Cirrhosis

What is cirrhosis of the liver?

Cirrhosis is a disease in which scar tissue replaces normal liver tissue. The scar tissue grows when your liver is damaged repeatedly over time.

• • Cirrhosis is caused mainly by drinking too much alcohol for a long time, having viral hepatitis, or having a buildup of fat in your liver (fatty liver)
  • Symptoms include not feeling hungry, weight loss, and feeling weak and tired all over
  • Doctors can sometimes treat symptoms and problems of cirrhosis, but the damage to your liver is permanent

What are the complications of cirrhosis?

Severe cirrhosis that goes on for a long time can cause several problems:

• • Liver failure (the liver stops working properly)
  • Portal hypertension (high blood pressure develops in the veins that connect the intestines to the liver)
  • Liver cancer

Liver failure causes many serious complications:

• • Excessive bleeding
  • Brain dysfunction (your brain won't work properly)
  • Kidney failure
  • Difficulty digesting and absorbing food

Portal hypertension causes blood to back up in the veins connected to the liver. These veins may enlarge and twist. The veins at the lower end of the esophagus, in the stomach, or in the rectum may be affected. Enlarged, twisted veins are fragile and prone to bleeding, so you may:

• • Vomit large amounts of blood
  • Pass a lot of blood from your rectum

If you bleed slowly and it continues for a long time, you may have a low blood count (anemia). If you bleed rapidly, your blood pressure may become dangerously low (shock). You may even die.

What causes cirrhosis?

The most common causes of cirrhosis include:

• • Drinking too much alcohol for a long time
  • Having chronic (long-lasting) hepatitis B or C

What are the symptoms of cirrhosis?

Many people with cirrhosis don't have any symptoms for years.

When you do get symptoms, they can include:

• • Feeling tired and ill
  • Not feeling hungry and losing weight
  • Jaundice (yellow skin and whites of the eyes)
  • A reddish purple rash of tiny dots or larger splotches
  • Itching all over

If your cirrhosis is caused by alcohol or a long-term liver disorder, you may also have:

• • Muscles wasting away
  • Red palms
  • Swollen belly (from excess fluid)
  • Small, bright red spots on your skin with thin blood vessels around them that look like spider legs (spider angiomas)
  • Swollen salivary glands — the glands that make your saliva (spit)
  • Swollen breasts, shrunken testes, and less hair under arms (in men)

How can doctors tell if I have cirrhosis?

Your doctor will suspect you have cirrhosis if you drink too much or have hepatitis and have some of the symptoms listed above. To tell if you have cirrhosis, doctors will:

• • Do blood tests to see how well your liver is working (there's no blood test that can tell whether you actually have cirrhosis)
  • Sometimes do an ultrasound or CT scan of your liver

A liver biopsy (in which a small piece of the liver is removed to look at under a microscope) may be needed if the other tests aren't clear.

If you have cirrhosis, your doctor will do an ultrasound every 6 months to check for liver cancer.

How do doctors treat cirrhosis?

There is no cure for cirrhosis. The liver damage is permanent. Doctors will treat your symptoms. You can also help keep the cirrhosis from getting worse by doing the following:

• • Stop drinking alcohol, if you were drinking too much
  • If you have chronic hepatitis C, take medicine to treat it
  • Avoid medicines that stress the liver (such as acetaminophen)
  • Eat foods that are good for you

If you have portal hypertension and enlarged, twisted veins in your esophagus (the tube that connects your throat to your stomach), doctors may:

• • Give you certain medicines called beta-blockers to lower the pressure in the liver veins
  • Look down your throat with a flexible scope and close off the enlarged veins by injecting them with a substance or putting special rubber bands around them

If those things don't work, your doctor may put a thin plastic tube in the veins of your liver to re-route the blood and lower the pressure. This is called a TIPS procedure.

If your liver is very bad and barely working, you may need a liver transplant (surgery to replace your bad liver with a healthy one). Because alcohol will damage your new liver too, doctors usually do a transplant only if you have stopped drinking.