Cirrhosis of the liver

Overview

Hampered liver function

Cirrhosis is the presence of scar tissue in the liver, the largest solid organ in your body. The early signs of cirrhosis are often subtle, making it likely to go undetected for several years. Later, it can cause flu-like symptoms, such as fatigue, fever, loss of appetite, nausea, and vomiting. In later stages it can cause malnutrition, swelling in the legs (edema) or abdomen (ascities), and jaundice.

If the disease progresses into "decompensated" cirrhosis, the liver becomes too damaged to function properly. Most often the result of heavy drinking over a period of many years, the scarring of liver tissue characteristic of cirrhosis can also be caused by viral hepatitis, several inherited diseases and, less frequently, by exposure to environmental toxins or severe reactions to prescribed medications.

The first line of defense against cirrhosis is to remove, if possible, the cause of the damage. If the cirrhosis is alcohol-induced, stopping drinking immediately will halt the damage. When caused by hepatitis or another disease, treating the disease is the crucial. If caught early, the symptoms of cirrhosis can be controlled.

Detailed Description

Performing a number of functions, the liver is vital to good health. It is responsible for filtering all the blood in the body and removing toxins and waste. It also produces the proteins the body needs for energy and other processes, such as blood clotting. It is responsible for carbohydrate, fat, protein metabolism and vitamin storage. It also produces bile, which your body uses to digest fats. It also plays a role in immune functions.

The scar tissue that forms in cirrhosis destroys the structure of the liver, blocking the flow of blood through the organ. The loss of normal liver tissue slows the processing of nutrients, hormones, drugs, and toxins by the liver. Also slowed is production of proteins and other substances made by the liver.

If left unchecked, cirrhosis can lead to mental dysfunction, such as confusion and disorientation, hemorrhage, and kidney or liver failure.

How Common Is Cirrhosis?

Cirrhosis is the seventh leading cause of death by disease in the United States and the third leading cause of death for adults between ages 45 and 65. About 25,000 people die from cirrhosis each year, though many more suffer the symptoms for years. An estimated 50% of cases are alcohol-induced. Women are more sensitive to the toxic effects of alcohol than men, and, even though they drink less, are more likely to develop cirrhosis.

Conventional Treatment

Goals of Treatment

The damage to liver tissue caused by cirrhosis is permanent, but your liver can function even when part of it is damaged. Medications for less serious symptoms and surgery in more advanced stages can keep the effects on your life to a minimum. For treatment to be successful, it is crucial to arrest the destruction of tissue by removing or neutralizing the underlying cause.

Treatment Overview

Treatment for cirrhosis depends on what stage the disease was diagnosed and the underlying cause. Delaying or preventing continued damage to the liver is the first goal of treatment. If alcohol is the issue, your doctor will work with you to find a treatment program or support system. If the cirrhosis is caused by hepatitis, your doctor will prescribe medications to keep the hepatitis in check. If the liver damage is in its later stages, transplant surgery may be necessary.

Drug Therapy

Several drugs can help ease the symptoms associated with cirrhosis. Your doctor, however, will prescribe with care because of the body's weakened ability to metabolize medications.

Several drugs can help ease the symptoms associated with cirrhosis. Your doctor, however, will prescribe with care because of the body's weakened ability to metabolize medications.
Inderal
Aldactone
Lasix http://www.nmihi.com/f/furosemide.html
Zantac
Pepcid

Surgery

In some cases, surgery may be necessary in the treatment of cirrhosis. Often surgery is indicated because of increased pressure in the portal vein, which leads into the liver. When portal vein is blocked, the body will grow other veins in an effort to go around the obstruction. These veins, called varices, can grow into esophagus and or stomach. Surgery can remove pressure and stop the growth of varices by diverting the blood flow into a vein connected directly to the heart.

When the liver becomes too damaged to function, a liver transplant is the treatment of last resort.

Appropriate Health Settings

Care for people with cirrhosis is usually provided on an outpatient basis, unless severe complications arise, including:

• Gastrointestinal bleeding
• Kidney failure
• Encephalopathy

Healthcare Professionals Who May Be Involved in Treatment

Professionals who may be involved in cirrhosis treatment include:

• Family physicians
• Internists
• Gastroenterologists
• General surgeons
• Transplant surgeons
• Interventional radiologists

Activity and Diet Recommendations

Eating a well-balanced, nutritious diet is especially important for people with cirrhosis. Carbohydrates and protein help promote liver regeneration and provide energy for muscle rebuilding. Keeping salt at a minimum helps prevent the fluid retention (both in the abdomen and limbs) that's typical of cirrhosis.

Exercise is also essential to keeping the symptoms of cirrhosis in check. Physical activity can help keep the swelling caused by edema in check. As will elevating the legs above the level of your heart when sitting or lying down.

Several nutritional supplements can be helpful, including A, B complex, D, and K — to make up for the liver's inability to store them properly — and vitamin B-12, folic acid, and thiamin to treat anemia.

Possible Complications

These complications or secondary diseases may accompany cirrhosis:

• Liver failure
• Portal hypertension
• Bleeding esophageal varices
• Cancer of the liver
• Renal failure
• Mental confusion
• Coma

Considerations

Women
Women with some autoimmune diseases, such as Crohn's disease, arthritis, and fibromyalgia, often develop primary biliary cirrhosis, a type of cirrhosis in which the bile ducts become inflamed and, in severe cases, permanently scarred. Women between the ages of 35 and 50 are most at risk for this type of cirrhosis.

A medication called ursodiol (ursodeoxycholic acid) appears to be effective in slowing the course of primary biliary cirrhosis.

Pregnancy
Women with cirrhosis may find it harder to get pregnant because cirrhosis can cause irregularities in the menstrual cycle, most often amenorrhea (the cessation of periods). Once pregnant, women with cirrhosis have a higher risk of miscarriage and premature labor. The symptoms of cirrhosis often worsen during pregnancy.

Considerations for Children and Adolescents
Cirrhosis in children is usually caused by an inherited condition, such as glycogen storage disease, galactosemia, fructose intolerance, tyrosinemia, or acid cholesterol ester-hydrolase deficiency. Bilary atresia (a congenital abnormality of the bile ducts) can also cause cirrhosis in infancy.