly serious because the presence of scar tissue makes it difficult for the liver to carry out functions that are essential for life and health. Among other key tasks, your liver detoxifies harmful substances, purifies your blood and manufactures vital nutrients.

Cirrhosis rarely causes signs and symptoms in its early stages. But as liver function deteriorates, you may experience fatigue, exhaustion, nausea, unintended weight loss and swelling in your legs and abdomen. In time, your skin and the whites of your eyes may turn yellow (jaundice), and you might have intense itching from bile deposits in your skin.

Alcoholism and chronic infection with the hepatitis C virus are the two main causes of cirrhosis. But a number of other factors can lead to the disease, including some inherited conditions, damaged bile ducts, immune system problems and prolonged exposure to certain environmental toxins.

Although liver damage from cirrhosis is irreversible, the disease usually progresses slowly and symptoms are often controllable. Specific treatment for cirrhosis depends on the underlying cause. People with hepatitis-related cirrhosis may be treated with anti-viral medications, for instance, while alcoholic cirrhosis can be helped only by avoiding alcohol. When damage is so severe that liver function is severely impaired, a liver transplant may be the only option.

Signs and symptoms

You may not have signs and symptoms of cirrhosis in the early stages of the disease. But as more scar tissue replaces healthy tissue and liver function declines, you may experience some of the following:

  • Lack of appetite

  • Weight loss

  • Nausea

  • Small, red spider veins under your skin or easy bruising

  • Weakness

  • Fatigue

  • Yellowing of your skin and eyes and dark, cola-colored urine

  • Bleeding from engorged veins in your esophagus or intestines

  • Loss of interest in sex

  • Fluid in your abdominal cavity (ascites)

  • Itching on your hands and feet and eventually on your entire body

  • Swelling of your legs and feet from retained fluid (edema)

  • Mental confusion, such as forgetfulness or trouble concentrating (encephalopathy)

Causes

Weighing between 3 and 4 pounds, the liver is the largest internal organ in your body. It's located on the right side of your abdomen, just beneath your lower ribs. A healthy liver performs more than 500 vital functions, including processing most of the nutrients absorbed from your intestine, removing drugs, alcohol and other harmful substances from your bloodstream and manufacturing bile — the greenish fluid stored in your gallbladder that helps digest fats. It also produces cholesterol, blood-clotting factors and certain other proteins.

Because of the complexity of the liver and its exposure to so many potentially toxic substances, it would seem especially vulnerable to disease. But the liver has an amazing capacity for regeneration — it can heal itself by replacing or repairing injured cells. In cirrhosis, however, the healing process seems to go slightly awry. In response to chronic injury, cells called stellate cells increase dramatically in size and number. This leads to the formation of excess scar tissue that interferes with the liver's ability to function. And although groups of cells may continue to regenerate, the pattern of regeneration is no longer normal.

What damages the liver?

Many people associate cirrhosis with alcohol abuse, and in fact, chronic alcoholism is the primary cause of cirrhosis. Alcoholic cirrhosis usually occurs after a decade or more of heavy drinking, although the amount of alcohol that can injure the liver varies from person to person. The liver is particularly vulnerable because it breaks down alcohol into highly toxic chemicals. Some of these chemicals trigger inflammation that eventually destroys liver cells. In time, web-like scars and small knots of abnormal tissue replace healthy liver tissue. In the initial stages of cirrhosis, the liver swells, but it later shrinks as larger areas of scar tissue form.

Other causes of cirrhosis include:

  • Chronic hepatitis B and hepatitis C. The serious liver infection hepatitis C ranks second only to alcoholism as a cause of cirrhosis. Nearly a quarter of people with chronic hepatitis C develop cirrhosis, usually more than 2 decades after infection, and many eventually progress to end-stage liver disease or liver cancer. Infection with another hepatitis strain, hepatitis B, can also lead to cirrhosis.

  • Autoimmune hepatitis. In this disorder, the body's immune system attacks liver cells, causing inflammation similar to the inflammation that occurs in viral hepatitis. Normally, your immune system protects you from viruses, bacteria and other disease-causing organisms. It's not clear why the body sometimes attacks its own cells, but researchers believe a virus or bacteria might trigger this response in people with a genetic predisposition to develop an autoimmune disorder. Many people with autoimmune hepatitis also have other autoimmune problems such as thyroiditis, Grave's disease or ulcerative colitis. Autoimmune hepatitis can affect people of any age, although it's more common in women than in men. Because the inflammation is usually severe and chronic, it may lead to cirrhosis and eventually to liver failure.

  • Nonalcoholic fatty liver disease (nonalcoholic steatohepatitis). In this disorder, fat accumulates in the liver, leading to inflammation and occasionally to scar tissue. It's not the same as a condition known as fatty liver (hepatic steatosis), which doesn't damage liver cells. Although the exact cause isn't known, nonalcoholic fatty liver disease seems to be associated with diabetes, obesity and elevated lipid levels.

  • Inherited diseases. These include disorders that cause high levels of certain minerals such as copper (Wilson's disease) or iron (hemochromatosis) to accumulate in the liver. Other inherited conditions that may cause cirrhosis include cystic fibrosis and alpha-1-antitrypsin deficiency — a disorder in which abnormal protein damages liver cells.

  • Blocked or inflamed bile ducts. Bile is a fluid that aids in the digestion of fats. It's produced in your liver and travels to your gallbladder and small intestine (duodenum) through thin tubes called bile ducts. Diseases such as primary biliary cirrhosis or primary sclerosing cholangitis can cause the ducts to become inflamed, scarred or blocked. This forces bile back into the liver, where it damages tissue and eventually may lead to cirrhosis. Complications from surgery on the liver, bile ducts or gallbladder (secondary biliary cirrhosis) also can lead to blocked bile ducts. Babies sometimes develop cirrhosis as a result of biliary atresia — a condition in which the bile ducts are closed or missing at birth.

  • Prolonged exposure to toxic materials. Your liver is the primary clearinghouse for alcohol, drugs and other toxins. Prolonged exposure to environmental toxins such as arsenic and severe reactions to some drugs — including prescription drugs — can lead to cirrhosis.

Risk factors

Excessive drinking is the single greatest risk factor for cirrhosis. The type of alcohol is less important than the amount consumed over a period of years. What's more, even small amounts of alcohol can be damaging if you're infected with the hepatitis B or C virus.

Other risk factors include:

  • Chronic infection with hepatitis C or B. Most people with hepatitis C became infected through blood transfusions received before 1992, the year improved blood-screening tests became available. You can also contract the virus by injecting intravenous drugs using contaminated needles or, less commonly, from needles used in tattooing or body piercing. Hepatitis B is usually transmitted sexually or through contaminated needles. Long-term infection with hepatitis C slowly damages the liver, with cirrhosis developing in 20 percent of people 20 or more years after infection. The older you are when you're infected with the hepatitis C virus, the more likely you are to develop cirrhosis.

  • Sex. More men than women develop cirrhosis, primarily because men tend to drink more heavily than do women.

  • Certain inherited diseases. These include diseases that cause excess copper or iron to be deposited in the liver as well as galactosemia — a rare disorder that affects the way the body metabolizes milk sugar (lactose) — and glycogen storage diseases, which prevent glycogen, the stored form of glucose, from being formed or released when it's needed by the body.

  • Drug reactions and exposure to environmental toxins. In rare cases, cirrhosis may result from a severe reaction to the drug methotrexate (Rheumatrex, Folex), an immune-suppressing medication, or to amiodarone (Cordarone, Pacerone), which is used to treat heart arrhythmias. Long-term exposure to environmental toxins such as arsenic can also cause cirrhosis.

 

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