• Ken D. Nguyen, MD

Cirrhosis

Updated: Jul 4, 2018

Dr. Ken D. Nguyen is the president and co-founder of Pacifica Digestive Health. His clinical interests include screening and management of gastric cancer in Asian patients, viral hepatitis (including hepatitis B and hepatitis C), advanced liver disease and cirrhosis, colon cancer screening, and international medicine.


What is Cirrhosis?


Cirrhosis is a condition whereby the liver is permanently scarred or injured by chronic conditions or diseases. The scar tissue that forms of the liver prevents sufficient blood flow to the organ making it useless. Cirrhosis may be caused by certain illnesses, direct harm to the liver cells, indirect harm through inflammation and swelling or a blockage in the bile ducts, which drain bile from the liver cells.


The liver is considered one of the most important organs of the body. It sits on the upper right side of the abdomen, right below the ribs and weighs about three pounds. Its functions include:

  • Converting food into energy

  • Metabolizing medication and removing alcohol and poisons from your body

  • Formation of bile


What are Symptoms of Cirrhosis?


Cirrhosis may actually go unnoticed at first because it has very few symptoms in the beginning. The largest issues that cause symptoms include loss of proper functioning liver cells and the distortion of the structure of the liver caused by scarring. Some of the symptoms include:

  • Extreme exhaustion and weakness

  • Loss of appetite, accompanied by an upset stomach and weight loss

  • Easy bleeding or bruising

  • For women, rare or absent periods, unrelated to menopause

  • For men, loss of sex drive or tender and enlarged breasts

These are all early signs of cirrhosis that may difficult to distinguished from other conditions. However, at the later stages of cirrhosis more complications that occur. Once this occurs, the prognosis and life-expectancy of cirrhosis is progressive worse. These symptoms may include:

  • Jaundice (yellowing of the skin and the whites of eyes)

  • Building up of fluid inside the belly (ascites) and swelling of the legs (edema)

  • The build-up of ammonia and other toxins in the blood, leading to sleep disturbances, trouble concentrating, coma and unresponsiveness

  • Vomiting blood from bleeding in the stomach or esophagus

If you develop any of these late-stage symptoms, it is strongly recommended that you seek medical care from a gastroenterologist or hepatologist. And if indicated, you may be referred to transplant center to be evaluated for a liver transplant.


What are Possible Causes of Cirrhosis?


Common causes of cirrhosis include:

  • Long-term abuse of alcohol

  • Hemochromatosis

  • Chronic viral Hepatitis (B or C)

  • Autoimmune hepatitis

  • Obesity and fatty liver disease: It was common to relate cirrhosis with alcoholics but with the rise in obesity levels, cirrhosis is now found in people who take little to no alcohol. Liver disease related to obesity such as nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) have become more widespread. These can easily lead to inflammation of the liver and eventually lead to cirrhosis.

  • Inherited illnesses: Two inherited illnesses cause the storage of metals in the liver. Wilson’s disease, which is rare but causes the storage of copper in the liver, brain, kidneys, and corneas of the eyes. Hemochromatosis, which causes the storage of excess iron in the liver and other organs.

  • Chronic bile duct inflammation and damage: This includes primary biliary cirrhosis (PBC), where the microscopic bile ducts are slowly destroyed. Primary sclerosing cholangitis (PSC) is chronic inflammation that eventually leads scarring of the larger bile ducts. Biliary atresia, which is injury and loss of bile ducts is usually present at birth and inherited genetically.


How is Cirrhosis Diagnosed?


Cirrhosis can sometimes be difficult to diagnosis, especially when someone does not have any symptoms yet. However, your doctors can help diagnosis cirrhosis using a thorough history, a thorough physical exam, and various tests, including:

  • Blood tests

  • Imaging studies

  • Ultrasound-based transient elastography or Magnetic Resonance Elastography

  • Liver biopsy


What the Treatment Options for Cirrhosis?


In general, if you have been diagnosed with cirrhosis and regardless of the cause, you should avoid further injury to liver by avoiding or stopping alcohol. You should be followed closely by a primary care doctor and if you have significant complications of cirrhosis, you should also be followed closely by a gastroenterologist or hepatologist. You should get all the recommended vaccinations, including seasonal flu vaccine, and vaccines for hepatitis A and hepatitis B if you're not already immune.


Following a diet is also very important, especially if you have complications such as ascites or edema. You should be following a low-sodium/low-salt diet (less than 2g of salt a day). You should also eat a high protein diet, especially vegetable protein, to preventing breakdown of muscle tissue leading to build of ammonia. You should also avoid raw seafood which puts you at risk of contracting hepatitis A and hepatitis E.


If you have been diagnosed cirrhosis from hepatitis B or hepatitis C, you should receive medications to treat your viral hepatitis. Hepatitis B cannot be cured but can be suppressed with antiviral medications to prevent further progression. There are now several different types of antiviral medications that can be used to completely cure hepatitis C.


If you have developed significant complications from cirrhosis and have been diagnosis with end-stage liver disease, the only treatment option may be liver transplant. Liver transplant involves taking out the diseased liver and replaced it with a whole liver or part of the liver from a healthy individual. Afterward, you will need to be on anti-rejection medications for the rest of your life to prevent rejection. Liver transplants are only done at specialized transplant centers but your local gastroenterologist or hepatologist can help determine if you need to be referred to a transplant center.


Conclusion


Patients with cirrhosis may be able to live normal lives if their condition is properly treated and any complications is managed with a help of a gastroenterologist or hepatologist. Complication of cirrhosis may be managed medications and adherence to a proper diet. And if needed, liver transplant success rates are relative high with modern medicine and surgical techniques.

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