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
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
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
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.
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
Small, red spider veins under your skin or easy bruising
Yellowing of your skin and eyes and dark, cola-colored urine
Bleeding from engorged veins in your esophagus or intestines
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
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.
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.
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.
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.
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.
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
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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