Learn About Cirrhosis

Cirrhosis of the liverOur Commonly Used Terms page is available for more information on technical terms listed in bold below.

Fibrosis* of the liver occurs when scar tissue forms as liver cells die after being damaged. This process happens slowly, little by little, until eventually (if the damage continues over time) it transitions to cirrhosis as the entire liver is damaged and scarred, causing the liver to shrink and harden. Once cirrhosis occurs, the damage is permanent.

Any long term illness that causes liver damage can induce fibrosis and lead to cirrhosis. Viruses such as Hepatitis C and Hepatitis B, and chronic alcohol abuse are some of the most common causes of cirrhosis in adults. Sometimes fat buildup in the liver can lead to cirrhosis as often happens with those suffering from diabetes or people who are overweight. There are genetic issues that can lead to cirrhosis such as liver disease from a buildup of iron. Sometimes the immune system identifies the liver as a foreign body and attacks it, known as Autoimmune Hepatitis. Improperly functioning bile ducts, poisons in the environment, ingredients in medications taken on their own or together can also negatively impact your liver.

What happens in cirrhosis?
Once the liver is hardened and scarred with cirrhosis, blood is restricted in the organ and pressure builds up in the vein that carries blood to the liver; the portal vein. The condition of portal hypertension occurs when the pressure is very high. Blood is redirected through other veins, causing them to be enlarged. These varices are located from your esophagus to your stomach and can cause a number or potentially lethal issues. Additionally,  portal hypertension can cause blood to backup to the spleen. The additional blood flow to the spleen causes it to enlarge, and too many platelets (important for clotting blood) are destroyed. This liver disease can also cause fewer proteins in the blood, like Albumin, which is another sign that cirrhosis is wreaking havoc on the system.

The liver is necessary to remove toxins and other hazardous substances such as ammonia– with the liver incapacitated, toxins that would normally be filtered out by the liver build up in the body. Hepatocellular carcinoma (HCC) is a liver cancer triggered by advanced cirrhosis when mutated liver cells multiply at a higher rate.

What are the symptoms of cirrhosis?
In the early stages of cirrhosis, it is common to be symptom free. In a person with compensated cirrhosis, many years of scarring can occur before the pressure at the portal vein becomes high enough to trigger symptoms, or until there is enough scarring that the liver is no longer able to adequately provide its functions. During this time, if no steps are taken to prevent further damage (for example, if you go without treatment for chronic Hepatitis C infection, or you continue drinking), it is only a matter of time until the pressure at the portal vein gets to be too high and your liver’s cells are overpowered. Early symptoms that have been reported are weight loss, nausea and appetite loss, a decrease in muscle mass and decreased energy.

As the disease worsens and you progress to having decompensated cirrhosis, other symptoms will become apparent. Internal bleeding from varices in the esophagus is common, as the walls of the veins becoming thin and rupture. Ascites occurs when your stomach fills with fluid. Confusion and other changes in the brain’s ability to function and process due to high toxicity in the blood as the liver fails is called encephalopathy. Once bile ducts are blocked or the liver is no longer able to keep up with filtering out bilirubin from the blood, many people experience jaundice, a yellowing of the skin and eyes that is a very clear indicator that the liver is not working properly.

How will your medical provider manage your cirrhosis?
It is necessary to be proactive in your battle with cirrhosis, and visit your physician often. In people with compensated cirrhosis, visits are commonly scheduled every 3-6 months to keep an eye on the progress of the disease and to try to catch complications in the early stages (for the best treatment options), or even possibly to delay the complication.
Patients who have decompensated cirrhosis may have to visit with their doctor more frequently for the best management of existing complications.Every 1-2 years, it is important that all cirrhosis patients have an upper endoscopy in order to watch for varices developing in the stomach and esophagus. A small tube with a camera is send down the esophagus, providing your physician with the best picture of the state of your veins. If no varices are present, the doctor will want to repeat the procedure every couple years to see if varices do develop. If varices are present, treatment options will be discussed to prevent bleeding.Blood tests are used frequently to keep an eye on liver function as well as check for signs of liver cancer. The provider will want to regularly get a clear picture of the health of your liver through the use of various technology, including ultrasound, CT scans or MRI. Your doctor should regularly conduct tests for the presence of cancer- the best potential for successful treatment is when you catch the cancer in its early stages.

Ascites (fluid in your stomach) is a fairly common complication and may be treated through medications such as water pills as well as recommendations for dietary changes (i.e. reducing salt intake) to help control this issue. Paracentesis* is a procedure to drain this fluid, used when other methods quit working. Sometimes the stomach is distended and hard and the patient must go to a trained provider who will utilize a special needle to remove the fluid from your stomach.

Once the disease progresses to decompensated cirrhosis, the doctor may recommend discussing the pros and cons of a liver transplant. A liver transplant is not right for everyone so it is important to work with your doctor to weigh all the aspects of moving forward. If your body is able to undergo the surgery, your doctor will lead you and your family through the changes and challenges you may face.