Scott H Plantz, MD, FAAEM
Francisco Talavera, PharmD, PhD
Cirrhosis is a chronic (ongoing, long-term) disease of the liver. It means damage to the normal liver tissue that keeps this important organ from working as it should. If the damage is not stopped, the liver gradually loses its ability to carry out its normal functions. This is called liver failure, sometimes referred to as end-stage liver disease.
- The liver is the largest organ in the body and one of
the most essential.
- It is about the size a football and is located on the right side in front, just below the lower rib cage.
- It produces substances that help fight infections and clot blood, filters toxins and infectious agents out of the blood, helps in the absorption of certain nutrients from foods, and stores energy for later use.
- These are just some of its many functions in the body.
- The liver may be injured by a single event, as in acute (new, short-term) hepatitis; by regular injury over months
or years, as in biliary tract blockage or chronic hepatitis; or by continuous injury, as in daily alcohol abuse.
- The liver responds to cell damage by producing strands of scar tissue that surround islands (nodules) of healing cells, making the liver knobby.
- At first, the inflammation in the liver causes it to swell. As the disease progresses and the amount of scar tissue in the liver increases, the liver will actually shrink.
- The scar tissue presses on the many blood vessels in the liver. This interrupts flow of blood to liver cells, which then die.
- Loss of liver cells hinders the liver's ability to perform its normal functions.
- Loss of liver function affects the body in many ways. Cirrhosis, if severe enough, can cause many different complications. These can be severe, as follows:
- Portal hypertension: The nodules and scar tissue can compress veins within the liver. This causes the blood pressure within the liver to be high, a condition known as portal hypertension.
- High pressures within blood vessels of the liver occur in 60% of people who have cirrhosis.
- Cirrhosis is the most common cause of portal hypertension in the United States.
- Portal hypertension may cause bleeding into the intestines and fluid accumulation throughout the body.
- Hepatic encephalopathy: In this condition, toxins build up in the bloodstream becausethe scarred liver is unable to rid them from the body.
- The toxins can cause you to behave bizarrely, to become confused, and to lose your ability to take care of yourself or others.
- Some people become very sleepy and cannot waken easily.
- Gastrointestinal bleeding: Portal hypertension causes backing up of blood flow in the veins of the stomach and esophagus.
- This causes the veins to enlarge, forming "varices" (varicose veins).
- These varices can tear and bleed, and this bleeding can be life threatening.
- This usually shows up as vomiting blood.
- Infection: If you have cirrhosis, you are at risk for many infections because your liver cannot form the proteins needed to fight off infection.
- Fluid retention (ascites): High pressures (portal hypertension) force fluid out of blood vessels in your liver, pooling it in your abdomen.
- Several liters of this fluid can pool in your abdomen, causing pain, swelling, difficulty breathing, and dehydration.
- As fluid pools in your abdomen, your kidneys will try to hold onto more water, because they think your body is dehydrated. The excess fluid collects in your lungs, legs, and abdomen.
- Hepatorenal syndrome: For
unknown reasons, liver failure leads to kidney failure in some people.
- Often the progress toward liver failure is slow and gradual.
- After heart disease and cancer, cirrhosis is the third most common cause of death in people aged 45-65 years in the United States. It is a leading cause of death by disease overall. An estimated 25,000 people die of cirrhosis in the United States each year.
- Although cirrhosis has traditionally been linked with alcoholism, it has many causes. The most common causes in the United States are chronic alcoholism andhepatitis C.
- There is no cure for cirrhosis, but removing the cause can slow the disease. If the damage is not too severe, the liver can heal itself over time.
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