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Topic Overview

What is cirrhosis?

Cirrhosis (say "suh-ROH-sus") is a very serious condition in which scarring damages the liver. The liver is a large organ that is part of the digestive system. It does a wide range of complex jobs that are vital for life. For example, the liver:

• Makes many important substances, including bile to help digest food and clotting factors to help stop bleeding.
• Filters poisons from the blood.
• Breaks down (metabolizes) alcohol and many drugs.
• Controls the amounts of sugar, protein, and fat in the bloodstream.
• Stores important vitamins and minerals, including iron.

When a person has cirrhosis, scar tissue (fibrosis) replaces healthy tissue. This scar tissue prevents the liver from working as it should. For example, the liver may stop producing enough clotting factors, which can lead to bleeding and bruising. Bile and poisons may build up in the blood. Scarring can also cause high blood pressure in the vein that carries blood from the intestines through the liver (portal hypertension). This can lead to severe bleeding in the digestive tract and other serious problems.

Cirrhosis can be deadly. But early treatment can help stop damage to the liver.

What causes cirrhosis?

Cirrhosis can have many causes. Some of the main ones include:

• Long-term, heavy use of alcohol.
• Chronic viral hepatitis.
• Autoimmune diseases, such as autoimmune hepatitis or primary sclerosing cholangitis (PSC).
• Nonalcoholic steatohepatitis (NASH).
• Blocked bile ducts. A disease called primary biliary cirrhosis develops when the ducts that carry bile out of the liver become inflamed and blocked.
• Inherited diseases, such as Wilson's disease, cystic fibrosis, or hemochromatosis.

Less common causes of cirrhosis include severe reactions to medicines or long-term exposure to poisons, such as arsenic. Some people have cirrhosis without an obvious cause.

What are the symptoms?

You may not have symptoms in the early stages of cirrhosis. As it gets worse, it can cause a number of symptoms, including:

• Fatigue.
• Small red spots and tiny lines on the skin called spider angiomas.
• Bruising easily.
• Heavy nosebleeds.
• Weight loss.
• Yellowing of the skin (jaundice).
• Itching.
• Swelling from fluid buildup in the legs (edema) and the abdomen (ascites).
• Bleeding from enlarged veins in the digestive tract.
• Confusion.

How is cirrhosis diagnosed?

The doctor will start with a physical exam and questions about your symptoms and past health. If the doctor suspects cirrhosis, you may have blood tests and imaging tests, such as an ultrasound or CT scan. These tests can help your doctor find out what is causing the liver damage and how severe it is.

To confirm that you have cirrhosis, the doctor may do a liver biopsy. This means that he or she will use a needle to take a sample of liver tissue for testing.

How is it treated?

Treatment may include medicines, surgery, or other options, depending on the cause of your cirrhosis and what problems it is causing. It is important to get treated for cirrhosis as soon as possible. Treatment cannot cure cirrhosis. But it can sometimes prevent or delay further liver damage.

There are things you can do to help limit the damage to your liver and control the symptoms:

• Do not drink any alcohol. If you don't stop completely, liver damage may quickly get worse.
• Talk to your doctor before you take any medicines. This includes both prescription and over-the-counter drugs, vitamins, supplements, and herbs. Medicines that can hurt your liver include acetaminophen (such as Tylenol) and other pain medicines such as aspirin, ibuprofen (such as Advil or Motrin), and naproxen (Aleve).
• Make sure that your immunizations are up-to-date. You are at higher risk for infections.
• Follow a low-sodium diet. This can help prevent fluid buildup, a common problem in cirrhosis that can become life-threatening.

Symptoms may not appear until a problem is severe. So it's important to see your doctor for regular checkups and lab tests. You may also need testing to check for possible problems such as enlarged veins in your digestive tract or liver cancer.

If cirrhosis becomes life-threatening, then a liver transplant may be an option. But a transplant is expensive, organs are hard to find, and it doesn't always work.

If your cirrhosis is getting worse, you may choose to get care that focuses on your comfort and dignity. Palliative care can provide support and symptom relief so you can make the most of the time you have left. You may also want to make important end-of-life decisions, such as writing a living will. It can be comforting to know that you will get the type of care you want.

It can be hard to face having cirrhosis. If you feel very sad or hopeless, be sure to tell your doctor. You may be able to get counseling or other types of help. Think about joining a support group. Talking with other people who have cirrhosis can be a big help.

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