Health
| TZPSS science |
| Topics Front Page |
Knowledge has power.
| Liver Cirrhosis |
The liver, the largest organ in the body, is essential in keeping
the body functioning properly. It removes or neutralizes
poisons from the blood, produces immune agents to control
infection, and removes germs and bacteria from the blood. It
makes proteins that regulate blood clotting and produces bile
to help absorb fats and fat-soluble vitamins. You cannot live
without a functioning liver.
In cirrhosis of the liver, scar tissue replaces normal, healthy
tissue, blocking the flow of blood through the organ and
preventing it from working as it should. Cirrhosis is the twelfth
leading cause of death by disease, killing about 26,000 people
each year. Also, the cost of cirrhosis in terms of human
suffering, hospital costs, and lost productivity is high.
Causes
Cirrhosis has many causes. In the United States, chronic
alcoholism and hepatitis C are the most common ones.
Alcoholic liver disease. To many people, cirrhosis of the liver
is synonymous with chronic alcoholism, but in fact, alcoholism
is only one of the causes. Alcoholic cirrhosis usually develops
after more than a decade of heavy drinking. The amount of
alcohol that can injure the liver varies greatly from person to
person. In women, as few as two to three drinks per day have
been linked with cirrhosis and in men, as few as three to four
drinks per day. Alcohol seems to injure the liver by blocking
the normal metabolism of protein, fats, and carbohydrates.
Chronic hepatitis C. The hepatitis C virus ranks with alcohol
as a major cause of chronic liver disease and cirrhosis in the
United States. Infection with this virus causes inflammation of
and low grade damage to the liver that over several decades
can lead to cirrhosis.
Chronic hepatitis B and D. The hepatitis B virus is probably
the most common cause of cirrhosis worldwide, but it is less
common in the United States and the Western world. Hepatitis
B, like hepatitis C, causes liver inflammation and injury that
over several decades can lead to cirrhosis. Hepatitis D is
another virus that infects the liver, but only in people who
already have hepatitis B.
Autoimmune hepatitis. This disease appears to be caused by
the immune system attacking the liver and causing
inflammation, damage, and eventually scarring and cirrhosis.
Inherited diseases. Alpha-1 antitrypsin deficiency,
hemochromatosis, Wilson's disease, galactosemia, and
glycogen storage diseases are among the inherited diseases
that interfere with the way the liver produces, processes, and
stores enzymes, proteins, metals, and other substances the
body needs to function properly.
Nonalcoholic steatohepatitis (NASH). In NASH, fat builds up
in the liver and eventually causes scar tissue. This type of
hepatitis appears to be associated with diabetes, protein
malnutrition, obesity, coronary artery disease, and treatment
with corticosteroid medications.
Blocked bile ducts. When the ducts that carry bile out of the
liver are blocked, bile backs up and damages liver tissue. In
babies, blocked bile ducts are most commonly caused by biliary
atresia, a disease in which the bile ducts are absent or injured.
In adults, the most common cause is primary biliary cirrhosis, a
disease in which the ducts become inflamed, blocked, and
scarred. Secondary biliary cirrhosis can happen after
gallbladder surgery if the ducts are inadvertently tied off or
injured.
Drugs, toxins, and infections. Severe reactions to
prescription drugs, prolonged exposure to environmental
toxins, the parasitic infection schistosomiasis, and repeated
bouts of heart failure with liver congestion can all lead to
cirrhosis.
Symptoms
Many people with cirrhosis have no symptoms in the early
stages of the disease. However, as scar tissue replaces healthy
cells, liver function starts to fail and a person may experience
the following symptoms:
* exhaustion
* fatigue
* loss of appetite
* nausea
* weakness
* weight loss
* abdominal pain
* spider-like blood vessels (spider angiomas) that develop
on the skin
As the disease progresses, complications may develop. In
some people, these may be the first signs of the disease.
Complications of Cirrhosis
Loss of liver function affects the body in many ways. Following
are the common problems, or complications, caused by
cirrhosis.
Edema and ascites. When the liver loses its ability to make
the protein albumin, water accumulates in the legs (edema)
and abdomen (ascites).
Bruising and bleeding. When the liver slows or stops
production of the proteins needed for blood clotting, a person
will bruise or bleed easily. The palms of the hands may be
reddish and blotchy with palmar erythema.
Jaundice. Jaundice is a yellowing of the skin and eyes that
occurs when the diseased liver does not absorb enough
bilirubin.
Itching. Bile products deposited in the skin may cause intense
itching.
Gallstones. If cirrhosis prevents bile from reaching the
gallbladder, gallstones may develop.
Toxins in the blood or brain. A damaged liver cannot remove
toxins from the blood, causing them to accumulate in the
blood and eventually the brain. There, toxins can dull mental
functioning and cause personality changes, coma, and even
death. Signs of the buildup of toxins in the brain include
neglect of personal appearance, unresponsiveness,
forgetfulness, trouble concentrating, or changes in sleep habits.
Sensitivity to medication. Cirrhosis slows the liver's ability to
filter medications from the blood. Because the liver does not
remove drugs from the blood at the usual rate, they act longer
than expected and build up in the body. This causes a person
to be more sensitive to medications and their side effects.
Portal hypertension. Normally, blood from the intestines and
spleen is carried to the liver through the portal vein. But
cirrhosis slows the normal flow of blood through the portal
vein, which increases the pressure inside it. This condition is
called portal hypertension.
Varices. When blood flow through the portal vein slows, blood
from the intestines and spleen backs up into blood vessels in
the stomach and esophagus. These blood vessels may become
enlarged because they are not meant to carry this much blood.
The enlarged blood vessels, called varices, have thin walls and
carry high pressure, and thus are more likely to burst. If they
do burst, the result is a serious bleeding problem in the upper
stomach or esophagus that requires immediate medical
attention.
Insulin resistance and type 2 diabetes. Cirrhosis causes
resistance to insulin. This hormone, produced by the pancreas,
enables blood glucose to be used as energy by the cells of the
body. If you have insulin resistance, your muscle, fat, and liver
cells do not use insulin properly. The pancreas tries to keep up
with the demand for insulin by producing more. Eventually, the
pancreas cannot keep up with the body's need for insulin, and
type 2 diabetes develops as excess glucose builds up in the
bloodstream.
Liver cancer. Hepatocellular carcinoma, a type of liver cancer
commonly caused by cirrhosis, starts in the liver tissue itself. It
has a high mortality rate.
Problems in other organs. Cirrhosis can cause immune
system dysfunction, leading to infection. Fluid in the abdomen
(ascites) may become infected with bacteria normally present in
the intestines. Cirrhosis can also lead to impotence, kidney
dysfunction and failure, and osteoporosis.
Diagnosis
The doctor may diagnose cirrhosis on the basis of symptoms,
laboratory tests, the medical history, and a physical
examination. For example, during a physical examination, the
doctor may notice that the liver feels harder or larger than
usual and order blood tests that can show whether liver
disease is present.
If looking at the liver is necessary to check for signs of disease,
the doctor might order a computerized axial tomography (CAT)
scan, ultrasound, magnetic resonance imaging (MRI), or a scan
of the liver using a radioisotope (a harmless radioactive
substance that highlights the liver). Or the doctor might look
at the liver using a laparoscope, an instrument that is inserted
through the abdomen and relays pictures back to a computer
screen.
A liver biopsy will confirm the diagnosis. For a biopsy, the
doctor uses a needle to take a tiny sample of liver tissue, then
examines it under the microscope for scarring or other signs of
disease.
Treatment
Liver damage from cirrhosis cannot be reversed, but treatment
can stop or delay further progression and reduce
complications. Treatment depends on the cause of cirrhosis
and any complications a person is experiencing. For example,
cirrhosis caused by alcohol abuse is treated by abstaining from
alcohol. Treatment for hepatitis-related cirrhosis involves
medications used to treat the different types of hepatitis, such
as interferon for viral hepatitis and corticosteroids for
autoimmune hepatitis. Cirrhosis caused by Wilson's disease, in
which copper builds up in organs, is treated with medications
to remove the copper. These are just a few examples—
treatment for cirrhosis resulting from other diseases depends
on the underlying cause. In all cases, regardless of the cause,
following a healthy diet and avoiding alcohol are essential
because the body needs all the nutrients it can get, and alcohol
will only lead to more liver damage. Light physical activity can
help stop or delay cirrhosis as well.
Treatment will also include remedies for complications. For
example, for ascites and edema, the doctor may recommend a
low-sodium diet or the use of diuretics, which are drugs that
remove fluid from the body. Antibiotics will be prescribed for
infections, and various medications can help with itching.
Protein causes toxins to form in the digestive tract, so eating
less protein will help decrease the buildup of toxins in the
blood and brain. The doctor may also prescribe laxatives to
help absorb the toxins and remove them from the intestines.
For portal hypertension, the doctor may prescribe a blood
pressure medication such as a beta-blocker. If varices bleed,
the doctor may either inject them with a clotting agent or
perform a so-called rubber-band ligation, which uses a special
device to compress the varices and stop the bleeding.
When complications cannot be controlled or when the liver
becomes so damaged from scarring that it completely stops
functioning, a liver transplant is necessary. In liver
transplantation surgery, a diseased liver is removed and
replaced with a healthy one from an organ donor. About 80 to
90 percent of patients survive liver transplantation. Survival
rates have improved over the past several years because of
drugs such as cyclosporine and tacrolimus, which suppress the
immune system and keep it from attacking and damaging the
new liver.
Content Credit NDDIC
the body functioning properly. It removes or neutralizes
poisons from the blood, produces immune agents to control
infection, and removes germs and bacteria from the blood. It
makes proteins that regulate blood clotting and produces bile
to help absorb fats and fat-soluble vitamins. You cannot live
without a functioning liver.
In cirrhosis of the liver, scar tissue replaces normal, healthy
tissue, blocking the flow of blood through the organ and
preventing it from working as it should. Cirrhosis is the twelfth
leading cause of death by disease, killing about 26,000 people
each year. Also, the cost of cirrhosis in terms of human
suffering, hospital costs, and lost productivity is high.
Causes
Cirrhosis has many causes. In the United States, chronic
alcoholism and hepatitis C are the most common ones.
Alcoholic liver disease. To many people, cirrhosis of the liver
is synonymous with chronic alcoholism, but in fact, alcoholism
is only one of the causes. Alcoholic cirrhosis usually develops
after more than a decade of heavy drinking. The amount of
alcohol that can injure the liver varies greatly from person to
person. In women, as few as two to three drinks per day have
been linked with cirrhosis and in men, as few as three to four
drinks per day. Alcohol seems to injure the liver by blocking
the normal metabolism of protein, fats, and carbohydrates.
Chronic hepatitis C. The hepatitis C virus ranks with alcohol
as a major cause of chronic liver disease and cirrhosis in the
United States. Infection with this virus causes inflammation of
and low grade damage to the liver that over several decades
can lead to cirrhosis.
Chronic hepatitis B and D. The hepatitis B virus is probably
the most common cause of cirrhosis worldwide, but it is less
common in the United States and the Western world. Hepatitis
B, like hepatitis C, causes liver inflammation and injury that
over several decades can lead to cirrhosis. Hepatitis D is
another virus that infects the liver, but only in people who
already have hepatitis B.
Autoimmune hepatitis. This disease appears to be caused by
the immune system attacking the liver and causing
inflammation, damage, and eventually scarring and cirrhosis.
Inherited diseases. Alpha-1 antitrypsin deficiency,
hemochromatosis, Wilson's disease, galactosemia, and
glycogen storage diseases are among the inherited diseases
that interfere with the way the liver produces, processes, and
stores enzymes, proteins, metals, and other substances the
body needs to function properly.
Nonalcoholic steatohepatitis (NASH). In NASH, fat builds up
in the liver and eventually causes scar tissue. This type of
hepatitis appears to be associated with diabetes, protein
malnutrition, obesity, coronary artery disease, and treatment
with corticosteroid medications.
Blocked bile ducts. When the ducts that carry bile out of the
liver are blocked, bile backs up and damages liver tissue. In
babies, blocked bile ducts are most commonly caused by biliary
atresia, a disease in which the bile ducts are absent or injured.
In adults, the most common cause is primary biliary cirrhosis, a
disease in which the ducts become inflamed, blocked, and
scarred. Secondary biliary cirrhosis can happen after
gallbladder surgery if the ducts are inadvertently tied off or
injured.
Drugs, toxins, and infections. Severe reactions to
prescription drugs, prolonged exposure to environmental
toxins, the parasitic infection schistosomiasis, and repeated
bouts of heart failure with liver congestion can all lead to
cirrhosis.
Symptoms
Many people with cirrhosis have no symptoms in the early
stages of the disease. However, as scar tissue replaces healthy
cells, liver function starts to fail and a person may experience
the following symptoms:
* exhaustion
* fatigue
* loss of appetite
* nausea
* weakness
* weight loss
* abdominal pain
* spider-like blood vessels (spider angiomas) that develop
on the skin
As the disease progresses, complications may develop. In
some people, these may be the first signs of the disease.
Complications of Cirrhosis
Loss of liver function affects the body in many ways. Following
are the common problems, or complications, caused by
cirrhosis.
Edema and ascites. When the liver loses its ability to make
the protein albumin, water accumulates in the legs (edema)
and abdomen (ascites).
Bruising and bleeding. When the liver slows or stops
production of the proteins needed for blood clotting, a person
will bruise or bleed easily. The palms of the hands may be
reddish and blotchy with palmar erythema.
Jaundice. Jaundice is a yellowing of the skin and eyes that
occurs when the diseased liver does not absorb enough
bilirubin.
Itching. Bile products deposited in the skin may cause intense
itching.
Gallstones. If cirrhosis prevents bile from reaching the
gallbladder, gallstones may develop.
Toxins in the blood or brain. A damaged liver cannot remove
toxins from the blood, causing them to accumulate in the
blood and eventually the brain. There, toxins can dull mental
functioning and cause personality changes, coma, and even
death. Signs of the buildup of toxins in the brain include
neglect of personal appearance, unresponsiveness,
forgetfulness, trouble concentrating, or changes in sleep habits.
Sensitivity to medication. Cirrhosis slows the liver's ability to
filter medications from the blood. Because the liver does not
remove drugs from the blood at the usual rate, they act longer
than expected and build up in the body. This causes a person
to be more sensitive to medications and their side effects.
Portal hypertension. Normally, blood from the intestines and
spleen is carried to the liver through the portal vein. But
cirrhosis slows the normal flow of blood through the portal
vein, which increases the pressure inside it. This condition is
called portal hypertension.
Varices. When blood flow through the portal vein slows, blood
from the intestines and spleen backs up into blood vessels in
the stomach and esophagus. These blood vessels may become
enlarged because they are not meant to carry this much blood.
The enlarged blood vessels, called varices, have thin walls and
carry high pressure, and thus are more likely to burst. If they
do burst, the result is a serious bleeding problem in the upper
stomach or esophagus that requires immediate medical
attention.
Insulin resistance and type 2 diabetes. Cirrhosis causes
resistance to insulin. This hormone, produced by the pancreas,
enables blood glucose to be used as energy by the cells of the
body. If you have insulin resistance, your muscle, fat, and liver
cells do not use insulin properly. The pancreas tries to keep up
with the demand for insulin by producing more. Eventually, the
pancreas cannot keep up with the body's need for insulin, and
type 2 diabetes develops as excess glucose builds up in the
bloodstream.
Liver cancer. Hepatocellular carcinoma, a type of liver cancer
commonly caused by cirrhosis, starts in the liver tissue itself. It
has a high mortality rate.
Problems in other organs. Cirrhosis can cause immune
system dysfunction, leading to infection. Fluid in the abdomen
(ascites) may become infected with bacteria normally present in
the intestines. Cirrhosis can also lead to impotence, kidney
dysfunction and failure, and osteoporosis.
Diagnosis
The doctor may diagnose cirrhosis on the basis of symptoms,
laboratory tests, the medical history, and a physical
examination. For example, during a physical examination, the
doctor may notice that the liver feels harder or larger than
usual and order blood tests that can show whether liver
disease is present.
If looking at the liver is necessary to check for signs of disease,
the doctor might order a computerized axial tomography (CAT)
scan, ultrasound, magnetic resonance imaging (MRI), or a scan
of the liver using a radioisotope (a harmless radioactive
substance that highlights the liver). Or the doctor might look
at the liver using a laparoscope, an instrument that is inserted
through the abdomen and relays pictures back to a computer
screen.
A liver biopsy will confirm the diagnosis. For a biopsy, the
doctor uses a needle to take a tiny sample of liver tissue, then
examines it under the microscope for scarring or other signs of
disease.
Treatment
Liver damage from cirrhosis cannot be reversed, but treatment
can stop or delay further progression and reduce
complications. Treatment depends on the cause of cirrhosis
and any complications a person is experiencing. For example,
cirrhosis caused by alcohol abuse is treated by abstaining from
alcohol. Treatment for hepatitis-related cirrhosis involves
medications used to treat the different types of hepatitis, such
as interferon for viral hepatitis and corticosteroids for
autoimmune hepatitis. Cirrhosis caused by Wilson's disease, in
which copper builds up in organs, is treated with medications
to remove the copper. These are just a few examples—
treatment for cirrhosis resulting from other diseases depends
on the underlying cause. In all cases, regardless of the cause,
following a healthy diet and avoiding alcohol are essential
because the body needs all the nutrients it can get, and alcohol
will only lead to more liver damage. Light physical activity can
help stop or delay cirrhosis as well.
Treatment will also include remedies for complications. For
example, for ascites and edema, the doctor may recommend a
low-sodium diet or the use of diuretics, which are drugs that
remove fluid from the body. Antibiotics will be prescribed for
infections, and various medications can help with itching.
Protein causes toxins to form in the digestive tract, so eating
less protein will help decrease the buildup of toxins in the
blood and brain. The doctor may also prescribe laxatives to
help absorb the toxins and remove them from the intestines.
For portal hypertension, the doctor may prescribe a blood
pressure medication such as a beta-blocker. If varices bleed,
the doctor may either inject them with a clotting agent or
perform a so-called rubber-band ligation, which uses a special
device to compress the varices and stop the bleeding.
When complications cannot be controlled or when the liver
becomes so damaged from scarring that it completely stops
functioning, a liver transplant is necessary. In liver
transplantation surgery, a diseased liver is removed and
replaced with a healthy one from an organ donor. About 80 to
90 percent of patients survive liver transplantation. Survival
rates have improved over the past several years because of
drugs such as cyclosporine and tacrolimus, which suppress the
immune system and keep it from attacking and damaging the
new liver.
Content Credit NDDIC
| MEDICAL NOTES |
DISEASES AND
CONDITIONS
Acidosis
Acne
Acromegaly
Addison's Disease
Adrenal Crisis
Age. macular degn
Alzheimer's disease
Autoimmune
Hepatitis
Barrett's Esophagus
Cancer
Constipation
Colon Polyps
Crohns Disease
Cushing's Syndrm.
Diabetes
Erectile Dysfunction
Fecal Incontinence
Gallstones
Gastritis
Gastroenteritis
Gastroesophageal
Reflux (GERD)
Growth Hormone
Def.
Heartburn
Hemochromatosis
Hemorrhoids
Hyperparathyroidism
Hypertension
Inflam. Bowel Dis.
Kidney Stone
Liver Cirrhosis
Migraines
Multiple Sclerosis
Obesity
Osteorithritis
Osteoporosis
Pancreatitis
Parkinson's Disease
Peyronies' Disease
Prolactinoma
Psoriasis
Sprain and Strain
Stroke
Ulcerative Colitis
Urin. Incontinence
Vitiligo
CONDITIONS
Acidosis
Acne
Acromegaly
Addison's Disease
Adrenal Crisis
Age. macular degn
Alzheimer's disease
Autoimmune
Hepatitis
Barrett's Esophagus
Cancer
Constipation
Colon Polyps
Crohns Disease
Cushing's Syndrm.
Diabetes
Erectile Dysfunction
Fecal Incontinence
Gallstones
Gastritis
Gastroenteritis
Gastroesophageal
Reflux (GERD)
Growth Hormone
Def.
Heartburn
Hemochromatosis
Hemorrhoids
Hyperparathyroidism
Hypertension
Inflam. Bowel Dis.
Kidney Stone
Liver Cirrhosis
Migraines
Multiple Sclerosis
Obesity
Osteorithritis
Osteoporosis
Pancreatitis
Parkinson's Disease
Peyronies' Disease
Prolactinoma
Psoriasis
Sprain and Strain
Stroke
Ulcerative Colitis
Urin. Incontinence
Vitiligo