to seek medical advice
If you're experiencing any of the signs and symptoms of
cirrhosis — weight loss, fatigue, jaundice and swelling in your legs or
abdomen, especially if you drink alcohol or have had hepatitis — see
your doctor. A physical exam and certain tests can help diagnose
cirrhosis and rule out other reasons for your signs and symptoms.
Screening and diagnosis
Because cirrhosis seldom causes signs and symptoms in the
early stages, your doctor may discover the disease during a routine
medical examination. By gently pressing your abdomen, your doctor can
often tell whether your liver is enlarged and firm, a sign of liver
disease. As cirrhosis progresses, however, your liver often shrinks,
leading to a backflow of blood and an enlarged spleen, which may also be
detected in a physical exam.
If your doctor suspects cirrhosis, you're likely to have
certain tests, including:
Liver blood tests.
A damaged liver releases certain enzymes. Measuring these enzymes
may help determine whether you have liver damage.
Bilirubin, a red-yellow pigment that results from the normal
breakdown of red blood cells, is metabolized in your liver and
excreted in your urine. But in advanced cirrhosis, your liver can't
process bilirubin, leading to high blood levels of the pigment.
This noninvasive test uses sound waves to produce a picture of
internal organs, including the liver. Ultrasound is painless and
usually takes less than 30 minutes. While you lie on a bed or
examining table, a wand-shaped device (transducer) is placed on your
body. It emits sound waves that are reflected from your liver and
transformed into a computer image.
Computerized tomography (CT) scan.
This test uses X-rays to produce cross-sectional images of your
Magnetic resonance imaging (MRI).
Instead of X-rays, MRI creates images using a magnetic field and
radio waves. Sometimes a contrast dye also may be used. The test can
take from 15 minutes to an hour. You may find an MRI more
uncomfortable than a CT scan. That's because you'll likely be
enclosed in a tube that's confining and because the machine
generates a thumping noise some people find disturbing.
Although other tests can provide a great deal of information about
the extent and type of liver damage, a biopsy is the only way to
definitively diagnose cirrhosis. In this procedure, a small sample
of tissue is removed from your liver and examined under a
microscope. Your doctor is likely to use a thin cutting needle to
obtain the sample. Needle biopsies are relatively simple procedures
requiring only local anesthesia, but your doctor may choose not to
do one if you have bleeding problems or severe abdominal swelling (ascites).
Risks include bruising, bleeding and infection.
Because cirrhosis disrupts the normal function of your
liver, it can cause a number of serious complications:
Increased pressure in the portal vein (portal hypertension).
At any one time, your liver holds about 13 percent of your body's
total blood, which enters the liver through two different vascular
systems. Blood from your intestine, spleen and pancreas enters
through a large blood vessel called the portal vein. Cirrhosis slows
and blocks the normal flow of blood, increasing pressure within the
portal vein and leading to widespread and serious complications such
as enlarged veins (varices) and fluid retention (ascites).
Enlarged veins (varices).
Portal hypertension often causes additional blood vessels to form —
mainly in your stomach and esophagus. Sometimes other veins form
around your navel and at the rectum. Similar to varicose veins, the
blood vessels are thin-walled, twisted and engorged with blood. This
makes them likely to bleed — a problem that occurs in about 30
percent of people with cirrhosis. Massive bleeding in the upper
stomach or esophagus from these blood vessels is a life-threatening
emergency that requires immediate medical care.
Liver disease can cause large amounts of fluid to accumulate in your
legs (edema) and abdominal cavity (ascites). Abdominal fluid is
especially common in alcoholic cirrhosis. Several factors play a
role, including portal hypertension, decreased ability of the blood
vessels to retain fluid and changes in the hormones and chemicals
that regulate fluids in your body. Ascites can be uncomfortable and
may interfere with breathing. In addition, abdominal fluid may
become infected (spontaneous bacterial peritonitis) and require
treatment with antibiotics. Although not life-threatening in itself,
ascites is usually a sign of advanced cirrhosis.
Bruising and bleeding.
Cirrhosis interferes with the production of proteins that help your
blood clot and with the absorption of vitamin K, which plays a role
in synthesizing these proteins. As a result you may bruise and bleed
more easily than normal. Bleeding in the gastrointestinal tract is
This occurs when your liver isn't able to remove bilirubin — the
residue of old red blood cells — from your blood. Eventually,
bilirubin builds up and is deposited in your skin and the whites of
your eyes, causing a yellow color. Excreted bilirubin may turn your
urine dark brown and your stools a pale clay color.
Bile salts deposited in your skin can cause intense itching.
A liver damaged by cirrhosis has trouble removing toxins from your
body — normally one of the liver's key tasks. The buildup of toxins
such as ammonia — a byproduct of protein digestion — can damage your
brain, leading to changes in your mental state, behavior and
personality (hepatic encephalopathy). Symptoms of hepatic
encephalopathy include forgetfulness, confusion and mood changes,
and in advanced cases, delirium and coma.
Weak bones (osteoporosis).
Cirrhosis interferes with the liver's ability to process vitamin D
and calcium, both of which are essential for bone growth and health.
As a result, weak, brittle bones and bone loss are a common
complication of the disease. Calcitriol, a form of vitamin D, may be
particularly helpful in treating the problem.
Cirrhosis from any cause greatly increases the risk of liver cancer,
which occurs when malignant cells begin growing in the tissues of
your liver. Unfortunately, liver cancer is rarely discovered early,
and the prognosis is often poor. The outlook for people with liver
cancer is further complicated because a liver transplant is seldom
an option. In most cases, the cancer recurs outside the liver after
This occurs when extensive damage to liver cells makes it impossible
for your liver to function.
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